Form Of Inflammatory Arthritis Research Articles

Joint-specific memory, resident memory T cells and the rolling window of opportunity in arthritis.

In rheumatoid arthritis, juvenile idiopathic arthritis and other forms of inflammatory arthritis, the immune system targets certain joints but not others. The pattern of joints affected varies by disease and by individual, with flares most commonly involving joints that were previously inflamed. This phenomenon, termed joint-specific memory, is difficult to explain by systemic immunity alone. Mechanisms of joint-specific memory include the involvement of synovial resident memory T cells that remain in the joint during remission and initiate localized disease recurrence. In addition, arthritis-induced durable changes in synovial fibroblasts and macrophages can amplify inflammation in a site-specific manner. Together with ongoing systemic processes that promote extension of arthritis to new joints, these local factors set the stage for a stepwise progression in disease severity, a paradigm for arthritis chronicity that we term the joint accumulation model. Although durable drug-free remission through early treatment remains elusive for most forms of arthritis, the joint accumulation paradigm defines new therapeutic targets, emphasizes the importance of sustained treatment to prevent disease extension to new joints, and identifies a rolling window of opportunity for altering the natural history of arthritis that extends well beyond the initiation phase of disease.

The subanalysis of Rheuma-VOR demonstrates aconsiderable need for rheumatological care

Early diagnosis and treatment of inflammatory rheumatic diseases can prevent consequential damage such as permanently limited mobility and joint or organ damage. Simultaneously, there is an increasing deficit in medical care owing to the lack of rheumatological capacity. Rural regions are particularly affected. The available unconfirmed diagnoses of the study Rheuma-VOR were analysed regarding another definitive inflammatory rheumatic disease. The returned questionnaires of the rheumatologists participating in Rheuma-VOR were screened for definitive inflammatory rheumatic diseases other than the required diagnosis of rheumatoid arthritis, psoriatic arthritis or spondyloarthritis. Of 910 unconfirmed diagnoses, in 245 patients another definitive diagnosis could be confirmed. A total of 29.8% of thediagnoses corresponded to degenerative joint changes or chronic pain syndrome, whereas 26.1% involved different forms of inflammatory arthritis. The majority of diagnoses (40.5%) were collagenosis or vasculitis, DISCUSSION: The available data show that a rheumatological presentation was indicated for the majority of patients. Owing to the increasing deficits in medical care aprior selection of the patients is crucial to make optimal use of restricted rheumatological capacities.

OA05 Cycling: a tool for cardiovascular exercise in patients with established ankylosing spondyloarthritis

OA05 Cycling: a tool for cardiovascular exercise in patients with established ankylosing spondyloarthritis

The Role of Interleukin-22 in The Diagnosis and Evaluation of Disease Activity in Rheumatoid Arthritis

Background: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that primarily affects small joints, resulting in joint inflammation, pain, and limited mobility. The identification of novel biomarkers specific to RA could enhance early diagnosis and treatment and also improve the monitoring of the disease activity and treatment response. In this study, the levels of IL-22 were measured in 133 patients with inflammatory arthritis using the ELISA method with the aim of assessing the diagnostic value of IL-22 in the diagnosis of RA and evaluating the disease activity. The findings revealed that serum IL-22 levels were significantly higher in RA patients compared to patients with other types of inflammatory arthritis. Additionally, positive correlations were observed between IL-22 and disease activity scores as determined by CDAI, DAS-28 ESR, and DAS-28 CRP. Notably, when IL-22 was used as a diagnostic tool, with a cut-off value of ≥ 26.9 pg/ml, it exhibited a sensitivity of 83%, specificity of 75%, and an AUC of 0.838. Furthermore, significant associations were found between IL-22 levels and the age of RA patients, while no significant correlations were observed with gender, BMI, and smoking index. It is noteworthy that IL-22 levels were significantly correlated with ESR, RF titer, and ACPA levels. Consequently, IL-22 can be regarded as a valuable biomarker for diagnosing RA and evaluating disease activity. Subjects and method: This cross-sectional study was conducted from September 2022 to January 2023, involving 133 patients with inflammatory arthritis, including RA and other forms of inflammatory arthritis. All patients were recruited from As-Sader Teaching Hospital in Najaf. The ages of the patients included in the present study range from 20 to 70 years, with a sample comprising 116 females and 17 males. Results: The higher median (IQR) value of IL-22 was observed among the RA patients [36.9 (28.6-63.7) pg/ml] compared to that of the other patients with inflammatory arthritis [23.6 (19.8-26.8) pg/ml]. The difference between the two groups of patients was highly significant (P < 0.0001). Among the RA patients, a highly significant difference in the median (IQR) level of IL-22 was observed among the disease activity groups according to CDAI, DAS-28 ESR, and DAS-28 CRP (P < 0.0001). Conclusion: Interleukin-22 can be regarded as a reliable biomarker for the diagnosis of RA and holds potential for assessing disease activity.

Development of a novel anti-inflammatory recombinant uricase with extended half-life for gout therapy

Gout is a form of inflammatory arthritis that results from elevated serum uric acid levels and the deposition of urate crystals in multiple joints. The inflammatory response during an acute gout attack is mediated by the activation of the NLRP3 inflammasome, leading to the release of IL-1β and inducing a localized tissue inflammatory response. Urate lowering therapies such as Pegloticase effectively reduce serum uric acid levels but are generally associated with an increase in acute gout flares. In this study, we developed a long-acting anti-inflammatory recombinant uricase by sequential fusing interleukin-1 receptor antagonist (IL-1Ra) and albumin-binding domain (ABD) with the N-terminal end of Arthrobacter globiformis uricase (AgUox). The recombinant uricase has longer in vivo half-life, and significantly alleviates monosodium urate (MSU) crystals induced inflammation in mouse model compared with the wild-type AgUox. This long-acting anti-inflammatory recombinant uricase has the potential to be developed as an effective urate lowering therapy with better safety profiles.

P069 Stress matters: inflammatory arthritis patients' perspective of impact of stress

Abstract Background/Aims The objective of this survey was to gather patients’ perspectives on how stress triggered their inflammatory arthritis as well as exacerbates flares in their disease. Methods NRAS wanted to reach people living with RA and other forms of inflammatory arthritis via a national survey to gauge how they recognise and manage stress, and whether health professionals considered stress as a factor in their active disease. The survey was designed to capture demographics, impact of stress on patients’ disease as well as work status and restrictions on lifestyle. The national online survey was distributed via all NRAS social media platforms as well as email. Results 1265 responses from across the UK were gathered. The majority of respondents were female (87.0%) and over the age of 55 years old (70.5%). Approximately 45% had a disease duration of more than 10 years, 30% between 4 and 10 years, and 23% less than 3 years. When asked on a scale of 1 (not at all) to 5 (completely) how much stress had impacted the onset of their arthritis symptoms, 56% responded either ‘completely’ or ‘greatly’. Only 9% reported that stress did not have an impact on the onset of their symptoms. When asked if they felt a stressful event in the 12 months prior to their diagnosis had triggered their inflammatory arthritis 28% said yes and 48% responded maybe. Some of the top reported causes of stress prior to diagnosis were: death of a close family member, menopause, work difficulties and family commitments. The majority of respondents (67%) said that health professionals did not ask them about stress during the diagnosis process, with only 11% saying this was discussed. Participants were asked how much they agreed with the statement that they are often asked about their mental health in routine appointments - 75% disagreed or strongly disagreed. Conclusion With the majority of respondents identifying that stress and stressful events exacerbate their symptoms of inflammatory arthritis, more should be done to measure and offer support for managing stress. While many had found their own ways of coping with stress more needs to be done to make support more easily accessible. Further research would be beneficial in identifying if managing stress within this patient population could significantly reduce inflammatory arthritis symptoms, reducing the distress and pain caused by flares and also reduce the impact on the health service of clinical intervention. Disclosure C. Jacklin: Grants/research support; InMedix funded with hands off grant this survey work. E. Caton: None. S. Matthews: None.

Therapeutic Utility and Adverse Effects of Biologic Disease-Modifying Anti-Rheumatic Drugs in Inflammatory Arthritis.

Targeting specific pathologic pro-inflammatory cytokines or related molecules leads to excellent therapeutic effects in inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Most of these agents, known as biologic disease-modifying anti-rheumatic drugs (bDMARDs), are produced in live cell lines and are usually monoclonal antibodies. Several types of monoclonal antibodies target different pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL)-17A, IL-6, and IL-23/12. Some bDMARDs, such as rituximab and abatacept, target specific cell-surface molecules to control the inflammatory response. The therapeutic effects of these bDMARDs differ in different forms of inflammatory arthritis and are associated with different adverse events. In this article, we summarize the therapeutic utility and adverse effects of bDMARDs and suggest future research directions for developing bDMARDs.

Study on association between SLC2A9 rs3733591 and Gout susceptibility in 481 Vietnamese individuals

Gout is a common form of inflammatory arthritis that is strongly associated with elevated uric acid concentration in the blood. The development of the disease is not onlytriggered by environmental factors but also genetic variations. Previous studies demonstrated that the genetic associations with gout vary in different populations in the world. This study aimed to identify the relationship between SLC2A9 rs3733591and gout susceptibility in the Vietnamese population.Total DNAs were extracted from 481 blood samples including 160 patients with gout and 321 age-matched healthy controls. The genotyping of SLC2A9 rs3733591 was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Chi-squared test was used to test whether the genotypes frequencies of rs3733591 follow Hardy-Weinberg equilibrium (HWE) and to check its association with gout in three models (additive, recessive, dominant) and allele form. The result showed that SLC2A9 rs3733591 was in agreement with Hardy-Weinberg equilibrium (p>0.05). However, there was no association between the rs3733591 and gout in any tested models (p>0.05).This study will contribute to the genetic study of gout susceptibility in Vietnam.

Association between Clinical Use of Colchicine and Risk of Type 2 Diabetes Mellitus among Gouty Patients: A Nationwide Cohort Study.

Background: Gout is the most common form of inflammatory arthritis in adults. Even though a link between gouty arthritis and type 2 diabetes mellitus (T2DM) has been reported, there is a limited understanding of the association between the anti-inflammatory agent colchicine and the risk of T2DM. This aim of this study was to assess the association between the use of colchicine and the risk of T2DM in an Asian cohort. Methods: A retrospective cohort study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan from 2000 to 2013. The study cohorts comprised 3841 gouty patients using colchicine (the exposed cohort) and 7682 gouty patients not using colchicine (the unexposed -cohort). The primary outcome was incident DM. The hazard ratios (HRs) and 95% confidence intervals (CIs) derived from a Cox proportional regression model were used to assess the association between colchicine use and the risk of diabetes. Results: The cumulative incidence of T2DM was significantly lower in the exposed cohort (18.8%) than in the unexposed cohort (25.0%). The risk of T2DM was significantly lower in colchicine users than in non-users (adjusted HR, 0.74; 95% CI, 0.36–0.87). The inverse relationship between colchicine use and diabetes risk remained consistent across sex and age groups. Conclusions: This cohort study provides longitudinal evidence that the use of colchicine is associated with a reduced risk of T2DM. This conclusion, however, needs to be interpreted cautiously given the lack of body mass index data in the NHIRD. Further studies are needed to determine the clinical implications of this study.

Anti-gout potential of selected edible flowers

Gout is a form of inflammatory arthritis triggered by the interaction between monosodium urate crystals and tissues during the purine metabolism by xanthine oxidase. This study aimed to determine the xanthine oxidase inhibitory activity, total phenolic content, total flavonoid content and total anthocyanin content of 10 selected edible flowers, namely Rosa sp., Malus sp., Lavandula sp., Lilium sp., Hibiscus sabdariffa L., Chrysanthemum sp., Matricaria sp., Gomphrena sp., Myosotis sp. and Jasminum sp. extracted using hot water infusion method. Phytochemical contents and the anti-gout activity of the flower extracts using the xanthine oxidase inhibition assay were determined spectrophotometrically. The results revealed that three aqueous flower extracts (Rosa sp., Hibiscus sabdariffa L. and Malus sp.) exhibited potent xanthine oxidase inhibitory activity (IC50 values, 0.10±0.15 µg/mL, 0.12±0.11 µg/mL and 2.59±3.8 µg/mL, respectively), which were comparable to the positive control, allopurinol (IC50 value, 4.9±0.00 µg/mL). The highest phenolic and flavonoid contents were found in Lavandula sp. (4.39±0.13 mg GAE/g and 63.46±1.07 mg RE/g) while Rosa sp. showed the highest content of anthocyanin (70.14±4.82 mg c-3-gE/g). Positive correlations were observed between the phytochemicals and xanthine oxidase inhibitory activity of the flower extracts. Hence, this study suggests that Rosa sp., Hibiscus sabdariffa L. and Malus sp. possess anti-gout potential, which is associated with the presence of possible anti-gout phytochemicals. The isolation of the bioactive compounds that exhibit significant anti-gout activity among the selected flowers is recommended for future research.

What’s new on the front-line of gout pharmacotherapy?

ABSTRACT Introduction Gout is the most common form of inflammatory arthritis affecting millions of persons around the world. Painful flares and tophaceous deposits are debilitating, reduce quality of life and put strain on health-care systems. Areas Covered This review provides an overview of the treatment of gout flares and lowering serum urate. First line agents are discussed with emphasis on emerging evidence. Novel therapies are also covered. Expert opinion Lifestyle modifications form a part of gout prevention. NSAIDs, colchicine, and glucocorticoids are first line agents for gout flares. The IL-1β antagonists are highly effective for arresting flares but their cost-effectiveness render them salvage therapies. Allopurinol is an agent of first choice for urate lowering therapy. In Southeast Asian and Black populations, screening for HLA*B58:01 mutation is a cost-effective approach to decrease the occurrence of allopurinol hypersensitivity syndrome. Febuxostat is another efficacious urate lowering therapy, but has received a U.S. FDA black box warning for cardiovascular safety. Novel uricosurics are a class for continued drug development; verinurad and arhalofenate are agents with future promise. For patients with recalcitrant gout, pegloticase is effective. Its immunogenicity significantly threatens the achievement of sustained urate lowering responses. Abrogating pegloticase’s immunogenicity with immunomodulatory co-therapy may lend to sustained efficacy.

X-ray dark-field radiography for in situ gout diagnosis by means of an ex vivo animal study

Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate (MSU) crystals in peripheral joints and tissue. Detection of MSU crystals is essential for definitive diagnosis, however the gold standard is an invasive process which is rarely utilized. In fact, most patients are diagnosed or even misdiagnosed based on manifested clinical signs, as indicated by the unchanged premature mortality among gout patients over the past decade, although effective treatment is now available. An alternative, non-invasive approach for the detection of MSU crystals is X-ray dark-field radiography. In our work, we demonstrate that dark-field X-ray radiography can detect naturally developed gout in animals with high diagnostic sensitivity and specificity based on the in situ measurement of MSU crystals. With the results of this study as a potential basis for further research, we believe that X-ray dark-field radiography has the potential to substantially improve gout diagnostics.

Nomogram for accurate and quantitative prediction of the risk of psoriatic arthritis in Chinese adult patients with moderate and severe plaque psoriasis.

Psoriatic arthritis (PsA) is an inflammatory form of arthritis that appears approximately 7-10 years after psoriasis and remains undiagnosed in most of patients. Currently, only a few quantitative and succinct PsA-risk prediction models are available. The aim of this study was to establish and validate a prediction model for quantitatively assessing the risk of PsA in moderate and severe plaque psoriasis patients. A non-interventional and cross-sectional study was conducted. Demographic, clinical, and laboratory records were collected and blindly reviewed. Logistic regression was used to develop this prediction model. With C-index and calibration curve, internal validation was performed. Five-fold cross validation, external validation and decision curve analysis (DCA) were also applied to assess this model. Among 405 patients, 111 patients had PsA. Arthralgia (OR = 39.346; 95%CI: 20.139-82.579), C-reactive protein (OR = 2.008; 95%CI: 1.051-3.838), lymphocyte level (OR = 0.341; 95%CI: 0.177-0.621), hypertension (OR = 0.235; 95%CI: 0.077-0.660) and disease duration (OR = 1.033; 95%CI: 0.998-1.071) were identified as potential predictors affecting the risk of transition from moderate and severe PsO to PsA. C-index for the prediction nomogram was 0.911 (95%CI: 0.879-0.943), and was confirmed to be 0.905 through 1000-time bootstrapping internal validation. Cross validation and external validation were preformed and proved the accuracy and generalizability of this prediction model. This study establishes a quantitative predictive nomogram with good predictive power for assessing the risk of PsA in patients with moderate and severe PsO.

SERUM LEVEL OF IL-33 IN GOUTY RENAL PATIENTS

Background: Gout is a form of inflammatory arthritis and the most common metabolic disease in humans. It may result in tophi, kidney stones, or even kidney damage. It has become more common in recent decades due to increasing risk factors in the population, such as metabolic syndrome. Interleukin-33, the latest discovery in IL-1 cytokine family, acts as an early alerter of inflammation, it has been linked to several human pathologies including autoimmune diseases, sepsis, and allergy through its specific IL-1 receptor ST2 (suppression of tumorigenicity 2). However, there is little information regarding the role of IL-33 in gout.Aim of the Work: Our study aimed to examine the clinical utility of IL-33 level in serum among gouty patients and correlating its concentration with renal affection.Patients and Methods: Our case-control study was conducted on 90 subjects divided into three groups. Group I: included thirty gout patients, with no evidence of kidney affection, Group II: included thirty gout patients with kidney affection, their diagnosis based on the American College of Rheumatology classification criteria, Group III: thirty age and sex-matched, apparently healthy subjects included in the study as a control group. All individuals were subjected to detailed medical history, clinical examination including weight measurement and body mass index (BMI), and laboratory parameters including serum uric acid, creatinine, urea, lipid profile, and serum level of IL-33 measured by ELISA.Results: Serum IL-33 was predominantly increased in gout patients (with or without kidney affection) compared to healthy controls and was even higher in patients without kidney injury compared to gout patients with kidney injury. IL-33 was positively correlated with serum HDL, BMI, although it was negatively correlated with LDL and cholesterol.In Conclusion: IL-33 might have a protective role in kidney injury among gout patients.

A Case of Paraneoplastic Arthralgias

Hypertrophic Osteoarthropathy (HOA) is a rare condition that presents with arthralgias, digital clubbing, and abnormal periosteal bone deposition seen on x rays. The secondary form of HOA may be associated with an underlying malignancy, thus highlighting the importance of early clinical recognition. We present the case of a 44-year-old woman who presented with several weeks of lower extremity swelling, arthralgias, and digital clubbing who was later found to have non-small cell lung cancer. Diagnosis can be challenging due to variable presentations that can often mimic other forms of inflammatory arthritis. Treatment is focused on addressing the underlying cause. Nonsteroidal anti-inflammatory drugs (NSAIDS) are commonly used for pain relief while intravenous bisphosphonates have been trialed with some success in case reports.

Обзор эффективности и безопасности нестероидных противовоспалительных препаратов для лечения острого приступа подагрического артрита

Gout is one of the most common forms of inflammatory arthritis. Medical care for gout includes non-steroidal anti-inflammatory drugs (NSAIDs). This paper reviews the efficacy and safety of NSAIDs prescribed for the acute attack of gout, in particular, AMBENIUM® parenteral. It was demonstrated that phenylbutazone is a powerful NSAID that provides significant analgesic and anti-inflammatory effects. Considering a broad spectrum of adverse reactions of NSAIDs, these agents should be prescribed and used under in-depth analysis of patient’s condition, comorbidities and the level of their decompensation, and potential drug interactions. In addition, optimal dosages and duration of NSAID treatment are of particular importance. The authors conclude that AMBENIUM® parenteral is an effective and safe therapeutic modality for gout. Its profile and risk/benefit ratio are regarded as “favorable” compared to other NSAIDs. KEYWORDS: gout, arthritis, pain, non-steroidal anti-inflammatory drugs, parenteral, efficacy, safety. FOR CITATION: Vasilyuk V.B., Syraeva G.I., Faraponova M.V. Efficacy and safety of non-steroidal anti-inflammatory drugs for acute attack of gout. Russian Medical Inquiry. 2021;5(2):96–101. DOI: 10.32364/2587-6821-2021-5-2-96-101.

Frequency Distribution of Bone Fractures in Rheumatoid Arthritis Patients: ACross-Sectional Study in Police Teaching Hospital, Khartoum 2019

Background: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults. This study reveals the frequency distribution of bone fractures and the most frequent fracture sites in RA patients in Police teaching hospital, Sudan. Materials and method: A cross-sectional study was conducted in Khartoum, Sudan from September 2018 to September 2019. The questionnaire is in form of Multiple choice questions, Composed of Demographic information Regards their (age, sex, Occupation, and social habit), Information about the RA disease (duration, Risk factor, and investigation). Information concerning Bone fracture (if there is any fracture, site, how it detected). Statistical analysis was performed using SPSS, Version 22.0. (IBM, USA). Results: From patients diagnosed with RA, 25% had bone fractures out of 72 RA patients. A 72 rheumatic patients were involved in this crosssectional study, 11 of them (15.3%) were males and 61 (84.7%) were females. the mean of age was 50.6 years (48 years for male, 51years for female). The duration of rheumatoid in the majority of patients (36.1%) was falling between 2-5 years of diagnosis. The most common site of fracture is hip (36.9%) following by carpal bones (26.3%), then spinal vertebrae (10.5%). Conclusion: 25% of RA patients experienced bone fractures because of falling the most common site of bone fractures in RA patients is hip bone. Physicians should know the association between RA, bone fractures, and corticosteroid use to decrease bone fracture incidence. Also, investigations such as bone loss measurement should be done routinely to any RA patient.

Effects of mannuronic acid (M2000) on gene expression profile of signal transducer and activator of transcription proteins (STATs) in rheumatoid arthritis patients

Rheumatoid arthritis (RA), a form of inflammatory arthritis, is a chronic joint disease characterized by pain and inflammation that affects 0.5% to 1% of the population worldwide. The safety, efficacy, tolerability, and potency of β-D-mannuronic acid (M2000) as a novel NSAID with immunosuppressive property has been reported by several in vitro studies, experimental models and clinical trials phase I/II and III in ankylosing spondylitis and rheumatoid arthritis (RA) patients This research is designed to study the therapeutic efficacy of oral administration of mannuronic acid in RA patients who had inadequate response to conventional drugs and to assess the effect of this drug on gene expression of the signal transducer and activator of transcription (STATs) protein (STAT1, STAT3, STAT4, and STAT6). The study has included 15 RA patients who had an insufficient response to the conventional therapy. The oral dose of mannuronic acid was 1000mg divided into two 500 mg doses per day for 3 months as an addition to conventional therapy. There were 15 healthy volunteer in the control group. Blood samples were collected from both groups, once from healthy controls and twice from RA patients before and after treatment by M2000. The peripheral blood mononuclear cells (PBMCs) were isolated to assess the gene expression level of STAT1, STAT3, STAT4, and STAT6 using the real-time PCR method. Results obtained in this study demonstrated a significant difference in the gene expression level of STAT1 between healthy controls and patients before treatment as well as a significant reduction in RA patients after treatment compared with the level before treatment. In addition, the gene expression level of STAT3 and STAT4 showed a significant reduction in RA patients after treatment compared to patients before treatment, while there was no significant difference between RA patients before treatment and the healthy control group for both molecules. On the other hand, there was no change in the gene expression level of STAT6 among all groups. The outcomes of this study confirmed that β-D-mannuronic acid (M2000) has the ability to control the levels of STAT1, STAT3 and STAT4 in RA patients, and might be beneficial in the management and therapy of RA.

Interdisciplinary approach to the management of patients with chronic gout

Gout, one of the most common forms of inflammatory arthritis, is characterized by severe joint pain, which often interferes with daily activities. In recent years, further research on its causes and on improving diagnosis, treatment and prevention has been ongoing. It is known that gout usually occurs due to the accumulation of sodium monourate crystals in joints due to high levels of serum uric acid. In 2019, the Annals of the Rheumatic Diseases journal published new data on imaging and clinical diagnostics methods based on the principles of evidence-based medicine. Formulated by experts, they were adopted as a consensus of the European League Against Rheumatism (EULAR). The American College of Rheumatology (ACR) has now developed new strategies to treat and prevent gout. On May 11, 2020, the Arthritis & Rheumatology Journal presented guidelines for the management of gout patients, including the treatment of acute gout attack, indications for urate-lowering therapy and instructions for its optimal use, as well as recommendations on lifestyle and drugs that are often prescribed to patients with comorbidity. The purpose of this review is to summarize current knowledge with a focus on recent advances in the algorithm for managing acute and chronic gout patients.

Renal disorders in rheumatologic diseases: the spectrum is changing (part 2. Arthridides).

This review is devoted to rheumatologic diseases mainly characterized by different types of arthritis. They may involve also different organs, including the kidney, but renal disease is more frequently caused by the nephrotoxicity of drugs to relieve pain or to interfere with the pathophysiology of the underlying disease. Rheumatoid arthritis is the prototype of arthropathies. This autoimmune disease mainly attacks joints, tendons and ligaments but can also involve internal organs including the kidney. Psoriatic arthritis is a complex disease in which psoriasis, a chronic inflammatory disease, is associated with the development of peripheral arthritis or spondylitis. The disease or its treatment may lead to kidney complications. Gout is a form of inflammatory arthritis which is characterized by an increase in the serum uric acid deposits in and around the joints of the extremities, the so called tophi. The disease is often associated with a metabolic syndrome with diabetes, obesity, hypertension, and cardiovascular disease. Kidney injury is frequent. It may be caused by kidney stones, urinary tract obstruction, tubulointerstitial and vascular lesions leading to CKD and renal failure.