Low Purine Research Articles

Physiological Mechanisms by Which the Functional Ingredients in Beer Impact Human Health.

Nutritional therapy, for example through beer, is the best solution to human chronic diseases. In this article, we demonstrate the physiological mechanisms of the functional ingredients in beer with health-promoting effects, based on the PubMed, Google, CNKI, and ISI Web of Science databases, published from 1997 to 2024. Beer, a complex of barley malt and hops, is rich in functional ingredients. The health effects of beer against 26 chronic diseases are highly similar to those of barley due to the physiological mechanisms of polyphenols (phenolic acids, flavonoids), melatonin, minerals, bitter acids, vitamins, and peptides. Functional beer with low purine and high active ingredients made from pure barley malt, as well as an additional functional food, represents an important development direction, specifically, ginger beer, ginseng beer, and coix-lily beer, as consumed by our ancestors ca. 9000 years ago. Low-purine beer can be produced via enzymatic and biological degradation and adsorption of purines, as well as dandelion addition. Therefore, this review paper not only reveals the physiological mechanisms of beer in overcoming chronic human diseases, but also provides a scientific basis for the development of functional beer with health-promoting effects.

Battle of the strategies: diet versus drug therapy for gout

The best results in combating gout are achieved through a combination of diet and drug therapy. Urate-lowering therapy, which includes febuxostat, has been shown to be more effective and convenient than diet when it comes to achieving and maintaining target uric acid (UA) levels in gout patients. Febuxostat, a xanthine oxidase inhibitor, helps to reduce UA levels in the blood by blocking its formation. This helps prevent the deposition of urate crystals in joints and tissues and reduces the frequency and severity of gout attacks. At the same time, a diet of low purine foods may also have some effect on UA levels. Diet can improve the results of drug treatment by reducing the need for medications and minimizing the risk of side effects. However, without adequate drug therapy, diet will not produce the desired results. Therefore, febuxostat remains the preferred urate-lowering treatment option for gout, especially given its proven efficacy in these patients.

Anti-hyperuricemic Evaluation of Swertia-chirayita and Febuxostat on Potassium Oxonate Induced Hyperuricemic Animal Model

Introduction: Hyperuricemia is a metabolic disease characterized by an increase in serum uric acid levels. Hyperuricemia can be controlled by low purine diet or drugs like allopurinol and febuxostat; however, the incidence of adverse effects to these drugs, especially on chronic use, is a major clinical problem. Swertia chirayita; a herb from Gentianaceace family, was selected to observe it’s in vivo uric acid lowering effect in white Albino Wistar rats in whom hyperuricemia was induced through potassium oxonate. Febuxostat was used as a standard. Aims and Objectives: To observe the in vivo effect of different doses of Swertia chirayita extract (SCE) on uric acid levels and to compare its effect with the allopathic medicine febuxostat. Place and Duration of study: A randomized controlled study was held at University of Health Sciences Lahore between June- August 2017. Material and Methods: Forty-eight healthy adult Albino Wistar rats were randomly divided into six groups. Group I and II served as negative and positive controls respectively. Hyperuricemia was induced by injecting KO solution (01ml) intraperitoneally on 1st, 3rd and 7th day of study. Group III received febuxostat 5 mg/kg through oral gavage. Group IV, V and VI were experimental groups, treated with 100, 200 and 400 mg/kg doses of Swertia Chirayita extract respectively through oral route, 02 hours after induction by KO once daily for 07 days. Blood samples were collected to record serum uric acid levels on day zero, first, third and seventh days. (SPSS)version 20 was used for data entry and analysis, pvalue ? 0.05 was given statistical importance. Results: In all experimental groups (IV, V, VI), serum uric acid levels were significantly reduced by Swertia chirayita extract (SCE) (p ? 0.001) as compared to hyperuricemic rats (group II). SCE showed dose dependent SUA suppression. Results of both febuxostat and SCE showed that average SUA levels of these groups were markedly less than hyperuricemic rats (Group II) (p < 0.001) Conclusion: In the light of its hypouricemic activity; we conclude that in the future, Swertia chirayita has the potential for newer therapeutic applications in this regard.

The Relationship Between Low Purine Diet Compliance with the Incidence of Gout Arthritis in the Elderly in Tinelo Village Working Area of Telaga Biru Health Center

Gout arthritis occurs due to triggers, such as foods and other compounds that contain excessive purines. Based on data from the Regional Basic Health Research of Gorontalo Province, the total number of joint diseases in Gorontalo is ranked 16th out of 34 Provinces and based on diagnoses for ages 45-54 years reaches 11.1%, ages 55-64 years reach 15.5%, and ages 65-74 years reach 18.6% with the highest total number dominated by women 8.5% compared to men 6.1%. This study was conducted to determine the relationship between low-purine diet adherence and the incidence of gout arthritis in the elderly in Tiello Village. This study is an observational analytical study with a cross-sectional approach, using questionnaire measuring instruments and then statistical analysis using a chi-square test with a meaning level of α=0.05. The population in this study was all elderly people with gout arthritis in Tinelo Village with a total of 70 people. This study used a Purposive sampling technique with a total sample in this study was 42 people. This study shows that there is a significant relationship between a low-purine diet and the incidence of gout arthritis in the elderly in Tinelo Village, Telaga Biru Health Center Working Area with a value of ρ=0.001 smaller than the value of α=0.05. There is a significant relationship between a low-purine diet and the incidence of gout arthritis in the elderly in Tinelo Village, Telaga Biru Puskemas Working Area.

Relationship Physical Activity and Eating with Gout Arthritis in Sukamaju Village

Arthritis is one of the diseases whose incidence is quite wide and can affect anyone regardless of age and ethnicity. Most cases of Gout arthritis have a primary background, so it requires long-term control of uric acid levels. The purpose of this study was to determine the relationship between physical activity and diet with the incidence of gout arthritis in Sukamaju village. This type of research used quantitative methods with analytical surveys with a cross sectional approach. The sample in this study was 80 respondents, the sampling technique was using random sampling. Data collection techniques used a physical activity questionnaire and dietary pattern questionnaire as well as examination using a uric acid tool. The analysis used univariate and bivariate with the Chi-Square Test. The results of this study showed that there was a relationship between physical activity and diet with gout arthritis with a p-value of 0.000 (ɑ 0.05). Based on research results, prevention of gouty arthritis is very important to improve the quality of life, this can be obtained with education and a low purine diet and a good diet and a healthy lifestyle.

The Effect of Providing Low Purine Diet Education with Booklet Media on Knowledge and Purine Intake in Gouty Arthritis Sufferers in the Pasundan Community Health Center Working Area

Gouty arthritis is a common disease throughout the world and its prevalence has increased in the last 50 years. Based on the fourth quarter report at the Pasundan Community Health Center, there were 113 cases of gout arthritis. Diet is a factor that causes an increase in uric acid in the blood. So it is important to provide education with booklets to regulate diet management for gouty arthritis. This study aims to determine the effect of low-purine diet education with booklets on knowledge and purine intake in gouty arthritis sufferers. Pre-Experimental Research Design via One Group Pretest-Posttest Design involving 26 gout arthritis sufferers in the Pasundan Community Health Center working area, sampling using a purposive sampling technique. Data were analyzed using the paired sample t-test. The results obtained increased knowledge (p-value = 0.000) and changes in purine intake (p-value = 0.000).

High Performance Liquid Chromatography Analysis and Description of Purine Content of Diets Suitable for Dogs with Leishmania Infection during Allopurinol Treatment-A Pilot Trial.

Reducing the alimentary purine intake contributes to the prevention of purine (especially xanthine) urolith formation, a common adverse effect of allopurinol treatment in dogs with Leishmania infections. Analyses of the purine content are not required in order to advertise a diet as low in purine. Due to different analytical methods, data provided on purine content are barely comparable. The aim of this study was to investigate the total purine content of 12 different dog diets. For this, the purine bases adenine, guanine, xanthine, and hypoxanthine were determined by standardised high performance liquid chromatography in commercially available urinary diets (n = 4), kidney diets (n = 2), low protein diets (n = 3), 1 vegan diet, 1 regular diet for healthy adult dogs, and 1 homemade low purine diet. Total purine amounts ranged between 10.2 and 90.9 mg/100 g of dry matter. The daily purine intake calculated for a 20 kg standard dog with the analysed diets ranged between 21.9 and 174.7 mg. The lowest daily purine intakes were achieved by 2 urinary urate diets, followed by the homemade diet. Differences in the purine content of commercially available diets need to be considered. Awareness has to be raised when selecting diets for dogs with Leishmania infections during allopurinol treatment in order to minimise the risk of urolith formation.

Socialization of Low Purine Diet in Elderly Patients With Gout Arthiritis at Puskesmas Batang Kuis

Gout arthritis is a disease caused by impaired purine metabolism resulting in excessive uric acid (hyperuricemia). It is said to be hyperuricemia if the uric acid level is more than 6.0 mg/dl in women and 7.0 mg/dl in men, which is measured based on blood serum. To overcome the problem of hyperuricemia, it is necessary to apply a low-purine diet, especially for elderly people with gout arthritis. The goal of a low-purine diet is to prevent monosodium urate crystals from accumulating in the joints. The implementation method used by the PkM team in collaboration with Puskesmas Batang Kuis partners and elderly people with gout arthritis consists of 4 stages. Based on the results of the activities of the 41 community service participants, frequency characteristics were obtained based on the uric acid value of the elderly at the Puskesmas Batang Kuis, namely the majority of gout categories in the elderly, namely the 7.6-9.0 category, as many as 25 people (61%). From the results of the activity it was also found that the number of elderly women with gout arthritis was more (28 people) while there were 13 men. The results of an evaluation of the increase in knowledge of 41 participants showed that the majority of elderly knowledge was categorized as good as many as 27 people (66%) participants with good knowledge. The low knowledge and understanding and awareness of the elderly regarding a low purine diet is the cause of the high number of gout arthritis sufferers. So we need a program that educates and raises public awareness and needs to monitor diet in the elderly.

Metabolic Modeling Identifies a Novel Molecular Type of Glioblastoma Associated with Good Prognosis.

Glioblastoma (GBM) is one of the most aggressive forms of cancer. Although IDH1 mutation indicates a good prognosis and a potential target for treatment, most GBMs are IDH1 wild-type. Identifying additional molecular markers would help to generate personalized therapies and improve patient outcomes. Here, we used our recently developed metabolic modeling method (genome-wide precision metabolic modeling, GPMM) to investigate the metabolic profiles of GBM, aiming to identify additional novel molecular markers for this disease. We systematically analyzed the metabolic reaction profiles of 149 GBM samples lacking IDH1 mutation. Forty-eight reactions showing significant association with prognosis were identified. Further analysis indicated that the purine recycling, nucleotide interconversion, and folate metabolism pathways were the most robust modules related to prognosis. Considering the three pathways, we then identified the most significant GBM type for a better prognosis, namely N+P-. This type presented high nucleotide interconversion (N+) and low purine recycling (P-). N+P--type exhibited a significantly better outcome (log-rank p = 4.7 × 10-7) than that of N-P+. GBM patients with the N+P--type had a median survival time of 19.6 months and lived 65% longer than other GBM patients. Our results highlighted a novel molecular type of GBM, which showed relatively high frequency (26%) in GBM patients lacking the IDH1 mutation, and therefore exhibits potential in GBM prognostic assessment and personalized therapy.

Urate oxidase from tea microbe Colletotrichum camelliae is involved in the caffeine metabolism pathway and plays a role in fungal virulence.

Tea is one of the most well-known, healthy beverages in the world. Tea plants produce caffeine as a secondary metabolite. Colletotrichum camelliae is one of the most important microbes frequently isolated from tea fields, and it causes anthracnose disease in tea plant. In the present work, we performed molecular microbiology and transcriptomic analyses of the C. camelliae - tea plant interaction to investigate the mechanism of fungal virulence and plant defense. Upon infection of tea plant with C. camelliae, we observed alterations in the expression of fungal transcripts, including those of many genes associated with caffeine metabolism, such as those encoding various transporters, xanthine dehydrogenase, and urate oxidase (UOX). In particular, the deletion of C. camelliae urate oxidase (CcUOX), which is involved in the caffeine metabolism pathway, reduced fungal tolerance to caffeine, and impaired fungal virulence. CcUOX is involved in caffeine metabolism by the degradation of uric acid contents. C. camelliaeΔCcUOX mutants impaired uric acid degradation in vivo. The CcUOX gene was cloned from C. camelliae, overexpressed in Escherichia coli, and the recombinant CcUOX protein displayed maximum activity at 30°C and a pH of 4.0. The recombinant CcUOX efficiently reduced uric acid in vitro suggesting a promising application in caffeine-contaminated environment management and in producing food with low purine contents to prevent uric acid related human diseases, such as hyperuricemia and gout.

The Benefits of Acupuncture Combined with a Low Purine Diet to Improve Uric Acid and Total Cholesterol in Diabetes Mellitus Patients with Hyperuricemia

Background: Diabetes mellitus with hyperuricemia causes the accumulation of monosodium urate crystals in the synovial joint tissue. The incidence of gout in Indonesia according to the Indonesian Rheumatology Association, namely: gout 1-2 percent of adults, is the most cases of arthritis in men and is estimated to be between 13.6 per 1,000 men and 6.4 per 1,000 women. The prevalence of gout increased with age, an average of 7 percent of men >75 years and 3 percent of women >85 years.Subjects dan Method: Quasi-Experimental with pre and post-test designs. The research time is between March to September 2021 at the Posyandu for the elderly in Surakarta City. The population of this study were all objects with fasting blood sugar levels between 100 mg/dl - 125 mg/dl and above 126 mg/dl, female blood uric acid levels exceeding 5.6 mg/dl in men and exceeding 6.5 in the city. Surakarta, sample selection using purposive sampling, sample size 40 subjects. The dependent variable is uric acid, cholesterol and total blood levels, the independent variable is combination acupuncture therapy with a low purine diet. The research instrument used a checklist for blood analysis and physical examination. Data analysis using t-test.Results: Uric acid levels after acupuncture therapy in the intervention group were lower (Mean= 3.31; SD= 0.61) than the control group (Mean= 5.83; SD= 1.29), and not statistically significant (p= 0.935). Total cholesterol level after acupuncture therapy in the intervention group was lower (Mean= 166.00; SD= 34.20) than the control group (Mean= 222.30; SD= 55.43), but it was statistically non-significant (p= 0.676).Conclusion: Acupuncture therapy can reduce uric acid levels and total cholesterol levels. Keywords: Acupuncture, low purine diet, uric acid level, cholesterol level Correspondence:Sumanto. College Leading Basic Research, Acupuncture Course, Health Polyetchnics, Ministry of Health Surakarta. Jl. Letjend Sutoyo Mojosongo, Surakarta, Central Java. Email: sumantoiman@gmail.com. Mobile phone: 08121608067.

Computer-assisted in vitro reconstitution of purine degradation pathway to lower the purine content in food.

With the increasing prevalence of gout and its etiological hyperuricemia, dietary control of gout based on low-purine food according to patients' eating habits is becoming a better choice compared to the existing drug treatment such as allopurinol with notorious side effects. Reconstructing the purine metabolic pathway in vitro to degrade purine substances in food into natural functional allantoin appears to be an innovative method for preparing nutritious and healthy food of low purine content. The present study reports a computer-assisted in vitro reconstruction of four purinolytic enzymes metabolizing adenosine into allantoin to reduce purine content in food for personalized dietary control of hyperuricemia and gout. Under the optimum reaction conditions of 40 °C and pH7, 0.1U of enzymes and 0.5 mmol L-1 adenosine determined by an orthogonal test design, 16 different enzyme complexes were experimentally tested. The tested enzyme composition and allantoin production values were used as input and output to build a three-layer back propagation artificial neural network (BP-ANN) model, which was further optimized by a genetic algorithm (GA). The optimum enzyme complex predicted by the GA-BP-ANN model produced 248.08±7.832 μmol L-1 allantoin, which was 19.9% higher than equimolar mixture of enzymes, and also more efficiently lowered purine contents in beer, as well as beef and yeast extracts. This is the first in vitro reconstitution of complete purine metabolic pathway by combining ANN and GA technologies, with successful application with respect to lowering the purine content in food, indicating a promising application of computer-assisted in vitro reconstitution of purinolytic pathway in low-purine food to prevent hyperuricemia and gout. © 2022 Society of Chemical Industry.

Human Milk Metabolomics Are Related to Maternal Adiposity, Infant Growth Rate and Allergies: The Chinese Human Milk Project.

The metabolomic profiles of Chinese human milk have been poorly documented. The objective of the study was to explore associations between human milk metabotypes, maternal adiposity, infant growth patterns, and risk of allergies. Two hundred mother–infant dyads from seven cities were randomly selected from the Chinese Human Milk Project (CHMP). Untargeted human milk metabolomic profiles were determined using HPLC-MS/MS. Two human milk metabotypes were identified using principal component analysis. Principal component (PC) 1 was characterized by high linoleic acid metabolites with low purine nucleosides and metabolites of glutamate and glutathione metabolism. PC 2 was characterized by high glycerophospholipids and sphingomyelins content. Higher PC1 scores were associated with slower infant growth rate and higher ambient temperature (p < 0.05). Higher PC 2 scores were related to higher maternal BMI and increased risk of infant allergies (p < 0.05). Future work is needed to understand the biologic mechanisms of these human milk metabotypes.

Role of diet in hyperuricemia and gout.

Gout is the most common form of inflammatory arthritis, affecting 41 million adults worldwide. The global burden of gout has been increasing over the last three decades, yet its management remains suboptimal. The primary aim of this manuscript is to review the impact of various diets such as the DASH, Mediterranean, and low purine diets; weight loss; and individual foods, including alcohol, caffeine, cherry, dairy, high-fructose corn syrup, omega-3 fatty acids, and vitamin C on hyperuricemia and clinical gout outcomes such as flares and tophi. Few studies to date have specifically evaluated the effect of various dietary approaches on hyperuricemia among people with gout and on gout-specific outcomes. Overall, the dietary factors appear to have a small effect on serum urate levels, and their impact on the long-term clinical course of gout is uncertain. Limited evidence suggests that avoidance of certain foods and beverages may decrease the frequency of gout flares. Weight loss may be beneficial for prevention as well as treatment of gout. Urate-lowering therapy remains the mainstay of therapy, with diet and dietary factors studied to date playing a limited role in the definitive management of gout.

The Association Between Dietary Purine Intake and Mortality: Evidence From the CHNS Cohort Study

ObjectivesTo investigate the association between dietary purine intake and mortality among Chinese adults. MethodsBased on data from the 2004–2015 China Health and Nutrition Survey (CHNS) and the corresponding edition of China Food Composition, the average purine intake per day from 2004 to 2011 was calculated and divided into five groups by quintiles. The outcome event and time we concerned were defined as self-reported death and time in 2015 survey. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CIs) for death. The possibly non-linear relation between purine intake and mortality was examined with restricted cubic splines. ResultsWe included 17,751 subjects and the average purine intake among them was 329.14 ± 142.74 mg/day. Purine intake was inversely associated with mortality (P = 0.002). Compared with the lowest quintiles, the HRs (95% CI) of the highest quintiles were 0.60 (0.46, 0.77) for purine (P < 0.001). Besides, a U-shaped relationship between purine intake and mortality was observed in males; however, there is no dose-response relationship in females. ConclusionsUnder the low purine intake levels of the Chinese population, purine intake showed a protective effect. We observed a U-shaped relationship between purine intake and mortality in men but not found in women. Funding SourcesNational Key R&D Program of China (2017YFC0907200,2017YFC0907201).

MO167AN UNUSUAL COURSE OF A 2,8 DHA CRYSTAL INDUCED NEPHROPATHY

Abstract Background and Aims 2, 8 dihydroxyadenine (DHA) deposition is a less known etiology of crystal-induced nephropathy, caused by a deficiency in a purine salvage enzyme, the adenine phosphoribosyl transferase (APRT). DHA is an insoluble molecule in urine leading to crystal formation, tubular obstruction or stone formation. The disease manifests as a history of urolithiasis, chronic kidney disease and even loss of renal allograft when the disease is undiagnosed in native kidneys. The cornerstone of treatment is the inhibition of xanthine dehydrogenase reducing thus the formation of 2,8-DHA and its renal excretion. Method A 59-year-old obese Lebanese male patient, born to a consanguineously married couple, was admitted to another hospital with desaturation, a history of progressive shortness of breath and a creatinine level of 2,8 mg/dl. He had no hypertension nor diabetes. His family history was positive for a sister with ESRD of unknown etiology. He was discharged on oxygen and continuous airway positive pressure therapy for severe obstructive sleep apnea. His renal function deteriorated leading to a creatinine level of 9.8 mg/dl three months later. There were no signs of systemic disease, no gross hematuria, no fluid overload. His blood pressure was normal. Laboratory work up showed anemia, low grade proteinuria, intermittent microscopic hematuria and negative serological and immunological workup. Kidney ultrasound showed normal size kidneys with no evidence of collecting system dilatation or urolithiasis. Due to this atypical presentation, the patient was admitted for a renal biopsy with a creatinine level of 11 mg/dl upon admission. Results The renal biopsy showed tubulo-interstitial nephritis associated with numerous brown-green crystals by Haematoxylin and eosin of various shapes birefringent under polarized light with the characteristic “maltese cross”. Crystals were found within tubular lumens and cytoplasm, interstitium, and macrophages. These findings were characteristic of 2,8 DHA crystals deposition in the kidney. The patient was started on 120 mg of Febuxostat with a low purine and high fluid diet. A genetic testing showed a pathogenic homozygous variant in the APRT gene which causes an amino acid change from Glycine to Aspartate at position 63. Two weeks later the patient was admitted to the ICU with pneumonia, respiratory failure, a creatinine of 9 mg/dl and severe metabolic encephalopathy. He received 4 sessions of hemodialysis followed by an improvement in his kidney function with a creatinine level down to 3.2 mg/dl a month after his discharge and he remains off dialysis until now. Conclusion Around 400 cases are currently recognized worldwide, emphasizing the under recognition of this autosomal recessive disease. Considering that the homozygoty causing a complete APRT deficiency should range between 1/50 000 and 1/100 000 cases, this would translate in at least 80 000 cases worldwide. The variant found in our patient has previously been described as disease causing for APRT deficiency in four cases. Reviewing the phenotype of these cases we find differences in terms of presentation and evolution, highlighting the variability in the APRT deficiency phenotype and underlining the fact that no correlation between phenotype and genotype was reported to date even for the same type of mutation. This case report shows us that the initiation of an adequate therapy is necessary even at advanced stages of the disease since it can improve our kidney outcome.

Comparison of Xanthine Oxidase Inhibitory Effect of Swertia chirayita and Febuxostat in Vitro

Introduction:Plasma uric acid ? 6.5 to 7.0 mg/dl increases the incidence of gout, hypertension, diabetes mellitus type 2, stroke and heart failure. Low purine diet, use of xanthine oxidase inhibitors allopurinol and febuxostat; or uricosuric agent’s probenecid, sulfinpyrazone and Benzbromarone are being used for treatment. Swertia chirayita extract (SCE) being practiced as anti-inflammatory and anti-oxidant was evaluated for inhibition of xanthine oxidase.&#x0D; Aims &amp; Objectives: To observe the in vitro effect of Swertia chirayita ethanolic extract on xanthine oxidase inhibition and its comparison with medicine febuxostat.&#x0D; Place and duration of study: The study was conducted in Pharmacology Department, University of Health Sciences Lahore during June-August 2017.&#x0D; Material &amp; Methods: Xanthine oxidase (XO) inhibition by ethanolic extract of the herb was compared with febuxostat. Serial dilutions of test compounds ranging from 1.25µg/ml to 100 µg/ml were prepared in absolute ethanol. Fixed volumes of xanthine, xanthine oxidase, phosphate buffer and test compounds were incubated. Uric acid concentration in the reaction mixture was calculated by measuring absorbance at 295nm by using Ultraviolet- Visible Spectrophotometer. Mean values and percent inhibition (± SD) was calculated. EZ Fit Enzyme Kinetic program was also used to calculate inhibitory concentration 50 percent (IC50), Michaelis constant (Km) and maximum rate of reaction (Vmax).&#x0D; Results: At maximum dose, (100 µg/ml) xanthine oxidase inhibition by febuxostat and Swertia chirayita was 98% and 80% percent respectively (p=0.01). Swertia chirayita extract showed IC50 at 9.15± 1.2 µg/ml whereas IC50 of febuxostat was 7.91± 0.9 µg/ml.&#x0D; Conclusion: In the light of XO inhibition, Swertia chirayita has potential to be explored as antihyperuricemic agent.

The Effect of Obesity and Other Factors towards On the Increased Risk of Rheumatism in Indonesia (Analysis of IFLS 2014)

The number of people with rheumatism worldwide has reached 355 million, and this is estimated by 2025, suggesting that more than 25% will experience paralysis. This study aims to determine obesity and other factors related to the increased risk of rheumatic diseases in Indonesia, the method used was data analysis using a complex sample survey. It used 2014 IFLS data and a cross sectional study design, as well as a multistage random sampling with a total of 29,106 respondents, and the results showed that the prevalence of rheumatic disease in Indonesia was 5.2% in 2014. The most dominant and unmodifiable variable that influenced incidence was gender (PR=1.686; 95% CI=1.488-1.910). Meanwhile, obesity is the most dominant and modifying variable that influences the incidence of rheumatic disease (PR=1.630; 95% CI=1.433-1.855). Factors that are simultaneously related to the increased risk of rheumatic diseases include age, gender, education, physical activity, protein consumption, obesity, and accident history. Considering the results, patients need to eat healthy and low purine foods, as well as implementing other healthy lifestyles such as appropriate, adequate, and regular physical activities in order to reduce the risk of rheumatism.

Penatalaksanaan Hiperurisemia Pada Penyakit Ginjal Kronik (CKD)

Management of hyperuricemia in CKD includes non pharmacology and pharmacology. Non-pharmacological with lifestyle change interventions such as exercise, weight loss, low purine meat consumption, avoid high fructose, reduce alcohol and herbs. The treatment of asymptomatic hyperuricemia in CKD is still controversial. In Japan and Korea given uric acid-lowering drugs when the serum uric acid level (SUA)&gt; 8 mg / dl but in America and Europe are not given drugs for fear of side effects. Soursop fruit consumption can be an alternative treatment for hyperuricemia in CKD both asymptomatic and symptomatic. The recommended drugs for hyperuricemia in CKD are allopurinol and febuxostat. Allopurinol is excreted through the kidneys so it is necessary to adjust the dose in CKD, starting from 50-100 mg / day, increasing it to 200-300 mg / day every 2-5 weeks until SUA &lt;6 mg / dl. The dose may be&gt; 300 mg / day if the patient is notified and the monitor may be toxic. In America, Europe and Japan recommend febuxostat only for the treatment of hyperuricemia.

Role of Vitamin C in Prophylaxis and Treatment of Gout-A Literature Review.

Gout, known as “the disease of the kings”, is the most frequent type of arthritis. It results from sustained hyperuricemia that leads to monosodium urate crystal deposition in joint structures and soft tissue. Environmental factors such as diet affect the incidence of gout; there is a known relationship between the occurrence of an acute attack of gout and the consumption of alcohol and meat; and a low purine diet is a widely recognized nonpharmacological method of supplementing the treatment and preventing recurrence of arthritis. This review aims to summarize the current knowledge about the role of vitamin C in prevention and treatment of gout. A PubMed/Medline database search on the role of vitamin C in purine metabolism was done. Reports from in vitro and animal studies seem to be promising and to allow explanation of the physiological relationship between vitamin C and uric acid. Most epidemiological studies indicate a significant correlation between high vitamin C intake and lower serum uric acid levels. Despite promising observations, there are few observational and interventional studies, and their results do not clearly define the benefits of a high daily intake of vitamin C in preventing the development and recurrence of gout.