Management Of Gouty Arthritis Research Articles

Relationship Between Quality of Life and Compliance with the Management of Gouty Arthritis in Lanao, Philippines

Relationship Between Quality of Life and Compliance with the Management of Gouty Arthritis in Lanao, Philippines

Efficacy of Virechana in Treating Raised Uric Acid Level in Gouty Arthritis - A Cohort Study

Vatarakta is a disorder predominantly affecting the joints with presenting symptoms like Sandhishula (pain), Sandhi shotha (swelling), Sandhi Graha (stiffness) Sparsh-asahishnuta (tenderness). Vatarakta in modern view has similarity with Gouty Arthritis. Gout and gouty arthritis though much prevalent in the western countries, it is not uncommon in India. The occurrence of Gout and gouty arthritis is common in the post pubertal males, and post-menopausal females. Hyperuricemia is a predisposing factor for the manifestation of gouty arthritis. The prevalence of gout varies between populations but is around 1% with a strong male predominance (10:1). As treatment given in modern is quite toxic this study on Vatarakta was taken up to find out the possible effects of Ayurvedic therapies in its management. Virechana is one of the Shodhana chikitsa in the management of Vatarakta. The objectives of the study were to study the efficacy of Virechana in reducing the raised uric acid level. Materials and Methods: 20 patients were included in this clinical study. Subjects were given Panchatikta guggulu ghrita for Snehapana, followed by Sarvanga abhyanga with Balaguduchyadi taila and Virechana with Nimbamrita Eranda taila. The total duration of the study was 7 days and follow up was done after 1 week. The assessment was carried based on subjective parameters like Sandhishoola, Sandhigraha and objective parameters like Twak Vaivarnyata, Sparshasahatwa, serum uric acid level, and McGill’s pain scale was done before and after treatment. Results were statistically analyzed using Wilcoxon signed-rank test. Results: Significant results were observed in subjective parameters such as Sandhishoola (85.6%) and Sandhigraha (75%) as well as objective parameter like twak Vaivarnyata (86.4%), Sparshasahatwa (90%), 32.8% serum uric acid level (32.8%), Mac gills pain scale (50%). Conclusion: Virechana with Nimbamritadi eranda taila was effective in the management of Gouty arthritis.

Efficacy of Ayurvedic treatment protocol in gouty arthritis- a clinical study.

Gout is an inflammatory response to the Monosodium urate crystals formed secondary to hyperuricaemia. The prevalence of gout has increased in recent years. The current conventional medical management aims at symptomatic management. In Ayurveda, gouty arthritis has similarity to Vata-Pittadhika Vatarakta, owing to its comparable aetiology and clinical features and treatment was planned accordingly. The present study is designed to evaluate the combined effect of Ayurvedic formulations and therapy in reducing the signs and symptoms and uric acid level in Gouty Arthritis. The study was a single group pre-post test design. The patients diagnosed on the basis of ACR EULAR Gout classification 2015 criteria. They were given Guduchi Siddha Ksheeravasthi (Therapeutic enema), Guduchi (Tinospora cordifolia) Kashaya (diluted decoction) and Punarnava Guggulu. Assessment of pain was done by Visual Analogue Scale and serum uric acid level was assessed on day 1 and on 31st day. Also, the change in symptoms were analyzed before and after the treatment. This study has been registered in the clinical trial registry-India. The obtained data were evaluated using paired t-test and Wilcoxon signed rank test. A significant improvement (p=0.0001) was observed in VAS scale (98.77%), serum uric acid levels (57.81%), subjective parameters. Moreover, erythrocyte sedimentation rate was observed to be normal level as compared to baseline of the therapy also with an enhancement of hemoglobin (Hb) levels. Thus, the present study revealed that Ayurvedic therapeutic interventions can play a major role in the management of gouty arthritis.

Anti-gout arthritic activities of Ethanolic and Aqueous leaf extracts of Cadaba fruticosa- An In vitro and In silico studies

In the present investigation an attempt was made to evaluate the in vitro and in silico anti-gout arthritic activity of ethanolic (EECF) and aqueous extracts (AECF) of leaves of Cadaba fruticosa. The in vitro anti-gout arthritic activity of EECF and AECF was evaluated in terms of their inhibitory potential of xanthine oxidase, proteinase enzymes as well as protein denaturation and membrane stabilization using standard protocols. For the analysis of in silico anti-gout arthritic activity, molecular docking was performed for the GC–Ms derived 15 phyto constituents using patch dock server to find a suitable antagonistic ligand for the enzymes cyclooxygenase I and matrix metalloproteinase IV since they are the key enzymes responsible for pain and degenerative changes. Among the EECF and AECF extracts the EECF extract exhibited higher inhibitory activity of the xanthine oxidase and proteinase enzyme. At the concentrations of 800 and 1000μg/ml the observed inhibitory activity was almost similar to the positive drug Allopurinol and Acetyl salicylic acid. Based on the docking score and activation energy the two phyto constituents Quercetin and Cadabicinediacetate inhibited the enzymes cyclooxygenase I and matrix metalloproteinase IV and serves as a better antagonistic ligand to suppress the pain and joint destruction. It may be concluded that the leaves of Cadaba fruticosa may further developed into a effective drug for the management of gouty arthritis due to its multi targeted inhibitory activity of several inflammatory mediators.

The effect of cryotherapy on the reduction of pain levels in gout arthritis patients in Jambi city

Background: Gouty arthritis is a disease caused by metabolic disorders with an increase in uric acid concentration which causes local joint pain. The management of gouty arthritis with pharmacological therapy usually uses several conventional drugs. The high prevalence of chronic pain experienced by sufferers has made the patient undergo non-pharmacological therapy with cold compresses (cryotherapy) to be more appropriate for joints with signs of inflammation such as redness and swelling that occur in patients with rheumatoid arthritis. Ice (ice packs) and ice water in the treatment of injuries and treatment modalities commonly used in the management of pain and injuries.Methods: This study used a quasi-experiment design with a two-group pre-test and post-test design approach. This study was conducted on patients with gout arthritis at PSTW Budi Luhur Jambi city with 16 respondent and control groups respectively. Data analysis in this study used univariate and bivariate using the independent t-test.Results: The results showed the average decreased levels of pain in patients with gouty arthritis in the control group without treatment pretest 3:50 whereas for the average posttest 3:19 and the average value decreased levels of pain in patients with gouty arthritis in the intervention group before performed cryotherapy 3:38 while for the average after treatment is 1.38, the statistical test p value is 0.000Conclusions: The influence cryotherapy to decrease rate gout arthritis pain in patients PSTW Budi Luhur in the city of Jambi.

BENEFITS OF CINNAMON CONSUMPTION IN PATIENTS WITH GOUT ARTHRITIS

Gout arthritis is a condition where an increase in uric acid levels can trigger the formation of crystals that can cause pain in the joints. Management of gouty arthritis can be done by pharmacological and non-pharmacological ways. Recently treating the disease using medicinal plants is increasingly in demand. One of the plants that has the potential as a cure for gouty arthritis is cinnamon (Cinnamomum burmanii). This review was compiled by searching library sources through NCBI, Garuda, Sinta and Google Scholar. The results of an article search found that consumption of cinnamon in patients with gouty arthritis is useful as an anti-inflammatory. This is because the content of cinnamaldehyde in cinnamon can inhibit lipoxygenase. The function of lipoxygenase is that it can convert free arachidonic acid into leukotriene. If the level of leukotrienes in the body falls, the inflammatory process will decrease

A Systematic Review Protocol to Assess the Effectiveness of Ayurveda Interventions in Gout

Introduction: Ayurveda offers healthy, harmonious, and long life by its holistic approach. Gout is a form of arthritis caused by excess uric acid in the bloodstream. Gout may be considered as Vatarakta or Vatasonita as per Ayurveda. Even though gout is managed well with conventional medicine, there are a lot of side effects. Ayurvedic treatment is found to be effective in the management of gouty arthritis with very few ill effects. But research works carried out in gout with Ayurvedic medicines are not yet compiled and analyzed. The purpose of this study is to conduct a systematic review of published data and gray literature on Ayurveda management of gout viz-à-viz Vatarakta to establish its safety and clinical effectiveness. Thus, finding more precise estimates of various Ayurveda interventions' effects in the management of gout either as stand-alone or as an add-on to conventional management. Materials and methods: Source for data analysis involves electronic search done from PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials: Issue 6 of 12, June 2018), AYUSH Research Portal (Govt. of India), DHARA, Google Scholar, Ancient Science of Life, Shodhganga@ INFLIBNET, and online clinical trial registers. Manual search in central and departmental libraries of Government Ayurveda College, Trivandrum and IPGT & RA, Gujarat Ayurved University, Jamnagar. There will be no language restrictions. Studies published till date (until March 2019) will be sought. The search will be rerun just before the final analyses, and further studies shall be retrieved for inclusion. Type of studies included randomized controlled trials (RCTs), quasi-experimental trials, single-group clinical trials, comparative clinical trials (CCTs), pragmatic trials, and review papers on Ayurvedic management of Gout, which will all be screened for data analysis. The study selection will follow the preferred reporting items for systematic review and meta-analysis guidelines. Data collection and synthesis: three investigators shall independently screen all citations and abstracts identified by a primary comprehensive search to sort out potentially eligible trials based on inclusion criteria. Data extraction forms for individual study shall be prepared and it may include methods, participant characteristics, intervention, and outcome. When disagreement persists or in case of ambiguity at the time of data extraction, efforts shall be initiated to obtain clarifications directly from authors/coauthors as much as possible. Primary data analysis of both the qualitative and quantitative data will be performed. Heterogeneity among trials will be assessed by inspecting forest plots. If heterogeneity is detected and it is still considered clinically meaningful to combine studies, then a random-effects model (Dersimonian-Laird Model) will be used. In cases where pooled estimates can be obtained, the systematic review will be followed by a meta-analysis (based on the homogeneity of the RCT methodological, appraisal will be done by Cochrane risk-of- bias tool for RCT); others would be presented by narrative synthesis [using Risk of Bias tool in non-randomised clinical trials/non-randomised controlled trials (NRCT)] and shall be represented in tabular and graphical form. The analysis of the systematically collected data shall be analyzed using R software. A sensitivity analysis, to investigate the robustness of the results to the quality components will be done, provided there are sufficient trials. A funnel plot will be utilized to indicate publication bias, heterogeneity of results, or differences in the methodological quality. Timelines: Data collection and analysis: 06 months (from the date of initiation). Journal selection and publication: 03 months (from the date of study completion). Dissemination: The systematic review will be published in a peer-reviewed journal. It will also be disseminated electronically and via print. The review may guide healthcare practices and policy framing in the treatment of gout with Ayurvedic interventions. Trial registration number: PROSPERO 2019: CRD42019131198.

Management of Gouty Arthritis with special reference to Vatarakta - A Case Report

Gouty Arthritis has now become a common disease condition which we deal in Ayurveda, but a proper treatment protocol is not followed in many cases. The case reported here was as a result of improper diet and lack of exercise which resulted in an increase serum uric acid level and joint inflammation. The treatment was given at IPD level diagnosing it as Gambhira Vatarakta with valid Chikitsa Siddhanta. This case report provides us a guidelines that even a chronic gouty arthritis with a very high serum uric acid can be treated as per Vataraktha Chikitsa Siddhanta in Ayurveda.

Comorbidities in gouty arthritis.

Gouty arthritis is increasing in prevalence in men and women, particularly in older age groups. A PubMed search was conducted to identify common comorbidities associated with gouty arthritis, their impact on quality of life, and strategies to manage gouty arthritis and its associated comorbidities. Gouty arthritis is associated with numerous comorbidities that are increasing in prevalence (chronic kidney disease [CKD], hypertension, obesity, diabetes, metabolic syndrome, and cardiovascular disease) and that negatively impact long-term prognosis and quality of life. Therefore, certain considerations and precautions are necessary when treating gouty arthritis in these patients. For example, nonsteroidal anti-inflammatory drugs can cause acute renal toxicity or worsen CKD and should be avoided in this population. Dosage adjustments are recommended when using colchicine and urate-lowering therapy in patients with CKD, which may limit efficacy. Febuxostat may be used in patients with mild to moderate renal impairment, but insufficient information is available for use in patients with creatinine clearance of less than 30 mL/min. Numerous drug-drug interactions in patients with gouty arthritis and comorbidities may alter serum uric acid levels. Several interleukin 1β inhibitors, which target the underlying inflammatory mechanism of gouty arthritis and many of its comorbidities, are in development and may provide an option for patients not adequately managed with other treatments. Gouty arthritis is associated with renal, metabolic, and cardiovascular comorbidities that negatively impact overall health. The management of gouty arthritis in the presence of comorbidities is particularly challenging because of contraindications, the need for dosage adjustments, and polypharmacy.

Management of Gouty Arthritis in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with gouty arthritis. However, data from randomized controlled trials in patients with gouty arthritis and CKD are limited, and current gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and colchicine are recommended first-line treatments for acute gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury. Also, colchicine toxicity is increased in patients with CKD, and dosage reduction is required based on level of kidney function. Allopurinol, febuxostat, and pegloticase are all effective treatments for controlling elevated uric acid levels after the treatment of an acute attack. However, in patients with CKD, required allopurinol dosage reductions may limit efficacy; pegloticase requires further investigation in this population, and febuxostat has not been studied in patients with creatinine clearance<30 mL/min. This article reviews the risks and benefits associated with currently available pharmacologic agents for the management of acute and chronic gouty arthritis including urate-lowering therapy in patients with CKD. Challenges specific to primary care providers are addressed, including guidance to help them decide when to collaborate with, or refer patients to, rheumatology and nephrology specialists based on the severity of gout and CKD.

AB0642 Efficacy of anakinra in gouty arthritis in real life population: a report of 36 cases.

BackgroundGout is a common arthritis that occurs particularly in subjects who have frequently associated comorbidities. These comorbid conditions could limit the use of conventional therapies (e.g. colchicine, non-steroidal anti-inflammatory drugs...

Adherence to uric acid treatment guidelines in a rheumatology clinic

The aim of this study was to evaluate adherence to recommended serum uric acid levels in the rheumatology outpatients department of a university teaching hospital. We performed a retrospective study of all patients with a definitive diagnosis of gout attending our subspecialty gout clinic between 1 January 2010 and 31 December 2010. We evaluated adherence with two recently suggested uric acid thresholds, <300 μmol/L (<5 mg/dL) and <360 μmol/L (<6 mg/dL). Patient management was judged to adhere to the guidelines if either (1) the latest serum uric acid level was less than the specified guideline targets or (2) uric acid-lowering therapy was titrated upwards or the agent changed if the serum uric acid was above the guideline targets. One hundred two patients with a definitive diagnosis of gout attended the outpatients department between 1 January 2010 and 31 December 2010 and were included in the study. Median serum uric acid level was 331 μmol/L (IQR 276-456 μmol/L). Eighty-six patients (84 %) were treated with allopurinol, six patients (6 %) were treated with febuxostat (one of whom also received probenecid), and one with rasburicase. In 80 patients (78 %), the management adhered to a target guideline of <360 μmol/L (<6 mg/dL). In 66 patients (65 %), the management adhered to a target guideline of <300 μmol/L (<5 mg/dL). A treat-to-target approach has the potential to improve patient outcomes in the management of gouty arthritis. Our study shows encouraging results with the majority of patients on appropriate therapy and reaching recommended targets.

Gout: Diagnosis and Management of Gouty Arthritis and Hyperuricemia

Robert Terkeltaub and N. Lawrence Edwards, Professional Communications, Inc., West Islip, New York, USA, 256 pages. $24.95 US. Drs. Terkeltaub and Edwards have chosen an opportune time to comprehensively review gout and hyperuricemia, as the field has had a number of new drug trials and epidemiologic studies in recent years. The book is well written and illustrated and is laid out logically, first describing the pathophysiology and epidemiology of …

Difficult-to-Treat Gouty Arthritis

Gouty arthritis is the most common inflammatory arthritis in adults and is characterized by very painful flares. Gouty arthritis results from an elevated body uric acid pool, which leads to deposition of monosodium urate crystals, mainly in the joints. These crystals trigger the release of proinflammatory cytokines, in particular interleukin (IL)-1β, which stimulates inflammation. Gouty arthritis can progress to a chronic, deforming and physically disabling disease through the development of disfiguring tophi, joint destruction and persistent pain. Standard treatments are effective in most patients. Acutely, anti-inflammatory therapies provide rapid pain relief and resolution of flares. Chronically, urate-lowering therapies reduce serum urate levels and, in combination with anti-inflammatory prophylaxis, reduce the risk of flares. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of co-morbidities. Indeed, metabolic syndrome, hypertension, dyslipidaemia, cardiovascular disease, diabetes mellitus and renal impairment are all highly prevalent in individuals with gouty arthritis, and may lead to standard treatments being ineffective or inappropriate. Such patients with difficult-to-treat disease require alternative therapies. Gouty arthritis can have a major impact on health-related quality of life (HR-QOL), especially in patients with difficult-to-treat disease, as revealed by recent studies comparing HR-QOL for patients with gouty arthritis with that of the general population. All studies revealed clinically significant reductions in physical functioning for individuals with gouty arthritis compared with the general population. The difference was particularly marked for patients with difficult-to-treat disease. Gouty arthritis also constitutes an important economic burden through absence from work and medical costs. Again, the burden is greater in patients with difficult-to-treat disease. The development of difficult-to-treat disease reflects the short-comings of current standard treatments in a growing number of gouty arthritis patients. This has been recognized by the pharmaceutical industry and has promoted the development of innovative therapies. An appreciation of the key role of IL-1β in inflammation in gouty arthritis has led to the development of a new class of anti-inflammatory agents that block IL-1β signal transduction. The current IL-1β blockers in trials are rilonacept and canakinumab. Canakinumab, a fully human anti-IL-1β monoclonal antibody, has been shown to produce rapid and sustained pain relief from acute flares in patients with difficult-to-treat disease, and both rilonacept and canakinumab have been shown to reduce the risk of recurrent flares. Promising new therapies for reducing serum urate levels are also being developed. These include the recently approved therapies pegloticase (a pegylated form of the enzyme uricase that converts urate to allantoin), inhibitors of renal urate transporter proteins, and inhibitors of purine nucleotide phosphorylase, an enzyme involved in purine metabolism. Further studies are warranted to establish the value and role of these new therapies in the management of gouty arthritis. These new options should help reduce the growing human burden associated with gouty arthritis, lowering the tophaceous burden, minimizing the risk of flares, and enabling patients to achieve rapid and effective pain relief when flares do occur.

Assessment and Management of Gouty Arthritis

Gout is a metabolic disorder of purine metabolism that leads to elevated serum concentrations of uric acid. When this happens, urate crystals may precipitate and accumulate in the joints and bursae. Gout is characterized by recurrent, painful attacks of arthritis, which is the major clinical complication of the disease. Early diagnosis and treatment of gout are important to prevent complications, and with early, sustained therapy, most patients can live without functional disability. If gout becomes chronic, individuals may experience severe limitations of activity. This article discusses the clinical manifestations, diagnosis and treatment of acute and chronic gout.