Gout Pain Research Articles

Health and Utilities in Patients With Gout Under the Care of a Rheumatologist.

To compare limitations in health between Dutch patients with gout and the general population and to determine factors influencing societal and patient values for health as assessed with different utility approaches. A cross-sectional study was done among 110 patients with gout under the care of a rheumatologist, with patients completing the EuroQol 5-domain instrument (EQ-5D), the EQ-5D visual analog scale (EQ-5D VAS), and the Short Form 6-dimensions health survey (SF-6D). Scores on EQ-5D domains were compared with age- and sex-matched general population data. Agreement between utility measures was assessed using the intraclass correlation coefficient (ICC). Mixture modeling was used to assess factors associated with the different approaches to assess utility. Compared to the general population, gout patients reported more limitations in mobility (66% versus 12%), self-care (24% versus 8%), daily activities (49% versus 24%), and pain (76% versus 45%), but equal anxiety/depressive symptoms (18% versus 19%). For patients with gout, utilities were reduced: the mean, median, and interquartile range, respectively, were 0.74, 0.81, and 0.69-0.84 for EQ-5D, 0.69, 0.67, and 0.59-0.81 for SF-6D, and 66, 70, and 57-77 for EQ-5D VAS. ICC agreement between each pair of utilities was only moderate (0.52-0.59). Only minor differences were seen in the type of variables associated with each utility approach, with worse Health Assessment Questionnaire scores, cardiovascular disease (CVD), gout concern, and gout pain consistently associated with lower utility. The strength of contribution of these variables, however, differed among the 3 approaches. Patients with gout experience substantially impaired health compared to the general population. Although absolute values of utility varied between instruments and perspectives, functional disability, CVD, and higher gout impact contributed to utility independently of which instrument was used.

Activation of peripheral KCNQ channels relieves gout pain.

Intense inflammatory pain caused by urate crystals in joints and other tissues is a major symptom of gout. Among therapy drugs that lower urate, benzbromarone (BBR), an inhibitor of urate transporters, is widely used because it is well tolerated and highly effective. We demonstrate that BBR is also an activator of voltage-gated KCNQ potassium channels. In cultured recombinant cells, BBR exhibited significant potentiation effects on KCNQ channels comparable to previously reported classical activators. In native dorsal root ganglion neurons, BBR effectively overcame the suppression of KCNQ currents, and the resultant neuronal hyperexcitability caused by inflammatory mediators, such as bradykinin (BK). Benzbromarone consistently attenuates BK-, formalin-, or monosodium urate-induced inflammatory pain in rat and mouse models. Notably, the analgesic effects of BBR are largely mediated through peripheral and not through central KCNQ channels, an observation supported both by pharmacokinetic studies and in vivo experiments. Moreover, multiple residues in the superficial part of the voltage sensing domain of KCNQ channels were identified critical for the potentiation activity of BBR by a molecular determinant investigation. Our data indicate that activation of peripheral KCNQ channels mediates the pain relief effects of BBR, potentially providing a new strategy for the development of more effective therapies for gout.

Importance of a Thorough Physical Examination

A 73-year-old white female presented for management of her tophaceous gout, pyoderma gangrenosum, and chronic back pain. On exam, there was an incidental finding of reticular, reddish-brown, non-tender, macular, non-blanching discoloration on her entire back, with a few superficial erosions (see Figure). The patient did not know the duration of her rash. It was neither pruritic nor painful. She denied arthralgia, fever, chills, or other constitutional symptoms. She did not have a history of insect bites, recent foreign travel, falls, or trauma. She frequently used a heating pad to alleviate her chronic back pain. Complete blood count, comprehensive metabolic panel, urine analysis, and inflammatory markers were within normal limits.

Effect of modular nursing plan on the pain and life quality of gout patients

Objective To explore the effect of modular nursing plan on the pain and life quality of gout patients.Methods Seventy-eight gout patients were chosen and divided into the observation group and the control group according to the admission number , each with 39 cases.The control group received the routine nursing, and the observation group received the modular nursing plan including the consultation , optimal pain treatment, active intervention and relaxation therapy .The pain intensity, the self-care ability and life quality of patients were respectively evaluated by the fingers pain score , the questionnaire on self-care ability and the health related quality of life （ HRQOL ） in two groups .Results The score of pain on the tenth day of hospitalization and the time alleviating pain were respectively （2.43 ±0.98）, （1.79 ±0.65） d in the observation group, and were （3.57 ±0.97）, （3.40 ±1.02） d in the control group, and the differences were statistically significant （t=-2.191, -3.062, respectively;P〈0.05）.The scores of self-care ability and HRQOL were respectively （52.48 ±7.26）, （9.57 ±2.40） in the observation group, and were higher than （39.37 ±6.88）, （5.07 ±2.17）in the control group, and the differences were statistically significant （t=8.238, 3.849, respectively;P〈0.05）.Conclusions The modular nursing plan can effectively relieve pain intensity in gout patients , and improve the patients ’ cognition and ability of self-care, and enhance the level of nursing, and increase the effectiveness of nursing . Key words: Gout; Pain; Life quality; Self-care; Modulan nursing plan

AB1069 Burden of Refractory Gouty Arthritis among Difficult-To-Treat Patients over One Year: Post- HOC Analysis from Motion Observational Study

BackgroundDifficult-to-treat (DTT) patients were refractory gouty arthritis (RGA) patients with ≥3 gout attacks along with contraindication, intolerance or inefficacy to NSAIDs, colchicine or steroids included in the MOTION study. There...

The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study

ObjectiveTo estimate disability from the remainder of musculoskeletal (MSK) disorders (categorised as other MSK) not covered by the estimates made specifically for osteoarthritis (OA), rheumatoid arthritis (RA), gout, low back...

The global burden of musculoskeletal conditions for 2010: an overview of methods

The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It...

Anti-Interleukin-1 Therapy in the Management of Gout

Gout is the most common inflammatory arthritis in humans. Current treatment options to control the pain and inflammation of acute and chronic gout include nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids. However, patients are commonly unresponsive to, intolerant of, or have contraindications to current treatments. Interleukin-1 (IL-1), a proinflammatory cytokine, plays a major role in mediating gouty inflammation. This role of IL-1 has led investigators to explore a new class of anti-inflammatory drugs that inhibit IL-1 signal transduction. IL-1 inhibitors currently in trials for gout include anakinra, rilonacept, and canakinumab. Anakinra is an IL‑1 receptor antagonist that inhibits the activity of both IL‑1α and IL‑1β, rilonacept is a soluble decoy receptor and canakinumab is an anti‑IL‑1β monoclonal antibody. In case cohorts, anakinra was found to be efficacious in combating acute gout pain and inflammation, whereas rilonacept has been found to be efficacious for reducing the risk of recurrent attacks. Canakinumab has been shown to be efficacious in both reducing pain and inflammation in acute attacks, and for reducing the risk of recurrent attacks. All three IL-1 inhibitors are generally well tolerated. This article reviews the current IL-1 inhibitors and the results of trials in which they have been tested for the management of acute and chronic gouty inflammation.

Habb-e-Asgand, polyherbal Unani formulation, protects liver and antioxidative enzymes against paracetamol induced hepatotoxicity

Context: Habb-e-Asgand, a polyherbal Homeopathy/Unani drug from Hamdard Wakf Laboratory, India, used in arthritis, gout and joint pain, is a mixture of many herbal medicinal plants. Scientific attempts to test and validate its efficacy are meager.Objective: To evaluate the hepatoprotective and antioxidative potential of Habb-e-Asgand against paracetamol toxicity.Materials and methods: Swiss albino male mice (n = 5/group) were treated with Habb-e-Asgand (250 mg/kg, body weight (b.w.) in normal saline orally for 14 days followed by a single dose of paracetamol (400 mg/kg b.w./normal saline) intraperitoneally 24 h before euthanization. We estimated liver function (LFTs) using diagnostic kits, while antioxidant enzymes, cytochrome P450 (CYP) and lipid peroxidation (LPO) were measured using spectrophotometric methods.Results: Paracetamol alone induced LFTs enzymes significantly (p < 0.05 and p < 0.01, 0.001), serum glutamate pyruvate transaminase (SGPT, ∼70%), serum glutamate oxaloacetate transaminase (SGOT, ∼20%), alkaline phosphatase (ALP, ∼20%), total bilirubin (∼30%), CYP activity (∼50%) and LPO (∼45%), while it significantly inhibited the activity of antioxidant enzymes glutathione reductase (GR, ∼35%), glutathione peroxidase (GPx, ∼40%), glutathione S-tranferase (GST, ∼16%), catalase (CAT, ∼84%) and glutathione (GSH, ∼30%) contents. Habb-e-Asgand alone and in combination of paracetamol significantly (p < 0.05, 0.01, 0.001) decreased LFT levels (20–25%), CYP activity (∼45%) and LPO level (∼25%), while it induced antioxidant enzyme activity (GR, ∼15%; GPx, ∼17%; GST, ∼20% and CAT, ∼60%).Discussion: Paracetamol metabolites may be mediating production of reactive oxidant species (ROS) and liver injury, which are attenuated by Habb-e-Asgand antioxidant constituents.Conclusion: Habb-e-Asgand may be used as a prophylaxis for ROS related liver injury.

OMERACT Endorsement of Measures of Outcome for Studies of Acute Gout

To determine the extent to which participants at the Outcome Measures in Rheumatology (OMERACT) 11 meeting agree that instruments used in clinical trials to measure OMERACT core outcome domains in acute gout fulfill OMERACT filter requirements of truth, discrimination, and feasibility; and where future research efforts need to be directed. Results of a systematic literature review and analysis of individual-level data from recent clinical studies of acute gout were presented to OMERACT participants. The information was discussed in breakout groups, and opinion was defined by subsequent voting in a plenary session. Endorsement was defined as at least 70% of participants voting in agreement with the proposition (where the denominator excluded those participants who did not vote or who voted "don't know"). The following measures were endorsed for use in clinical trials of acute gout: (1) 5-point Likert scale and/or visual analog scale (0 to 100 mm) to measure pain; (2) 4-point Likert scale for joint swelling; (3) 4-point Likert scale for joint tenderness; and (4) 5-point Likert scale for patient global assessment of response to treatment. Measures for the activity limitations domain were not endorsed. Measures of pain, joint swelling, joint tenderness, and patient global assessment in acute gout were endorsed at OMERACT 11. These measures should now be used in clinical trials of acute gout.

Risk Factors For Bone Pain Among Patients Receiving Myelosuppressive Chemotherapy and Primary Prophylactic Pegfilgrastim

IntroductionFebrile neutropenia (FN) is a common, life-threatening side effect of myelosuppressive chemotherapy. Prophylactic pegfilgrastim (Neulasta) beginning with the first cycle of chemotherapy has been shown to reduce the incidence of FN (Vogel CL et al., J Clin Oncol., 2005). Bone pain is the most common adverse event associated with pegfilgrastim, and most incidences of bone pain can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). However, little is known about risk factors for bone pain in patients treated with pegfilgrastim. MethodsThis study used individual patient data from 23 Amgen-sponsored, randomized clinical trials and included adults receiving myelosuppressive chemotherapy and primary prophylactic pegfilgrastim. Bone pain was identified based on the adverse events reported in the trials. Multivariable logistic regression models were used to identify risk factors associated with the occurrence of moderate to severe bone pain (grade 2+) in cycle 1 (the primary outcome) and across cycles 1-6 and any grade bone pain in cycle 1 and across cycles 1-6. Data collected in the trials and included in the regression model include baseline patient characteristics (gender, race, and age); disease characteristics (primary tumor type and tumor stage); treatment characteristics (taxane vs no taxane treatment and dose of pegfilgrastim); and medical history (osteoporosis/osteopenia, hypercholesterolemia, anemia, neutropenia, osteomyelitis/osteonecrosis, arthritis, peripheral neuropathy, chronic fatigue syndrome, gout, bone fracture, and bone pain). ResultsThis study included data from 1974 patients who received myelosuppressive chemotherapy and primary prophylactic pegfilgrastim. The most frequent tumor types in the study sample were breast cancer (54.8%), non-small cell lung cancer (17.1%), and non-Hodgkins lymphoma (13.6%). 41.2% of patients had stage IV disease. Grade 2+ bone pain was reported in 372 patients (18.8%) in cycle 1 and 564 patients (28.6%) across the first 6 cycles, while any grade bone pain was reported in 709 patients (35.9%) in cycle 1 and 1016 patients (51.5%) across the first 6 cycles. In the first cycle of chemotherapy, previous history of osteoporosis/osteopenia (odds ratio [OR] 1.28; 95% CI 1.04-1.56), gout (1.44; 0.98-2.13), and bone pain (1.28; 1.09-1.49), and pegfilgrastim dose (100 mcg/kg vs a fixed dose of 6 mg; 1.68; 1.13-2.51) were associated with increased risk of grade 2+ bone pain; compared with breast cancer, colorectal cancer was associated with reduced risk of grade 2+ bone pain (0.26; 0.11-0.60) and ovarian cancer with increased risk of grade 2+ bone pain (1.89; 0.98-3.64); compared with age <45 years, age ≥65 years was associated with reduced risk of grade 2+ bone pain (0.80; 0.63-1.01) (table).TableAdjusted ORs and 95% CIs of risk factors for grade 2+ bone pain in the first cycle and across the first 6 cycles of chemotherapyGrade 2+bone painCycle 1Adjusted OR (95% CI)Grade 2+bone painFirst 6 cyclesAdjusted OR (95% CI)Patient CharacteristicsHispanic (vs white)1.39 (0.90-2.15)1.57 (1.07-2.29)Age ≥65 years (vs <45 years)0.80 (0.63-1.01)0.82 (0.67-1.00)Disease CharacteristicsColorectal cancer (vs breast)0.26 (0.11-0.60)0.44 (0.25-0.77)Ovarian cancer (vs breast)1.89 (0.98-3.64)1.45 (0.82-2.58)Treatment CharacteristicsTaxane-based regimens1.11 (0.85-1.45)1.24 (0.98-1.57)Pegfilgrastim dose (100 mcg/kg vs a fixed dose of 6 mg)1.68 (1.13-2.51)1.21 (0.85-1.73)Medical HistoryHistory of osteoporosis/osteopenia1.28 (1.04-1.56)1.33 (1.11-1.59)History of gout1.44 (0.98-2.13)1.27 (0.88-1.82)History of bone pain1.28 (1.09-1.49)1.36 (1.18-1.56)Characteristics associated with risk of bone pain are shown. ConclusionsHistory of osteoporosis/osteopenia, history of bone pain, breast cancer (vs colorectal cancer), and younger age appear to be risk factors for bone pain in chemotherapy-treated patients who received primary prophylactic pegfilgrastim. The study results may be used to identify patients at increased risk of bone pain who may benefit from pain therapy. Disclosures:Xu: Amgen Inc. : Employment, Equity Ownership. Gong:Amgen Inc. : Employment, Equity Ownership. Vogl:Amgen Inc. : Employment, Equity Ownership. Abella:Amgen Inc. : Employment. Page:Amgen Inc. : Employment, Equity Ownership.

ISOLATION AND CHARACTERIZATION OF FLAVONE GLYCOSIDE VITEXIN FROM PEPEROMIA PELLUCIDA LINN

Peperomia Pellucida Linn , widely used in traditional medicine belongs to the family Piperaceae. It has been used for treating abdominal pain, acne ,boils, colic, fatigue, gout, headache, renal disorders, and rheumatic joint pain. The whole plant after collection, authentication and drying, was extracted with petroleum ether, chloroform, methanol and water using soxhlet extractor. The aim of the study was to isolate the phytoconstituents from the methanolic extract of peperomia pellucida by Preparative-Thin Layer Chromatography (P-TLC) and characterized by spectroscopic techniques (UV-visible spectroscopy, infrared spectroscopy,1H and 13C NMR spectroscopy and mass spectrometry). A flavonoidal structure was isolated from the methanolic extract of the plant. The light yellow coloured compound which solubilizes in methanol, ethanol and water having m.p. 203-204 O c and Rf value 0.61 in mobile phase acetonitrile : water: acetic acid (6:4:0.1) was identified by the various spectroscopical methods. So from this study, it is concluded that the isolated compound may be vitexin which is responsible for various pharmacological activities of the plant s .

FRI0387 Pain, health-related quality of life and health status in GOUT in europe

BackgroundGout is an increasingly prevalent rheumatic disease (with acute and chronic components) which is associated with significant reduction in Health-Related Quality of Life (HRQoL)1,2. Although much of this impairment results...

OP0187-PC Potentially harmful prescription of NSAIDS in a primary care population with musculoskeletal complaints

BackgroundTo reduce adverse drug events (ADEs), clinical guidelines recommend cautious prescription of non-steroidal anti-inflammatory drugs (NSAIDs) in patients known to be at a high risk of developing a serious ADE....

Canakinumab in gout

Introduction: Gout is a painful inflammatory arthritis with a prevalence of approximately 4% in the United States, affecting an estimated 8.3 million adults. The past 20 years have shown significant increases in the number of patients with gout and its incidence may still be increasing. Current treatment options to control the pain and inflammation of acute gout include nonsteroidal anti-inflammatory drugs, colchicine and corticosteroids, although patients are often unresponsive to, intolerant of, or have contraindications for, these therapies. Additional treatment options are therefore needed for this population with difficult-to-treat gout.Areas covered: Currently available and investigational anti-inflammatory agents for acute and chronic gout will briefly be reviewed. Canakinumab, a fully human monoclonal anti-interleukin (IL)-1β antibody that selectively blocks IL-1β and that is being investigated for the treatment of gout, will be discussed in greater detail.Expert opinion: Canakinumab has been found to be superior to triamcinolone acetonide in acute gout and to colchicine in gout attack prophylaxis in reducing pain and risk of new gout attacks. Canakinumab's long half-life contributes to its prolonged anti-inflammatory effects.

Improving musculoskeletal health: Global issues

Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and MSK pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases. Thus, prevention strategies require urgent attention globally.

Poor Footwear May Exacerbate Gout Pain, Impairment

Poor Footwear May Exacerbate Gout Pain, Impairment

Validation of pain and patient global scales in chronic gout: data from two randomised controlled trials

ObjectiveTo assess validity of pain and patient global scales in gout.MethodsThe authors used data from pegloticase clinical trials in chronic refractory gout to examine the validity of visual analogue scale...

Gout disease-specific quality of life and the association with gout characteristics.

PURPOSE: Assess the association of gout characteristics with health-related quality of life (HRQoL) using a new gout-specific HRQoL instrument, the Gout Impact Scale (GIS). PATIENTS AND METHODS: Gout patients completed the GIS (five scales [0-100 score each] representing impact of gout overall [three scales] and during an attack [two scales]) and other questions describing recent gout attacks, treatment, gout history, comorbidities, and demographics. Physicians confirmed gout diagnosis, presence of tophi, and most recent serum uric acid (sUA) level. Relationships between gout characteristics and GIS scores were examined using analysis of variance and correlation analyses. RESULTS: The majority of patients were male (90.2%) with a mean age of 62.2 (±11.8) years. Approximately one-half (49.7%) reported ≥3 gout attacks in the past year and the majority (57.9%) reported experiencing gout-related pain between attacks. Patients had appreciable concern about their gout ("gout concern overall" scale, 63.1 ± 28.0) but believed their treatment was adequate ("unmet gout treatment need" scale (38.2 ± 21.4) below scale mid-point). Significantly worse GIS scores were associated with increasing attack frequency and greater amount of time with pain between attacks (most scales, P < 0.001). Common objective measures such as sUA level, presence of tophi and the number of joints involved in a typical attack did not appear to be good indicators of the impact of gout on the patients' HRQoL. CONCLUSION: Attack frequency and gout pain between attacks were important correlates of patients' ratings of gout impact on their HRQoL. Further studies are needed to determine the minimal important difference for each GIS scale and interpret our results relative to other patient populations with gout.

Inhibition of cyclooxygenase activity by standardized hydroalcoholic extracts of four Asteraceae species from the Argentine Puna

We determined the anti-inflammatory activity of standardized extracts of four medicinal plant species (Baccharis incarum, B. boliviensis, Chuquiraga atacamensis, Parastrephia lucida) that grow in the Argentine Puna (3800 m above sea level) and that are used to reduce oxidative stress and alleviate gout and arthritic pain. The extracts of plant aerial parts were standardized in terms of total phenolic compounds and flavone/flavanone content and free radical scavenging activity. All extracts showed high phenolic compound concentration (0.5-1.6 mg/mL), mainly flavones and flavonols (0.1-0.8 mg/mL). The extracts showed hydrogen donating ability (DPPH and ABTS) and reactive oxygen species scavenging activity (O2-, OH-, H2O2). The ability of the extracts to inhibit cyclooxygenase enzymes (COX-1 and COX-2) was determined by calculating percent inhibition of PGE2 production measured by enzyme immunoassay. All extracts inhibited both enzymes with IC50 values of 2.0 to 16.7 microg/mL. The anti-inflammatory activity of B. incarum and C. atacamensis extracts was higher than that of B. boliviensis and P. lucida. The IC50 values obtained for indomethacin were 0.11 and 0.78 microM for COX-1 and COX-2, respectively. The present results are consistent with the anecdotal use of these species in phytotherapic preparations.