Treatment Of Gout Research Articles

Correlation of obesity, dietary patterns, and blood pressure with uric acid: data from the NHANES 2017–2018

BackgroundPrevalence rates of hyperuricemia and gout are increasing. Clinical investigations of hyperuricemia-related risk factors aid in the early detection, prevention, and management of hyperuricemia and gout. Ongoing research is examining the association of obesity, dietary patterns, and blood pressure (BP) with serum uric acid (sUA).MethodsA cross-sectional study was conducted based on the National Health and Nutrition Examination Survey. The exposures included body mass index (BMI), dietary patterns, and BP. The outcome variable was sUA level. The weighted multivariate linear regression models and smooth curve fittings were used to assess the association of BMI, dietary patterns, and BP with sUA.ResultsThere was a significantly positive correlation between BMI and sUA (β = 0.059, 95% CI: 0.054 to 0.064, P < 0.00001). Overweight and obese individuals had higher sUA levels than those with the normal BMI (β = 0.451, 95% CI: 0.357 to 0.546, P < 0.00001; β = 0.853, 95% CI: 0.760 to 0.946, P < 0.00001; respectively). Dietary energy intake was positively correlated with sUA (β = 0.000, 95% CI: 0.000 to 0.000, P = 0.01057). Dietary intake of carbohydrate and fiber were negatively correlated with sUA (β = − 0.001, 95% CI: − 0.002 to − 0.000, P < 0.00001; β = − 0.008, 95% CI: − 0.011 to − 0.004, P = 0.00001; respectively). Moreover, systolic BP was positively correlated with sUA (β = 0.006, 95% CI: 0.003 to 0.009, P = 0.00002). However, no statistical differences were found about the associations of dietary intake of total sugars, protein, total fat, cholesterol, and diastolic BP with sUA.ConclusionsThe current cross-sectional investigation of a nationally representative sample of US participants showed that BMI, dietary energy intake, and systolic BP were positively correlated with sUA levels; dietary carbohydrate and fiber intake were negatively correlated with sUA levels. The findings might be helpful for the management and treatment of hyperuricemia and gout.

Macrophages in gouty inflammation

Gout disorder is likely to be the most common cause of inflammatory arthritis. Hyperuricemia leads to formation of poorly soluble crystalline urate salts in tissues and joints, thus being etiological factor of the gout. The review summarizes modern views on the mechanisms of autoinflammation in gout disorder and it provides an outlook for the new treatment approaches. Inflammation in gout is related to phagocytosis of the urate crystals and the macrophagic NLRP3 inflammosome activation. This process consists of preliminary stage and proinflammatory cytokine generation phases. During the preliminary phase, soluble and crystalline urate salts initiate mRNA transcription for IL-1 and other proinflammatory cytokines precursors in macrophages, synthesis of NLRP3 inflammosome components, and formation of immune memory. Enhanced transcription of IL-1 and other cytokine precursors is implemented via PRAS49-AKT-mTOR signaling, IL- 1ra anti-inflammantory factor and TLR-MyD88-IRAK-NF-B pathway; the enhanced synthesis of NLRP3 inflammasome components provided via the TLR-NF-B pathway. The immune memory develops due to the epigenetic modifications, associated with (de-) acetylation and (de-) methylation of histones and DNA. During the next phase, the effect of soluble and crystalline urate salts upon macrophages promotes NLRP3 inflammosome activation, due to the following events: 1. К+, Cl- and Са2+ ionic currents shift; 2. lysosomic and mitochondrial damage, leading to the cathepsin B release and enhancement of reactive oxygen production, respectively; 3. NLRP3 relocation between the endoplasmic reticulum, Golgi complex and cytosol; 4. alteration of the NLRP3 structure due to auxiliary proteins attachment, phosphorylation, ubiquitination and acetylation. The NLRP3 inflammosome activity results into increased caspase 1 production which, in turn, produces IL-1 and pyroptotic pores proteins. The pyroptotic pores allow IL-1 passage, which further amplifies inflammation. During the pyroptosis, soluble and crystalline urate salts release from the cells, further increasing inflammation and tissue damage. Understanding the mechanisms of gout-associated inflammation helps us to formulate promising approaches to development of novel treatments. Macrophages are the key cells to crystal-induced inflammation development. Thus, new biothechnologies based on macrophage engineering may appear to be prospective in gout treatment. In this review, we have analyzed the prospects of M3 phenotype macrophages (AB-M3) usage in therapy, unlike M1 and M2 phenotypes, is able to produce anti-inflammatory cytokines in response to the inflammatory factors and, therefore, to inhibit crystal-induced inflammation. Meanwhile, unlike the anti-IL-1 medications, e.g., canakinumab, targeting a single end product of the gout inflammation (IL-1), AB-M3 macrophages inhibit not only IL-1 production, but also a group of other inflammatory cytokines.

Effect of A. polygama APEE (Actinidia polygama ethanol extract) or APWE (Actinidia polygama water extract) on wrinkle formation in UVB-irradiated hairless mice.

Actinidia polygama (silver vine) is considered a medical plant which has been used in oriental medicine. It has been used for the treatment of pain, gout, rheumatoid arthritis, and inflammation. Few studies reported on the effect of Actinidia polygama (silver vine) on skin photoaging. To evaluate the anti-photoaging effect of the ethanol and water extracts of A.polygama (APEE and APWE, respectively) in UVB-irradiated hairless mice. SKH-1hairless mice were exposed to UVB irradiation (30-60mJ/cm2 ), following orally APEE or APWE oral administration for 10weeks. We examined the effect on winkle improvement by a measuring Fullscope, PRIMOS, Craniometer, and Cutometer. Furthermore, we analyzed histological changes in mouse dorsal skin through hematoxylin and eosin (H&E) and Masson's trichrome (MT) staining. The expression of matrix metalloproteinase (1, 3, and 9) was analyzed by immunoblotting. Oral administration of APEE or APWE at 100 or 200mg/kg in UVB-irradiated mice alleviated the symptoms of skin aging, such as wrinkling, epidermal hyperplasia, and water loss. In addition, the APEE or APWE oral administration increased skin elasticity by enhancing the production of type I collagen, elastin, and hyaluronic acid synthase and downregulating matrix metalloproteinase (1, 3, and 9) expression. Based on results for our study, APEE or APWE could protect the UVB-mediated skin wrinkle and is new target for the developing anti-wrinkle cosmetics.

Excess Uric Acid Induces Gouty Nephropathy Through Crystal Formation: A Review of Recent Insights

Uric acid (UA) is the final product of purine metabolism in the human body, and impaired purine metabolism can increase the uric acid in serum, finally resulting in hyperuricemia (HUA). Current evidences suggest that urates might have antioxidant properties under certain circumstances, but most evidences suggest that urates promote inflammation. Hyperuricemia leads to the formation of urate crystals, which might be recognized as a red flag by the immune system. Such a response stimulates macrophage activation, leads to the activation of NOD-like receptor protein 3 (NLRP3) inflammasome vesicles, and ultimately the production and liberation of interleukin-1b (IL-1b) and interleukin-18 (IL-18), which can mediate inflammation, apoptosis and necroinflammation and cause an inflammatory cascade response. The kidney is one of the most commonly affected organs in HUA, which promotes the development of chronic kidney disease (CKD) by damaging endothelial cells, activating the renin-angiotensin system (RAS), and promoting inflammatory responses. Pharmacological interventions and lifestyle modifications are the primary means for controlling gout and lowering UA. The febuxostat is safe for CKD patients in the UA lowering therapy. Although dialysis can reduce UA levels, the application of drug is also necessary for dialysis patients. This article reviews the synthesis and metabolism of UA, etiology of HUA, the relationship between HUA and kidney disease, the treatment of gout and gouty nephropathy (GN).

Treatment for hyperuricemia and gout in Japan: Aspect of prescription and duration.

Treatment for hyperuricemia and gout in Japan: Aspect of prescription and duration.

The reality of treatment for hyperuricemia and gout in Japan: A historical cohort study using health insurance claims data.

Hyperuricemia causes gout and has also been associated with metabolic syndrome and cardiovascular disease. Uric acid‐lowering drugs (ULDs) are used to reduce uric acid levels for the treatment of hyperuricemia and gout. However, there is a lack of robust and real‐world data on the history and treatment of patients with newly diagnosed hyperuricemia or gout in Japan. This retrospective, longitudinal, historical cohort study determined the characteristics of patients with hyperuricemia and/or gout, and prescription of, and adherence to, ULDs using data from the JMDC Claims Database. The primary evaluation population included 64 677 patients with newly diagnosed hyperuricemia and/or gout. Of these, only 26 501 (41.0%) had a prescription for ULDs at diagnosis. Even when ULDs were prescribed, the persistence rate of prescriptions declined over time, with a 54.4% persistence rate for ULDs at 12 months after the index diagnosis. In subgroups of patients with or without hypertension and diabetes, the rate of ULD prescription continuation was significantly higher in those with comorbidities than in those without (76.8% vs. 42.6% in those with vs. without hypertension, and 78.7% vs. 52.2% in those with vs. without diabetes). These finding suggest that therapeutic interventions to lower serum uric acid levels are under‐utilized for patients with newly diagnosed hyperuricemia and/or gout in Japan.

Colchicine for cardiovascular medicine: a systematic review and meta-analysis.

Aim: Colchicine, a microtubule-disassembling (antitubulin) agent used for centuries for the treatment of gout and autoimmune diseases, is a drug of growing interest in the cardiovascular field. While in the last decades it has become cornerstone of pericarditis treatment, it has also emerged in the last few years as a promising drug in the management of coronary artery disease, atrial fibrillation and heart failure. This systematic review and meta-analysis aimed to assess the efficacy of colchicine in patients with cardiovascular diseases. Methods: Systematic search in electronic databases (MEDLINE/PubMed, Scopus, BioMed Central, the Cochrane Collaboration Database of Randomized Trials, ClinicalTrials.gov, EMBASE, Google Scholar) was performed to identify randomized controlled trials (RCTs) up to February 2021. Random-effects meta-analysis was performed to assess the risk of cardiovascular events, defined according to clinical setting. Results: Among 15,569 pooled patients from 21 RCTs, colchicine was superior to placebo in the reduction of cardiovascular events. In the setting of pericardial diseases, it was associated with a lower risk of recurrent pericarditis (17 vs 34%, RR=0.50, 95% CI: 0.42-0.60, I2=10%). In other studies assessing coronary artery disease patients, colchicine was associated with a reduced risk of major adverse cardiovascular events (MACE) such as myocardial infarction, stroke, cardiovascular death, coronary revascularisation and hospitalization (6.3 vs 9%, RR=0.67, 95% CI: 0.54-0.84, I2=55). Among patients with atrial fibrillation, it was associated with lower rates of recurrence (20 vs 30%, RR=0.68, 95% CI: 0.58-0.81, I2=0). In the single RCT on heart failure, colchicine was not associated with improved NYHA class. Conclusion: Colchicine is a valuable anti-inflammatory agent for the prevention of cardiovascular events in patients with inflammatory cardiac conditions such as pericardial diseases, coronary artery disease and atrial fibrillation.

Role of colchicine in the management of COVID-19 patients: A meta-analysis of cohort and randomized controlled trials

BackgroundColchicine is well known drug for the treatment of acute gout. Recently, it has also been used in the management of COVID-19 patients. AimThe aim of current study is to find out the role of colchicine in COVID-19 patients. Material & methodsThe relevant studies were searched in PubMed/Medline, Google scholar and clinical trail.gov.com till inception and sorted based on the inclusion and exclusion criteria. The quality assessment of studies were done using Newcastle Ottawa Quality Assessment Scale. The pooled estimate was calculated as odd ratio and pooled prevalence with 95% confidence interval. A random effect model was used and publication bias was assessed qualitatively by trim and fill method. ResultsOut of 38 studies, a total of 6 studies were found relevant for the analysis containing 1146 patients (705 males and 441 females). The pooled odd ratio was found to be 0.35 [0.23, 0.53] which indicate significance reduction of mortality in colchicine group as compared to non-colchicine group. The pooled prevalence of the patients treated with colchicine were found to be significant [0.11(0.03, 0.24)]. The heterogeneity among studies was also found to be low (I2 = 11%). However, funnel plot has indicated the involvement of publication bias [Egger: bias = 10.168291 (95% CI = 5.042044 to 15.294537) P = 0.0053]. ConclusionColchicine might be helpful in reduction of mortality in the management of COVID-19 patients. However, further studies are required to confirm its exact role.

Study on the analgesic, anti-inflammatory and hypouricemic effects of 50% ethanolic extract from Jasminum subtriplinerve Blume

Previous studies have reported in vitro antioxidant and inhibitory activity on xanthine oxidase of Jasminum subtriplinerve Blume, Oleaceae, which suggested the potential prevention of gout and supplementary treatment. This study evaluated analgesic, anti-inflammatory, and hypouricemic effects of the 50% ethanolic extract of J. subtriplinerve (EEJS) at the oral doses of 800 and 1200 mg/kg in mice. For acute oral toxicity, after oral administration of single doses of EEJS; mortality and toxic signs in male and female mice were noticed within 72 hours and 14 days. The analgesic effect was observed in acid acetic induced writhing in mouse model within 40 minutes. The anti-inflammatory effect was determined in mice-induced edema by 1% carrageenan. The hypouricemic effect was evaluated in mice with the peritoneal injection of potassium oxonate inducing acute and chronic hyperuricemia. The results showed that there was not any toxic sign in mice given orally at the maximum dose (Dmax) of 20 g EEJS/kg. At the dose of 800 and 1200 mg/kg, EEJS did exhibit analgesic effect until 40th minute. EEJS 1200 mg/kg expressed acute anti-inflammatory effect. EEJS had no acute hypouricemic effect at the oral doses of 800 and 1200 mg/kg. When given to mice with chronic hyperuricemia, 800 mg/kg EEJS reduced 30-44% blood uric acid concentration compared to pathological group. In conclusion, EEJS did not cause any toxic sign in mice at the Dmax of 20 g/kg. This extract had analgesic and chronic hypouricemic effects at the oral dose of 800 mg/kg in mice.

Trends in the Contribution of Genetic Susceptibility Loci to Hyperuricemia and Gout and Associated Novel Mechanisms.

Hyperuricemia and gout are complex diseases mediated by genetic, epigenetic, and environmental exposure interactions. The incidence and medical burden of gout, an inflammatory arthritis caused by hyperuricemia, increase every year, significantly increasing the disease burden. Genetic factors play an essential role in the development of hyperuricemia and gout. Currently, the search on disease-associated genetic variants through large-scale genome-wide scans has primarily improved our understanding of this disease. However, most genome-wide association studies (GWASs) still focus on the basic level, whereas the biological mechanisms underlying the association between genetic variants and the disease are still far from well understood. Therefore, we summarized the latest hyperuricemia- and gout-associated genetic loci identified in the Global Biobank Meta-analysis Initiative (GBMI) and elucidated the comprehensive potential molecular mechanisms underlying the effects of these gene variants in hyperuricemia and gout based on genetic perspectives, in terms of mechanisms affecting uric acid excretion and reabsorption, lipid metabolism, glucose metabolism, and nod-like receptor pyrin domain 3 (NLRP3) inflammasome and inflammatory pathways. Finally, we summarized the potential effect of genetic variants on disease prognosis and drug efficacy. In conclusion, we expect that this summary will increase our understanding of the pathogenesis of hyperuricemia and gout, provide a theoretical basis for the innovative development of new clinical treatment options, and enhance the capabilities of precision medicine for hyperuricemia and gout treatment.

Network pharmacology and in vivo experiments reveal the pharmacological effects and molecular mechanisms of Simiao Powder in prevention and treatment for gout

BackgroundGout is a common disease with high incidence due to unhealthy diet and living habits. Simiao Powder, as a classic formula consisted of four common herbs, has been widely used in clinical practice since ancient times to prevent and treat gout. However, the pharmacological mechanism of Simiao Powder is still unclear.MethodsBased on network pharmacology, Simiao Powder active compounds were identified in TCMSP, ETCM and BATMAN database, used to establish a network of interaction between potential targets of Simiao Powder and known therapeutic targets of gout. Subsequently, the key potential targets are being used for protein–protein interaction, GO enrichment analysis and KEGG pathway enrichment analysis through several authoritative open databases. Molecular docking through AutoDockTools software can verify interaction between molecules. Finally, to validate the predicted results, in vivo experiments based on hyperuricemic-gout mice model were designed and treated with Simiao powder and allopurinol. Serum levels of uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) and xanthine oxidase (XOD) were determined using a customized assay kit while the expression of PPAR-γ, PTGS1, IL-6 and Bcl2 mRNA were analyzed through qRT-PCR.ResultsDisease-target-compound network was visualized basing on the 20 bioactive compounds and the 19 potential targets using Cytoscape software. The results of PPI analysis, GO enrichment and KEGG pathway enrichment analysis indicate that the potential mechanism of Simiao Powder in treating gout may be achieved by regulating immune and inflammatory reactions, improving metabolism and endocrine. The results of molecular docking show that most of the targets and components have good binding activity. In vivo experiments revealed that Simiao powder can decreased serum UA and XOD levels in hyperuricemic-gout mice, and improved renal function. Furthermore, Simiao powder certainly regulates the expression of PPAR-γ, PTGS1, IL-6 and Bcl2 mRNA in ankle tissue in hyperuricemic-gout mice.ConclusionCollectively, this research predicted a multiple compounds, targets, and pathways model mechanism of Simiao Powder in the prevention and treatment of gout, providing new ideas and methods for in-depth research, via vivo experiments.

Current state and prospects of gout treatment in Korea.

Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.

Systematic Review and Meta-analysis of Electoacupunture Efficacy on Acute Gout

Objectives: The objective of this study was to appraise the effect of electroacupuncture (EA) for the treatment of acute gout.Methods: Since no suitable study could be found in the domestic database, we performed a literature search up to the end of December 2020 using four international electronic databases. Randomized controlled trials (RCTs) evaluating the effectiveness of EA in the treatment of acute gout were included. The risk of bias was evaluated from the Cochrane risk of bias tool.Results: Eight appropriate RCTs were included and analyzed. Three evaluation tools were mainly used: Total Effective Rate (TER), Uric acid (UA), and Pain score (VAS). In the case of TER, in all eight cases, electroacupuncture alone and combined treatment showed a statistically significant level of improvement compared to Western medicine treatment. In the case of VAS score, electroacupuncture alone and combined treatment showed a more significant effect than Western medicine treatment. In the case of UA level, electroacupuncture combined treatment showed a more significant effect than western medicine treatment. Although not all three evaluation tools were used in all studies, the majority of studies showed that electroacupuncture was effective for acute gout patients.Conclusions: The results of this study suggest that EA treatment may be effective for acute gout. It should be noted, however, that the studies included in this study were geographically biased, small in number, and mostly at high risk of bias. More well-designed studies are needed in the future.

Screening medicinal plant extracts for xanthine oxidase inhibitory activity

Objectives. The study aimed to test the ethanol extracts of ten medicinal plants for xanthine oxidase inhibitory activity.Methods. The degree of xanthine oxidase inhibitory activity was determined by measuring the absorbance spectrophotometrically at 290 nm, which is associated with uric acid formation. The selected medicinal plants included Piper lolot C.DC. (Piperaceae), Pandanus amaryllifolius R.(Pandanaceae), Brassica juncea L. (Brassicaceae), Piper betle L. (Piperaceae), Perilla frutescens L. (Lamiaceae), Anacardium occidentale L. (Anacardiaceae), Polygonum barbatum L. (Polygonaceae), Artocarpus Altilis P. (Moraceae), Vitex negundo L. (Verbenaceae), Annona squamosal L. (Annonaceae), which were selected based on folk medicine.Results. The results showed that the Piper betle L. has a strong ability to inhibit xanthine oxidase with an IC50 value of up to 1.18 μg/mL, compared to allopurinol 1.57 μg/mL. Different parts of Piper betle L. were compared and the leaves of Piper betle L. showed the best value for xanthine oxidase inhibitory and antioxidant activity.Conclusions. Piper betle L. showed the best potential for inhibition of xanthine oxidase among ten medicinal plants. Piper betle L. leaf extract showed strong xanthine oxidase inhibitory and antioxidant activity, compared to the whole plant, and the stem extract, which promises to be applied in the treatment of gout.

Updated review on gout

First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. The term is derived from the Latin word gutta (or 'drop'), and referred to the prevailing medieval belief that an excess of one of the four 'humors' - which in equilibrium were thought to maintain health - would, under certain circumstances, 'drop' or flow into a joint, causing pain and inflammation. Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that,atleast in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. Although there is evidence that colchicine, an alkaloid derived from the autumn crocus (Colchicum autumnale), was used as a powerful purgative in ancient Greece more than 2000 years ago, its first use as a selective and specific treatment for gout is attributed to the Byzantine Christian physician Alexander of Tralles in the sixth century AD.

Phytochemicals in traditional Chinese medicine can treat gout by regulating intestinal flora through inactivating NLRP3 and inhibiting XOD activity.

Gout is a common disease caused by hyperglycemia. Traditional drugs for gout have both good therapeutic effects and serious side effects. Traditional Chinese medicine (TCM) is one of the potential sources of modern medicine, and is the development of new drugs for many diseases, including gout. TCM is an indispensable part of gout treatment. Compared with anti-gout medication commonly used in clinic (e.g. the xanthine oxidase inhibitors allopurinol and febuxostat), traditional Chinese medicine has fewer side effects in the treatment of gout and can safely control serum uric acid and the level of inflammation. However, there have been few studies on how traditional Chinese medicine controls uric acid and inflammation levels in patients with gout. Herbs are a valuable resource in the search for new drugs to treat many diseases, including gout. Phytochemicals in TCM treatment of gout mainly includes two aspects, anti-inflammatory and reducing uric acid content. The anti-inflammatory mechanism is mainly through the inactivation of NF-κB and NLRP3 inflammasome to reduce the inflammatory response induced by uric acid crystals. The mechanism of lowering uric acid is mainly through inhibiting the activity of xanthine oxidase and up-regulating the expression of URAT1 and GLUT9.In recent years, the intestinal flora has become a new field of understanding diseases. It has been observed that the occurrence of gout is closely related to changes in the intestinal flora. Herbaceous plants contain fiber, polyphenols, polysaccharides and other active components. When taken orally, Chinese herbs act like prebiotics. After traditional Chinese medicine treatment, the abundance levels of Bifidobacterium, Lactobacillus, Bacteroidetes and Prevotella were increased, while the abundance of Proteus and the Firmicutes/Bacteroidetes ratio were decreased. Changes in the intestinal flora led to further changes in its metabolites, including short-chain fatty acids (SCFAs) and lipopolysaccharide (LPS), which ultimately down-regulate the TLR4/NF-κB inflammatory signaling pathway, up-regulate GLUT9 and URAT1 gene expression and inhibition of xanthine oxidase activity. Destruction of the intestinal barrier is also an important factor in the occurrence of gout. Disruption of the intestinal barrier allows LPS to enter the bloodstream and activates the expression of various inflammatory factors, which causes gout.

A critical review on the experimental model of animal for antigout drugs

In this era where the pharmaceutical companies and products are hiking in its need and production it is inevitable to document the safety and toxicity along with the indications of the same. This is where the experimental study has a vital role to play. Experimental pharmacology is the science where the drug interaction with different receptors and target sites in living organism are explained. This article reviews about the different aspects of experimental pharmacology and its uses. Gout is an acute inflammatory disease characterized by the presence of uric acid crystals in the joint. This event promotes neutrophil infiltration and activation that leads to tissue damage. Mice received oral administration of BL or saline daily for 7 days and then were injected with MSU in the knee cavity. The present review aims to provide an updated overview on history, types, uses and mechanism of drug treatment for gout (hyperuricemia) with the detail review on information about experimental model of antigout drugs, their operating procedure, these agent works correct overproduction or under excretion of uric acid.

Comment on: Cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout: A systematic and meta‐analysis

Comment on: Cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout: A systematic and meta‐analysis

HLA-B58.01 et vascularite rénale d’hypersensibilité à l’allopurinol chez un patient chinois

IntroductionAllopurinol, widely used in the treatment of hyperuricemia and gout, has been shown to cause severe cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as systemic reactions such as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). The HLA-B*5801 allele is known to be a risk factor for severe cutaneous manifestations of hypersensitivity to allopurinol, mostly in Asian populations. ObservationWe report the observation of a 47-year-old Chinese patient, with no previous medical history, carrying the HLA-B*5801 allele, who developed an isolated allopurinol hypersensitivity necrotizing renal vasculitis without cutaneous manifestations. Discussion. The identification of this allele should be proposed before prescribing allopurinol in patients originating from certain regions of Asia, and the imputability of allopurinol should be evoked in case of necrotizing renal vasculitis, even without associated cutaneous involvement.

Prospects of anti-inflammatory and urate-lowering therapy of gout: A vector from the past to the future

The article provides an overview of new and promising drugs aimed at anti-inflammatory and urate-lowering therapy of gout, both already registered and used in clinical practice, and at the stages of implementation or clinical research and demonstrating their high efficacy and safety. Modern views and approaches to the treatment of gout, reflected in foreign and domestic clinical recommendations, are shown. Emphasis is placed on the safety and efficacy of colchicine in gouty arthritis and its cardioprotective properties in comorbid patients suffering from gout in combination with cardiovascular pathology. Information is provided on the effectiveness of new anti-inflammatory drugs for symptomatic therapy of gout: kanakinumab, according to the experience of which our country occupies a leading position in Europe. The efficacy and safety of anakinra allows us to consider the drug as an effective alternative to the traditional approach to antiinflammatory therapy of gout. Rilonacept provides doctors with more potential treatment algorithms in a population of patients with gout that is difficult to treat with traditional treatment. The historical data on the use of adrenocorticotropic hormone as an anti-inflammatory agent in gout are given. Information on reserve, new and promising urate-lowering drugs is provided. The focus is on the safety and efficacy of febuxostat, based on the results of recent large randomized clinical trials. Other drugs that reduce the level of uric acid in the blood plasma are considered: uricosuric agents (probenecid, benzbromarone, sulfinpyrazone, lezinurad, verinurad, dotinurad and archalophenate), xanthine oxidase inhibitors (allopurinol and topiroxostat), pegylated uricase preparations (pegloticase and rasburicase), which can be considered in the future as reserve drugs with the possibility of combined applications with the main means for urate-lowering therapy.