Background: AA-amyloidosis complicates many chronic infections and inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, but its relationship to gout is extremely rare. As it is unknown definitely what the pathophysiological connections between gout and amyloidosis are, treatment issues of the diseases are open for discussion. Aim: To establish a link between gout and AA-amyloidosis, and to improve the quality of treatment in patients suffering from gout and AA-amyloidosis. Methods: We reviewed the English-language literature sources, searching not only for rare cases of the combination of gout and AA amyloidosis, but also detailed descriptions of the medical treatments for the two pathologies. Results: By July 2020, we had identified 14 cases describing AA amyloidosis in patients with gout. Most of those patients had been suffering tophaceous gout for at least 10 years, and were prescribed various methods of treatment; however, not all patients took colchicine regularly. In some cases, therapy with allopurinol and colchicine was effective against attacks of gouty arthritis, although amyloidogenic inflammation was not controlled sufficiently. However, there were no cases that described in detail the successful treatment of both diseases. Besides those 14 patients described in literature, we examined one more patient with amyloidosis that is secondary to gout, in whom the protein of amyloid A (AA) had affected the kidneys, intestines, and adrenal glands. The patient has been successfully treated with the combination of canakinumab, prednisone, colchicine and allopurinol. Conclusion: Clinicians should be aware that patients may have atypical combinations of diseases like gout and amyloidosis. The obtained results help to explain some pathogenic processes associated with AA-amyloidosis. Further research is necessary to confirm the effectiveness of different treatment options such as lifestyle biologic agents or other medicines with anti-inflammatory properties.
Gout is a complex multifactorial disease associated with the deposition of crystals of sodium monourate in various tissues of the body and the emergence, in this regard, of chronic hyperuricemia, which is clinically manifested by acute recurrent arthritis and the formation of gouty nodes – tofus. Methods of treating gout can be divided into two groups: lifestyle modification / change in eating habits and pharmacotherapy. But, before drugs appeared, diet was the only way to treat the disease. Since ancient times, gout has been associated with excessive nutrition and excessive consumption of alcoholic beverages. In the Middle Ages, gout was often called the “disease of the kings”, explaining this, firstly, by constant plentiful meals without any measure, and therefore the kidneys of the “abusers” could not cope with the removal of a huge concentration of uric acid. And secondly, the high prevalence of this disease among male aristocrats. Ordinary people ate on a limited basis and could not afford food rich in purines, so they fell ill less often. However, in the last decade, wider knowledge has been gained about dietary factors associated with hyperuricemia and gout. Obesity, excessive consumption of red meat and excess alcohol have already been recognized as causative factors. Legumes and purine-rich vegetables have been justified after numerous studies. New risk factors have been described, such as fructose and sweetened drinks. Finally, protective factors such as low fat dairy products have been studied. Patients with gout are forced to follow a diet throughout their lives, and not only during periods of exacerbation, but now it has become easier to adhere to it, since the diet allowed for food has expanded significantly. Although most of the prerequisites for dietary recommendations have been assigned ratings of medium / low or very low quality, this article will provide the basis for changes in eating habits in patients with hyperuricemia and gout in accordance with large international studies.
BackgroundLean muscle mass and strength decline starting approximately at 40 years of age to become 25% of body weight at 75–80 years old [1]. Within the existing literature, sarcopenia is a highly prevalent condition in older people. The prevalence of sarcopenia increases considerably with age ranging from 5% to 13% in 60 to 70 years, from 11% to 50% for the population aged 80 years and older. In older persons, sarcopenia is related to falls and physical disability leading to reduced quality of life [2]. The prevalence of osteoarthritis increases with age so that 30 to 50% of adults over the age of 65 years suffer from this condition [3]. Age-related factor that contributes includes to the development of OA include a decline in muscle strength. People with lower extremity OA had a two to five times increased incidence of falls than age-matched healthy controls [4].ObjectivesConduct analysis of condition of muscle strength and muscle functioning in older persons with osteoarthritis.MethodsProspective study of 159 patients aged 74±13,3 years was held. Condition of sarcopenia was estimated by lean body mass (LBM) in accordance with criteria of sarcopenia EWGSOP. Muscle strength was estimated by a hand dynamometer and muscle functioning was estimated on the basis of SPPB tests. Amount of pain was estimated by VAS.ResultsSarcopenia was revealed in 31,45% of older persons with ostearthritis. Cases of falls were observed in 28,30% (95% CI 21,5 - 36,0) in patients with osteoartritis with sarcopenia (average number of falls – 1,93) and in 16,98% of patients without sarcopenia (95% CI 11,5 – 23,7) (average number of falls – 0,48). Level of pain in patients with osteoartritis with sarcopenia amounted 3,16 points, in patients without sarcopenia – 3,49 points (p>0,05). Muscle strength in patients with sarcopenia was 14,36 kg, in patients without sarcopenia was significantly higher – 18,53 kg (p<0,05). Common point of SPPB tests in patients with sarcopenia was 6,9, in patients without sarcopenia significantly higher – 7,85 (p<0,05).ConclusionsPatients with sarcopenia in the presence of osteoarthritis were observed to have significant decrease of muscle strength and muscle functioning, increase of frequency of falls which raises risk of repeated falls and their frequency, and consequently, deteriorates condition of musculoskeletal system in older persons.References Ferrucci L., Baroni M., Ranchelli A. et al. Interaction Between Bone and Muscle in Older Persons with Mobility Limitations. Curr Pharm Des. 2014; 20(19): 3178–3197.Morley JE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging. 2008; 12:452–456.Felson DT. Risk factors for osteoarthritis: understanding joint vulnerability. Clinical orthopaedics and related research 2004;(427 Suppl):S16–21.Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? Womens Health (Lond Engl). 2012;8(6):685–96. Disclosure of InterestNone declared
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