Management of Gout

Anderson, Irsk; Davis, Andrew M.; Jan, Reem U.

doi:10.1001/jama.2021.19763

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…The guidelines unequivocally indicated that exercise is one of the non-pharmacological measures for patients with gout [10][11][12]. Nevertheless, there is still a lack of specific guidance and clinical evidence, and the effects of exercise on improving gout and the optimal frequency, timing, and type of exercise have not been fully clarified.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

The effects of aerobic exercise on body composition in overweight and obese patients with gout: a randomized, open-labeled, controlled trial

Jia

Zhu

Geng

et al. 2022

Trials

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Background Overweight and obesity are typical risk factors for the increased prevalence and incidence of gout. The existing guidelines unequivocally indicated that exercise is highly advantageous for patients with gout. Nevertheless, there is still a lack of specific guidance and clinical evidence. The effects of exercise on improving gout, and the optimal frequency, timing, and types of exercise have not been fully clarified. The present trial aims to determine the effects of a specific aerobic exercise program on body composition in overweight and obese patients with gout. Methods In this randomized, open-labeled, controlled trial, a total of 60 overweight and obese patients with gout [body mass index (BMI) ≥ 24 kg/m2; age,18–55 years old] are equally randomized (1:1) into two groups (n = 30): moderate-intensity aerobic exercise group (MIAEG), heart rate reserve (HRR) = [(HRmax-HRrest) × 60% intensity] + HRrest, and control group (CG). The moderate-intensity aerobic exercise training program will be conducted for 30–40 min/session and 3 days/week for 12 weeks. Participants in the CG will be asked to avoid making changes in their exercise habits. There will be no limitation in the type of exercise. The primary outcome is the number of patients whose body fat is reduced after 12 weeks. The secondary outcomes include the changes in BMI, waist-to-hip ratio (WHR), insulin resistance index (IRI), serum uric acid (sUA), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hepatic steatosis, and adverse effects after 12 weeks. One-way analysis of variance (ANOVA) will be used to compare the mean values of normally distributed variables between MIAEG and GC. Discussion The effect and optimal frequency of exercise for improving the status of overweight and obese patients with gout have not yet been determined. We design a 12-week randomized controlled trial and evaluate the effects of individualized aerobic exercise program on patients with gout. The results may assist such patients with a personalized scientific exercise program based on the disease status and motor abilities, so that patients are prone to exercise under the condition of low risk and achieve the greatest benefits. Trial registration ChiCTR2200062153. Registered on July 25, 2022, with ChiCTR. http://www.chictr.org.cn/

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Section: Background and Rationale {6a}mentioning

confidence: 99%

The effects of aerobic exercise on body composition in overweight and obese patients with gout: a randomized, open-labeled, controlled trial

Jia

Zhu

Geng

et al. 2022

Trials

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“…Nevertheless there are no recommendations about febuxostat use for its renoprotective action in the published CKD international guidelines, because of declared lack of scientific data about the subject [21][22][23][24][25].…”

Section: реальна ли ренопротекция для пациентов с гиперурикемией? лв ...mentioning

confidence: 99%

Is Renoprotection Real for Patients with Hyperuricemia?

Khimion

Burianov

Nayshtetik³

et al. 2022

FMEP

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Number of patients with progressive chronic kidney disease (CKD) is increasing all over the world. One of the risk factors for CKD development and progression is increased serum uric acid (sUA) level. Possibly, control of hyperurcemia with urate lowering therapy drugs can slow the decline in kidney function. The objective: to determine efficacy and safety of allopurinol and febuxostat in treatment of patients with CKD and hyperurcemia to reduce the sUA level and analyze its influence on glomerular filtration rate (GFR). Materials and methods. The study included 45 CKD patients (stages 3b-5) without other severe/decompensated diseases and contraindications to the allopurinol/febuxostat. All patients underwent a comprehensive clinical and laboratory examination, and were divided into the study groups: Group I (28 patients, 61.3±3.2 y.o., CKD3b-12, CKD4-10, on hemodialysis-6 patients) received febuxostat, Group II (24 patients, 60.7Ѓ}4.1 y.o., CKD3b-9, CKD4-10, on hemodialysis – 5 patients) took allopurinol. Results. Achievement of the target level of sUA was significantly often registered in Group I: after 1 month – in 45.5% (in group II – in 15.9%, p<0.001); after 3 months – in 67.5% (in group II – 21.2% p<0.01); after 6 months, these figures were 90% and 37.1%, respectively (p<0.01). sUA level <300 μmol/l was accompanied by significant positive GFR changes in group I patients; in group II there was a gradual progression of GFR deterioration in 31.8% of patients. Conclusions. In patients with pre-dialysis stages of CKD febuxostat demonstrates renoprotective abilities. Use of febuxostat in patients with CKD stage 3b-4 and in patients on hemodialysis is safe and more effective for target sUA level achievement than the use of allopurinol.

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“…The overproduction or underexcretion of urate is the main cause of hyperuricemia. Therefore, traditional pharmacological urate-lowering therapies (ULTs) target urate generation (xanthine oxidase inhibitors) 6,17 or renal urate excretion (uricosurics) 18 or directly increase urate degradation (uricase) 19,20 . However, these drugs have potential severe adverse effects and are not recommended for a large proportion of patients with asymptomatic hyperuricemia 21 .…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of hyperuricemia ranges from 10% to 20% in developed countries [3][4][5] . Consequently, the incidence of gout is 5% in the US, 4.75% in Europe, and 3.8% in Australia [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Insulated expression of periplasmic uricase inE. coliNissle 1917 for the treatment of hyperuricemia

Tang

Huang

et al. 2022

Preprint

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Hyperuricemia is a prevalent disease worldwide that is characterized by elevated urate levels in the blood owing to purine metabolic disorders, which can result in gout and comorbidities. As approximately one-third of urate is excreted by the small intestine and cleared by intestinal microorganisms, modulating the gut microbiota could be an attractive approach for hyperuricemia and gout treatment. In this study, we engineered a probiotic E. coli Nissle 1917 (EcN) strain, EcN C6, which expresses periplasmic uricase at an “insulated site”, for urate degeneration. Oral administration of EcN C6 successfully alleviated hyperuricemia, related symptom and gut microbiota in a purine-rich food-induced hyperuricemia rat model and a uox-knockout mouse model. Importantly, the expression of periplasmic uricase in the insulated site did not influence the probiotic properties or global gene transcription of EcN, suggesting that EcN C6 is a safe, effective and low cost therapeutic candidate for hyperuricemia treatment.

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Management of Gout

Abstract: This JAMA Clinical Guidelines Synopsis summarizes the American College of Rheumatology’s 2020 guideline for the management of gout.

Cited by 11 publications

References 14 publications

The effects of aerobic exercise on body composition in overweight and obese patients with gout: a randomized, open-labeled, controlled trial

The effects of aerobic exercise on body composition in overweight and obese patients with gout: a randomized, open-labeled, controlled trial

Is Renoprotection Real for Patients with Hyperuricemia?

Insulated expression of periplasmic uricase inE. coliNissle 1917 for the treatment of hyperuricemia

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