Management of gout in the real world: current practice versus guideline recommendations

Doghramji, Paul P.; Fermer, Steve; Wood, Robert; Morlock, Robert

doi:10.1080/00325481.2016.1114878

Cited by 13 publications

(9 citation statements)

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“…; Doghramji et al . ). Health professionals may be more likely to offer dietary advice if standardised guidelines were available; therefore, robust RCT‐level evidence is required in order to fully elucidate the effect of individual foods and dietary patterns on both SUA and gout.…”

Section: Resultsmentioning

confidence: 97%

“…Furthermore, there is some evidence that fibre intake is protective against gout (Lyu et al 2003;Zykova et al 2015). GPs in the US and Europe have reported that they offer dietary advice to gout sufferers less often than regular uric acid testing, indicating potential missed opportunities to improve patient outcomes (Oderda et al 2014;Doghramji et al 2016). Health professionals may be more likely to offer dietary advice if standardised Aim for an ideal bodyweight * * * Avoid crash dieting * * * Avoid high-protein/low-carbohydrate diets * * Include low-fat dairy products * * Favour soya beans and vegetable sources of protein * Combine animal and vegetarian sources of protein * Favour cherries * * Restrict intake of high-purine foods (<200 mg/day total purines) * * Avoid purine-rich foods such as organ meats, shellfish and yeast extracts * * * Eat purine-rich vegetables in moderation (asparagus, beans, cauliflower, lentils, mushrooms and spinach) guidelines were available; therefore, robust RCT-level evidence is required in order to fully elucidate the effect of individual foods and dietary patterns on both SUA and gout.…”

Section: Resultsmentioning

confidence: 99%

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Diet and gout – what is the role of purines?

Lockyer

Stanner

2016

Nutrition Bulletin

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Anecdotally, consumption of ‘rich’ foods and drinks, such as cheese and port, has been associated with the development of gout, a painful condition linked to high serum uric acid which normally affects joints in the extremities, such as toes. Risk factors for gout include obesity, genetics and use of certain medications, and men appear to be more at risk. In addition, sufferers report that certain foods trigger gout flares, although there is a paucity of evidence from randomised controlled trials investigating the effect of specific foods on circulating uric acid. Observational studies have consistently identified a positive relationship between gout and some, but not all, foods higher in compounds known as purines, which have been demonstrated to increase serum uric acid in their purified form under controlled conditions. This evidence indicates that foods which should be avoided or consumed infrequently by gout sufferers are offal, seafood and alcohol, especially beer, whereas dairy foods seem to be protective. Current dietary guidelines for the prevention and management of gout share common features and largely reflect international healthy eating guidelines, but differences exist in terms of reference to particular foods or nutrients such as fructose, vitamin C and cherries. More randomised controlled trials are needed to fully ascertain the effects of dietary components on gout risk and to generate more consistent guidelines.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Diet and gout – what is the role of purines?

Lockyer

Stanner

2016

Nutrition Bulletin

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“…5 6 Despite the availability of an increasing number and mode of actions of ULT, gout management is far from optimal. [7][8][9][10] Suboptimal treatment is related to various key barriers among both physicians and patients. [11][12][13] Importantly, a qualitative study revealed that a substantial proportion of patients receives contradictory information from different physician, contributing to poor treatment initiation and adherence.…”

Section: Introductionmentioning

confidence: 99%

Development of a patient decision aid for the initiation of urate-lowering therapy in gout patients

et al. 2022

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AimShared decision-making improves patients’ experiences with care, satisfaction with management decisions and possibly health outcomes. This study describes the development of a decision aid (DA) that supports patients with gout and their physicians in a face-to-face clinical setting to (a) decide whether or not to (re)start urate-lowering therapy (ULT) and (b) agree on the preferred ULT.MethodsRecommendations of the International Patient Decision Aid Standards group guided the development. A steering group of experts in gout and health services research specified the scope. Nominal group technique meetings were organised in which patients ranked the importance of preidentified potential characteristics/attributes of ULT and discussed further needs regarding the DA. A literature search was conducted to collect evidence on gout outcomes with and without ULT. Subsequently, the DA prototype was designed and adjusted using feedback from the steering group and results of cognitive debriefing interviews among five gout patients.ResultsThe final DA consists of six pages. First, the DA clarifies the decision at stake and describes gout including its risk factors, the role of lifestyle and treatment of flares. Next, risk of future flares with and without ULT in relation to serum uric acid levels is described and visualised. Relevant attributes of ULT are presented in an option grid distinguishing first-line and second-line ULT. Finally, patients’ believes and preferences are explicitly addressed before making the shared decision.ConclusionThis study provides initial support for usability of a DA for gout patients eligible for starting ULT.

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“…Colchicine, non-steroidal anti-in ammatory drugs, glucocorticoids, uric acid and allopurinol, are in general use for the treatment of gout (Doghramji et al 2016). However, a lot of current medicine treating gout have various side effects, containing anaphylactic reaction, transaminase increase and gastrointestinal reaction (Engel et al 2017).…”

Section: Introductionmentioning

confidence: 99%

A Network Pharmacology Exploring the Mechanism of a Chinese Medicine Pair for the Treatment of Gout

Zhao¹,

Liu²,

Wu³

2021

Preprint

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Background:Gout is a crystalline-related arthropathy aroused by monosodium urate aggradation, which directly have a bearing on the disturbance of purine excretory and/or hyperuricemia, and seriously affects human health. In China, Dioscoreae Hypoglaucae Rhizoma (DH) and Smilacis Glabrae Rhixoma (SG) are widely used as medicinal pairs to prevent and treat gout. However, there is still a lack of research on the mechanism of DS (DH and SG). The aim of this study is to identify the absorbable components, potential targets and related therapeutic pathways of DS by means of network pharmacology.Material/Methods:We searched the effective chemical components of DS from TCMSP database, and explored the target of DS from GeneCards, a Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine (BATMAN-TCM) and STITCH database. Databases such as Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD) and Pharmacogenomics Knowledgebase (PharmGkb) were used to query treatment targets for gout. Cytoscape software was applied to build the network map, KEGG database was applied to analyze the pathway of action, and finally a multi-component-multi-target-multi-channel DS treatment gout network was formed.Results: We found 16 active components, 24 KEGG metabolic pathways and 47 common targets of DS. The herb couple DS shares 9 targets with gout, including NOD like receptor protein 3 (NLRP3), Steryl-sulfatase (STS), Ephrin type-B receptor 2 (EPHB2), 5'-AMP-activated protein kinase catalytic subunit alpha-1 (PRKAA1), ROS Proto-Oncogene 1, Receptor Tyrosine Kinase (ROS1), Solute carrier family 22 member 12 (SLC22A12), Phospholipid-transporting ATPase IB (ATP8A2), Interferon regulatory factor 6 (IRF6) and P2X purinoceptor 7 (P2RX7), which may be the key point of DS in the treatment of gout.Conclusions:In this study, we tried to explain the mechanism of DS in the prevention and treatment of gout by using the network pharmacological method and provided an alternative way to study the effect of this Chinese medicine pair.

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Management of gout in the real world: current practice versus guideline recommendations

Abstract: Improvements in practice by physicians would include comprehensive assessment of the patient, adoption of regular monitoring during treatment, and the provision of patient education on adherence and lifestyle.

Cited by 13 publications

References 50 publications

Diet and gout – what is the role of purines?

Diet and gout – what is the role of purines?

Development of a patient decision aid for the initiation of urate-lowering therapy in gout patients

A Network Pharmacology Exploring the Mechanism of a Chinese Medicine Pair for the Treatment of Gout

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