The effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on serum uric acid in patients without gout: a prospective study

Waldron, Jenna L; Ashby, Helen; Razavi, Cyrus; Thomas, Osmond; Chugh, Sanjiv; Deshpande, Shreeram; Ford, Clare; Gama, Rousseau

doi:10.1093/rheumatology/kes327

Cited by 15 publications

(7 citation statements)

References 6 publications

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“…Both EULAR and BSR/BHPR suggest commencing allopurinol at a dose of 100 mg/day (BSR/BPHPR 50-100 mg/day) and increasing by 100 mg (50-100 mg) every few weeks according to SUA and renal function [ 3 , 4 ]. The systemic inflammatory response in acute gout commonly leads to a transient reduction in SUA [ 5 ], therefore BSR/BPHPR guidelines suggest SUA is checked 4–6 weeks post-flare [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

et al. 2013

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BackgroundGout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate.MethodsAudit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards.ResultsOf the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking.ConclusionsThe primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence.

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Section: Introductionmentioning

confidence: 99%

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

et al. 2013

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“…4 In the situation of acute systemic inflammatory response induced by elective knee or hip surgery, a decrease in SUA concentrations was observed. 5 Conversely, when systemic inflammation was suppressed, an increase in the levels of SUA in patients with systemic autoimmune rheumatic diseases was also observed. 6 There are several possible explanations for the decrease in SUA levels in higher inflammatory states.…”

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confidence: 99%

Inverted J-Shaped Association of High-Sensitivity C-Reactive Protein with the Levels of Serum Uric Acid: Cross-Sectional and Longitudinal Analyses

Liu¹,

Tian²,

Fan³

et al. 2022

JIR

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“…It is possible that antioxidant uric acid becomes increasingly consumed through its scavenging of free radicals, produced in the inflammatory process. 15 …”

Section: Discussionmentioning

confidence: 99%

Gouty Arthritis of the Spine in a Renal Transplant Patient

et al. 2015

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Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition.Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe.

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The effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on serum uric acid in patients without gout: a prospective study

Cited by 15 publications

References 6 publications

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

Inverted J-Shaped Association of High-Sensitivity C-Reactive Protein with the Levels of Serum Uric Acid: Cross-Sectional and Longitudinal Analyses

Gouty Arthritis of the Spine in a Renal Transplant Patient

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