Gout is a condition that resulted from deposition of monosodium urate crystals in various tissues (eg joints, connective tissue, kidney).
The patient experiences acute and chronic arthritis, soft tissue inflammation, tophus formation, gouty nephropathy and nephrolithiasis.
Primary hyperuricemia is called when uric acid saturation arises without coexisting diseases or drugs that alter uric acid production and excretion.
While in secondary hyperuricemia there is an excessive uric acid production or diminished renal clearance that occurs as a result of a disease, drug, dietary product or toxin.
Ultrasound may provide valuable information for the differential diagnosis of acute erosive arthritis, with a recent study showing that subcutaneous tissue changes and periosteal vascularity are more common in acute osteomyelitis (OM), whereas periosteal tophaceous material distinguishes gouty arthritis from acute OM and rheumatoid arthritis.
Uric acid-lowering therapy for gout also confers benefits for hyperlipidaemia, with febuxostat delivering greater reductions in cholesterol and triglyceride concentrations in the blood as compared with allopurinol and benzbromarone, according to a recent study.
The European League Against Rheumatism (EULAR) updates its recommendations for diagnosing gout, putting emphasis on three diagnostic approaches: establishing monosodium urate crystal deposition via synovial fluid analysis, identifying suggestive and associated clinical features of gout and hyperuricaemia, or performing imaging studies for evidence of MSU crystals.
In the treatment of gout, the risk of nonfatal cardiovascular (CV) events, including myocardial infarction and stroke, does not significantly differ between allopurinol and febuxostat, a study has shown.
Intake of sugar-sweetened beverage and fruit juice appears to increase the risk of developing gout, and this adverse association does not extend to fruit consumption, according to the results of a meta-analysis.
Biweekly treatment with pegloticase yields favourable effects on systolic and diastolic blood pressure as well as mean arterial pressure in gout patients who maintain a persistently low serum urate, and these effects are independent of changes in renal function, according to a posthoc analysis of two trials.
Eating fish rich in n-3 polyunsaturated fatty acid (PUFA) leads to a lower risk of recurrent gout attacks, a study has found. On the other hand, n-3 PUFA supplements such as fish oil and cod liver oil do not confer the same benefit.
Febuxostat does not appear to be more cardiotoxic than allopurinol in the treatment of elderly gout patients with or without cardiovascular comorbidities, according to a recent study. Neither drug is associated with elevated risks of cardiovascular events and all-cause mortality.
Both the extended- and immediate-release formulations of febuxostat are effective and well tolerated in the treatment of gout patients with normal or impaired renal function, according to the results of a phase III trial.
Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.
Implementation of the collaborative care in a rheumatoid arthritis (RA) clinic has led to improvements in nonbiologic disease-modifying antirheumatic drugs (nb-DMARDs) optimization, adherence to safety recommendations on nb-DMARD monitoring and detection of adverse drug events in RA patients, according to a Singapore study.
Use of menopausal hormone therapy (MHT) was associated with a significantly increased risk of invasive breast cancer, which became progressively greater with longer duration of use, a meta-analysis of worldwide prospective epidemiological studies has shown.