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Ni Z, Xiao Q, Xia Z, Kuang K, Yin B, Peng D. Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials. Front Immunol 2024; 14:1295154. [PMID: 38239361 PMCID: PMC10794621 DOI: 10.3389/fimmu.2023.1295154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Acute gouty arthritis (AGA) is a metabolic disorder in which recurrent pain episodes can severely affect the quality of life of gout sufferers. Electroacupuncture (EA) is a non-pharmacologic therapy. This systematic review aimed to assess the efficacy and safety of electroacupuncture in treating acute gouty arthritis. We searched eight Chinese and English databases from inception to July 30, 2023, and 242 studies were retrieved. Finally, 15 randomized controlled trials (n=1076) were included in a meta-analysis using Review Manager V.5.4.1. meta-analysis results included efficacy rate, visual rating scale (VAS) for pain, serum uric acid level (SUA), immediate analgesic effect, and incidence of adverse events. Electroacupuncture (or combined non-pharmacologic) treatment of AGA was significantly different from treatment with conventional medications (RR = 1.14, 95% confidence interval CI = 1.10 to 1.19, P < 0.00001). The analgesic effect of the electroacupuncture group was superior to that of conventional Western drug treatment (MD = -2.26, 95% CI = -2.71 to -1.81, P < 0.00001). The electroacupuncture group was better at lowering serum uric acid than the conventional western drug group (MD =-31.60, CI -44.24 to -18.96], P < 0.00001). In addition, electroacupuncture combined with Western drugs had better immediate analgesic effects than conventional Western drug treatment (MD = -1.85, CI -2.65 to -1.05, P < 0.00001). Five studies reported adverse events in the electroacupuncture group versus the drug group, including 19 cases of gastrointestinal symptoms and 6 cases of neurological symptoms (RR = 0.20, 95% CI = 0.04 to 0.88, P = 0.03). Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450037, identifier CRD42023450037.
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Affiliation(s)
- Zhichao Ni
- College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinwen Xiao
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zihao Xia
- College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kunlin Kuang
- College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bingzun Yin
- College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dezhong Peng
- College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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2
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Shang YX, Wei SF, Yang KP, Liu Y, Wei S, Dong X, Wang XC, Xie ZM, Fang RL, Liang LN, Li XF, Xu L, Chen MZ, Zhang KX, Huang JY, Wang L, Yang YG, Liao HL, Xing GE, Zheng YP, Li XF, Lin JL, Shi CQ, Zeng YP, Mo LD, Sun F, Li XP, Zhang Z, Chen K, He ZC, Liu JP. Efficacy of Qingpeng ointment (a Tibetan medicine) for acute gouty arthritis: a multi-center, randomized, double-blind, placebo-controlled trial. BMC Complement Med Ther 2024; 24:21. [PMID: 38178115 PMCID: PMC10768221 DOI: 10.1186/s12906-023-04328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of Qingpeng ointment (QPO), a Tibetan medicine for alleviating symptoms in individuals with acute gouty arthritis (AGA). METHODS This study was a randomized, double-blind, placebo-controlled trial that involved individuals with AGA whose joint pain, as measured on a visual analog scale (VAS) from 0 to 10, was equal to or greater than 3. The participants were randomly assigned to either the QPO or the placebo group and received their respective treatments twice daily for seven consecutive days. In case of intolerable pain, the participants were allowed to use diclofenac sodium sustained-release tablets as a rescue medicine. The primary outcomes measured were joint pain and swelling, while the secondary outcomes included joint mobility, redness, serum uric acid levels, C-reactive protein levels, and the amount of remaining rescue medicine. Any adverse events that occurred during the trial were also recorded. RESULTS A total of 203 cases were divided into two groups, with balanced baselines: 102 in the QPO group and 101 in the placebo group. For joint pain, differences between the groups were notable in the VAS scores [1.75 (0, 3.00) versus 2.00 (1.00, 3.50); P = 0.038], changes in VAS [5.00 (3.00, 6.00) versus 4.00 (2.00, 6.00); P = 0.036], and disappearance rate [26.47% compared to 15.84%; P = 0.046] after treatment. Concerning joint swelling, significant between-group differences were observed in the VAS scores [1.00 (0, 2.30) versus 2.00 (0.70, 3.00); P = 0.032] and disappearance rate [33.33% compared to 21.78%; P = 0.046] at treatment completion. The QPO group exhibited a statistically significant mobility improvement compared to the placebo group (P = 0.004). No significant differences were found in other secondary outcomes. Five patients, four from the QPO group and one from the other, encountered mild adverse events, primarily skin irritation. All of these cases were resolved after dosage reduction or discontinuation of the medication. CONCLUSIONS Compared to the placebo, QPO exhibits positive effects on AGA by alleviating pain, reducing swelling, and enhancing joint mobility, without causing significant adverse effects. TRIAL REGISTRATION ISRCTN34355813. Registered on 25/01/2021.
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Affiliation(s)
- Ya-Xi Shang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Shu-Feng Wei
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ke-Peng Yang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan Liu
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Su Wei
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xia Dong
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Chang Wang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-Min Xie
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ru-Lu Fang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li-Na Liang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiu-Feng Li
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Xu
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mu-Zhi Chen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kai-Xian Zhang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ji-Yong Huang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le Wang
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - You-Guo Yang
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Hong-Li Liao
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Gui-E Xing
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Ping Zheng
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Fen Li
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Jing-Lian Lin
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Cheng-Qian Shi
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong-Ping Zeng
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Li-Dan Mo
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Fan Sun
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Peng Li
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhuo Zhang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Chen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhao-Chun He
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway.
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Peng X, Li X, Xie B, Lai Y, Sosnik A, Boucetta H, Chen Z, He W. Gout therapeutics and drug delivery. J Control Release 2023; 362:728-754. [PMID: 37690697 DOI: 10.1016/j.jconrel.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Gout is a common inflammatory arthritis caused by persistently elevated uric acid levels. With the improvement of people's living standards, the consumption of processed food and the widespread use of drugs that induce elevated uric acid, gout rates are increasing, seriously affecting the human quality of life, and becoming a burden to health systems worldwide. Since the pathological mechanism of gout has been elucidated, there are relatively effective drug treatments in clinical practice. However, due to (bio)pharmaceutical shortcomings of these drugs, such as poor chemical stability and limited ability to target the pathophysiological pathways, traditional drug treatment strategies show low efficacy and safety. In this scenario, drug delivery systems (DDS) design that overcome these drawbacks is urgently called for. In this review, we initially describe the pathological features, the therapeutic targets, and the drugs currently in clinical use and under investigation to treat gout. We also comprehensively summarize recent research efforts utilizing lipid, polymeric and inorganic carriers to develop advanced DDS for improved gout management and therapy.
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Affiliation(s)
- Xiuju Peng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Xiaotong Li
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Bing Xie
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Yaoyao Lai
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Alejandro Sosnik
- Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa 3200003, Israel
| | - Hamza Boucetta
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
| | - Wei He
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 2111198, PR China; Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China.
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Schlesinger N, Pillinger MH, Simon LS, Lipsky PE. Interleukin-1β inhibitors for the management of acute gout flares: a systematic literature review. Arthritis Res Ther 2023; 25:128. [PMID: 37491293 PMCID: PMC10367374 DOI: 10.1186/s13075-023-03098-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES The objective of this systematic review was to assess the effects of interleukin-1β (IL-1β) inhibitors on gout flares. METHODS Studies published between 2011 and 2022 that evaluated the effects of IL-1β inhibitors in adult patients experiencing gout flares were eligible for inclusion. Outcomes including pain, frequency and intensity of gout flares, inflammation, and safety were assessed. Five electronic databases (Pubmed/Medline, Embase, Biosis/Ovid, Web of Science and Cochrane Library) were searched. Two independent reviewers performed study screening, data extraction and risk of bias assessments (Cochrane Risk of Bias Tool 2 for randomised controlled trials [RCTs] and Downs and Black for non-RCTs). Data are reported as a narrative synthesis. RESULTS Fourteen studies (10 RCTs) met the inclusion criteria, with canakinumab, anakinra, and rilonacept being the three included IL-1β inhibitors. A total of 4367 patients with a history of gout were included from the 14 studies (N = 3446, RCTs; N = 159, retrospective studies [with a history of gout]; N = 762, post hoc analysis [with a history of gout]). In the RCTs, canakinumab and rilonacept were reported to have a better response compared to an active comparator for resolving pain, while anakinra appeared to be not inferior to an active comparator for resolving pain. Furthermore, canakinumab and rilonacept reduced the frequency of gout flares compared to the comparators. All three medications were mostly well-tolerated compared to their comparators. CONCLUSION IL-1β inhibitors may be a beneficial and safe medication for patients experiencing gout flares for whom current standard therapies are unsuitable. REVIEW PROTOCOL REGISTRATION PROSPERO ID: CRD42021267670.
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Affiliation(s)
- Naomi Schlesinger
- Division of the Rheumatology at the Spencer Fox Eccles School of Medicine, University of Utah, Harold J, Ardella T, and Helen T Stevenson Presidential Endowed Chair of Rheumatology, Salt Lake City, UT, 84132, USA.
| | - Michael H Pillinger
- The Division of Rheumatology, NYU Grossman School of Medicine, New York, USA
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5
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Recent advances in gout drugs. Eur J Med Chem 2022; 245:114890. [DOI: 10.1016/j.ejmech.2022.114890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022]
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Cheng JJ, Ma XD, Ai GX, Yu QX, Chen XY, Yan F, Li YC, Xie JH, Su ZR, Xie QF. Palmatine Protects Against MSU-Induced Gouty Arthritis via Regulating the NF-κB/NLRP3 and Nrf2 Pathways. Drug Des Devel Ther 2022; 16:2119-2132. [PMID: 35812134 PMCID: PMC9259749 DOI: 10.2147/dddt.s356307] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Gouty arthritis could be triggered by the deposition of monosodium uric acid (MSU) crystals. Palmatine (PAL), a protoberberine alkaloid, has been proven to possess compelling health-beneficial activities. In this study, we aimed to explore the effect of PAL on LPS plus MSU crystal-stimulated gouty arthritis in vitro and in vivo. Methods PMA-differentiated THP-1 macrophages were primed with LPS and then stimulated with MSU crystal in the presence or absence of PAL. The expression of pro-inflammatory cytokines and oxidative stress-related biomarkers and signal pathway key targets were determined by ELISA kit, Western blot, immunohistochemistry and qRT-PCR, respectively. In addition, the anti-inflammatory and antioxidant activities of PAL on MSU-induced arthritis mice were also evaluated. Results The results indicated that PAL (20, 40 and 80 μM) dose-dependently decreased the mRNA expression and levels of pro-inflammatory cytokines (interleukin-1beta (IL-1β), IL-6, IL-18 and tumor necrosis factor alpha (TNF-α)). The levels of superoxide dismutase (SOD) and glutathione (GSH) were remarkably enhanced, while the level of malondialdehyde (MDA) was reduced. Western blot analysis revealed that PAL appreciably inhibited NF-κB/NLRP3 signaling pathways through inhibiting the phosphorylation of p-65 and IκBα, blocking the expression of NLRP3, ASC, IL-1β and Caspase-1, as well as enhancing the antioxidant protein expression of Nrf2 and HO-1. In vivo, PAL attenuated MSU-induced inflammation in gouty arthritis, as evidenced by mitigating the joint swelling, and decreasing the productions of IL-1β, IL-6, IL-18, TNF-α and MDA, while enhancing the levels of SOD and GSH. Moreover, PAL further attenuated the infiltration of neutrophils into joint synovitis. Conclusion PAL protected against MSU-induced inflammation and oxidative stress via regulating the NF-κB/NLRP3 and Nrf2 pathways. PAL may represent a potential candidate for the treatment of gouty arthritis.
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Affiliation(s)
- Juan-Juan Cheng
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Xing-Dong Ma
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Gao-Xiang Ai
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Qiu-Xia Yu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Xiao-Ying Chen
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Fang Yan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Li Ke and Qi Yu-ru Academic Experience Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Yu-Cui Li
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Jian-Hui Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,State Key Laboratory of Dampness Syndrome of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, 510120, People's Republic of China
| | - Zi-Ren Su
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Qing-Feng Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Li Ke and Qi Yu-ru Academic Experience Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006, People's Republic of China
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7
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Shang YX, Dong X, Xie ZM, Li XP, Wang XC, Huang JY, Wei SF, Liu Y, Liu JP. Efficacy and safety of Tibetan medicine Qingpeng ointment for acute gouty arthritis: protocol for a multi-center, randomized, double-blind, placebo-controlled trial. Trials 2022; 23:387. [PMID: 35549757 PMCID: PMC9097382 DOI: 10.1186/s13063-022-06338-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Acute gouty arthritis (AGA) is an inflammatory arthritis clinically characterized by severe pain, swelling, and restricted movement of joints, which may cause physical disability and decrease quality of life. The use of recommended first-line treatment agents for AGA may be limited by adverse events. There has been a traditional use of alternative therapies for AGA. Tibetan medicine Qingpeng ointment is one of the on-market herbal products used for symptom relief of AGA. Previous clinical studies indicated that Qingpeng ointment can relieve pain, swelling, redness, and dysfunction of joints in patients with AGA. However, there is no rigorous randomized trial to demonstrate its benefit for AGA. In order to evaluate the efficacy and safety of Qingpeng ointment for AGA, we designed a randomized controlled trial. Methods This study is designed as a multi-center, randomized, double-blind, placebo-controlled trial. Two hundred and six adults with acute flare of gout, and visual analogue scale (VAS) score of joint pain ≥ 3 points will be recruited. Participants will be randomly assigned to herbal treatment or placebo group at a ratio of 1:1. Qingpeng ointment, or equal placebo ointment, will be applied topically at involved joints twice a day for consecutive 7 days. Patients in both groups would be allowed giving diclofenac sodium sustained-release tablets as rescue therapy when VAS score of joint pain ≥ 7 points during the treatment. The primary outcomes will be joint pain measured by VAS score, and joint swelling measured using width and thickness of affected joints and VAS score. Other outcome measures will be joint mobility, joint redness, C-reactive protein, serum uric acid, and the use of rescue medicine as well as adverse effect. Discussion To the best of our knowledge, this study is the first multi-center, randomized, double-blind, and placebo-controlled clinical trial to assess the efficacy of Tibetan medicine Qingpeng ointment for AGA. The findings of this study would provide evidence for its use to relieve symptoms of AGA. Trial registration ISRCTN ISRCTN34355813. Registered on 25 January 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06338-1.
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Affiliation(s)
- Ya-Xi Shang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xia Dong
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, 102499, China
| | - Zhi-Min Xie
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Xiao-Peng Li
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Xin-Chang Wang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Ji-Yong Huang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Shu-Feng Wei
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, 102499, China
| | - Yuan Liu
- Liuzhou People's Hospital, Liuzhou, 545006, Guangxi Zhuang Autonomous Region, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
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Daoussis D, Kordas P, Varelas G, Michalaki M, Onoufriou A, Mamali I, Iliopoulos G, Melissaropoulos K, Ntelis K, Velissaris D, Tzimas G, Georgiou P, Vamvakopoulou S, Paliogianni F, Andonopoulos AP, Georgopoulos N. ACTH vs steroids for the treatment of acute gout in hospitalized patients: a randomized, open label, comparative study. Rheumatol Int 2022; 42:949-958. [PMID: 35445840 DOI: 10.1007/s00296-022-05128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
The management of acute gout in the hospital setting may be challenging since most patients are elderly with multiple unstable comorbidities. However, there are no prospective clinical trials for hospitalized patients with gout to guide optimal management. Evidence indicates that steroids or adrenocorticotropic hormone (ACTH) may be effective and safe therapeutic options for these patients. This study aimed at directly comparing the efficacy and safety of ACTH vs betamethasone for the treatment of gout in hospitalized patients. This is the first prospective clinical trial for hospitalized patients with gout. We designed a randomized, open label study to assess the efficacy and safety of a single intramuscular injection of either ACTH or betamethasone in hospitalized patients with acute gout. Primary efficacy endpoints were the change in intensity of pain as recorded using a Visual Analogue Scale (VAS) at baseline compared to 24 h (ΔVAS24h), and 48 h. Moreover, we assessed safety and effects on the hypothalamic-pituitary-adrenal (HPA) axis, glucose and lipid homeostasis, bone metabolism, electrolytes and renal function. 38 patients were recruited. Both treatments were highly effective. The mean ± SE ΔVAS24h and ΔVAS48h for ACTH was 4.48 ± 0.29 and 5.58 ± 0.26, respectively. The mean ± SE ΔVAS24h and ΔVAS48h for betamethasone was 4.67 ± 0.32 and 5.67 ± 0.28, respectively. Direct comparison between the two groups at 24 h and 48 h did not show statistically significant differences. Both treatments were well tolerated and safe. The effects on all metabolic parameters were mostly minimal and transient for both treatments. However, ACTH may affect less the HPA axis and bone metabolism compared to betamethasone, thus leading to the conclusion that. ACTH and betamethasone are effective and safe for the management of acute gout in hospitalized patients but that ACTH may associate with less disturbance of the HPA axis and bone metabolism. Our data support the use of both drugs as first line treatments for hospitalized patients with gout.Clinical trial registration: ClinicalTrials.gov NCT04306653.
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Affiliation(s)
- Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece.
| | | | - George Varelas
- Data and Media Lab, Department of Electrical and Computer Engineering, University of Peloponnese, Tripoli, Greece
| | - Marina Michalaki
- Department of Endocrinology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Anny Onoufriou
- Department of Microbiology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Irene Mamali
- Department of Endocrinology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - George Iliopoulos
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | | | | | - Dimitrios Velissaris
- Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Giannis Tzimas
- Data and Media Lab, Department of Electrical and Computer Engineering, University of Peloponnese, Tripoli, Greece
| | | | - Sofia Vamvakopoulou
- Department of Microbiology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Fotini Paliogianni
- Department of Microbiology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | | | - Neoklis Georgopoulos
- Department of Endocrinology, Patras University Hospital, University of Patras Medical School, Patras, Greece
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9
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Schlesinger N, Padnick-Silver L, LaMoreaux B. Enhancing the Response Rate to Recombinant Uricases in Patients with Gout. BioDrugs 2022; 36:95-103. [PMID: 35316517 PMCID: PMC8938732 DOI: 10.1007/s40259-022-00517-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/20/2022]
Abstract
Refractory, or uncontrolled, gout is a chronic, progressive, inflammatory arthropathy resulting from continued urate deposition after failed attempts to lower serum uric acid below the therapeutic threshold with oral urate-lowering therapies such as allopurinol and febuxostat. Recombinant uricase is increasingly being used to treat refractory gout; however, the immunogenicity of uricase-based therapies has limited the use of these biologic therapies. Antidrug antibodies against biologic therapies, including uricase and PEGylated uricase, can lead to loss of urate-lowering response, increased risk of infusion reactions, and subsequent treatment failure. However, co-therapy with an immunomodulator can attenuate antidrug antibody development, potentially increasing the likelihood of sustained urate lowering, therapy course completion, and successful treatment outcomes. This review summarizes evidence surrounding the use of immunomodulation as co-therapy with recombinant uricases.
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Affiliation(s)
- Naomi Schlesinger
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Brian LaMoreaux
- Medical Affairs, Horizon Therapeutics, 1 Horizon Way, Deerfield, IL, 60015, USA.
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10
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Tan QH, Liu L, Huang YQ, Yu YL, Huang JY, Chen CL, Tang ST, Feng YQ. Relationship Between Change in Serum Uric Acid and Ischemic Stroke in Chinese Hypertensive Patients. Front Cardiovasc Med 2021; 8:717128. [PMID: 34621799 PMCID: PMC8490735 DOI: 10.3389/fcvm.2021.717128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/13/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Limited studies focused on the association between serum uric acid (SUA) change with ischemic stroke, and their results remain controversial. The present study aimed to investigate the relationship between change in SUA with ischemic stroke among hypertensive patients. Method: This was a retrospective cohort study. We recruited adult hypertensive patients who had two consecutive measurements of SUA levels from 2013 to 2014 and reported no history of stroke. Change in SUA was assessed as SUA concentration measured in 2014 minus SUA concentration in 2013. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan–Meier analysis and log-rank test were performed to quantify the difference in cumulative event rate. Additionally, subgroup analysis and interaction tests were conducted to investigate heterogeneity. Results: A total of 4,628 hypertensive patients were included, and 93 cases of ischemic stroke occurred during the mean follow-up time of 3.14 years. Participants were categorized into three groups according to their SUA change tertiles [low (SUA decrease substantially): <-32.6 μmol/L; middle (SUA stable): ≥-32.6 μmol/L, <40.2 μmol/L; high (SUA increase substantially): ≥40.2 μmol/L]. In the fully adjusted model, setting the SUA stable group as reference, participants in the SUA increase substantially group had a significantly elevated risk of ischemic stroke [HR (95% CI), 1.76 (1.01, 3.06), P = 0.0451], but for the SUA decrease substantially group, the hazard effect was insignificant [HR (95% CI), 1.31 (0.75, 2.28), P = 0.3353]. Age played an interactive role in the relationship between SUA change and ischemic stroke. Younger participants (age < 65 years) tended to have a higher risk of ischemic stroke when SUA increase substantially. Conclusion: SUA increase substantially was significantly correlated with an elevated risk of ischemic stroke among patients with hypertension.
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Affiliation(s)
- Qiu-Hong Tan
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song-Tao Tang
- Department of Cardiology, Community Health Center of Liaobu County, Dongguan, China
| | - Ying-Qing Feng
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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11
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Brunetti L, Vekaria J, Lipsky PE, Schlesinger N. Treatment of Acute Gout Flares in the Emergency Department: Prescribing Patterns and Revisit Rates. Ann Pharmacother 2021; 56:422-429. [PMID: 34282640 DOI: 10.1177/10600280211032295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incidence and health care costs of gout flares have increased in the United States. The increased costs may be a result of a lack of adherence to treatment guidelines and medication knowledge. Identifying causes for this trend is vital to mitigate inappropriate resource use. OBJECTIVES The aim was to identify pharmacotherapy use related to gout treatment before, during hospital visit or stay, and on discharge in patients presenting to the emergency department (ED) with gout flares. Secondary end points included opioid use, revisit rates, and associated risk factors. METHODS We performed a retrospective cohort study at a community teaching hospital ED. All consecutive patients visiting the ED from January 2016 to July 2019 with a primary diagnosis of gout flare were included. Data were extracted from the electronic medical records. RESULTS The analysis included 214 patients. Anti-inflammatory medication was not prescribed in 33.6% during the hospital visit and 29.6% of patients on discharge. History of opioid use (odds ratio [OR] = 3.3; 95% CI = 1.3-8.6; P = 0.014) and gastroesophageal reflux disease (OR = 3.5; 95% CI = 1.09-10.9; P = 0.035) were associated with opioid prescription on discharge. ED revisits within 90 days for any gout-related or non-gout-related cause were recorded in 16.8% of patients. CONCLUSION AND RELEVANCE Roughly 30% of patients did not receive an anti-inflammatory on discharge, and opioids were frequently overused in gout management in the ED. There is an opportunity for further education of health care providers regarding gout treatment.
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Affiliation(s)
| | | | - Peter E Lipsky
- RILITE Research Institute and AMPEL BioSolutions, Charlottesville, VA, USA
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12
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Doaré E, Robin F, Racapé H, Le Mélédo G, Orione C, Guggenbuhl P, Goupille P, Gervais E, Dernis E, Bouvard B, Marhadour T, Coiffier G, Saraux A. Features and Outcomes of Microcrystalline Arthritis Treated by Biologics: A Retrospective Study. Rheumatol Ther 2021; 8:1241-1253. [PMID: 34218418 PMCID: PMC8380607 DOI: 10.1007/s40744-021-00335-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The usual treatments for crystal-associated arthritis are sometimes contraindicated; thus, new therapies against interleukin-1beta (IL-1) have been developed. We evaluated the characteristics of patients who received biological treatment for crystal-associated arthritis. PATIENTS AND METHODS We conducted a multicentric retrospective observational study in six rheumatology units in western France. Patients receiving a biological treatment for crystal-associated arthritis between 1 January 2010 and 31 December 2018 were included. Improvement was defined as at least a 50% decrease in the count of synovitis and C-reactive protein level. RESULTS Forty-six patients were included: 31 (67.4%) were treated for gouty arthritis, and 15 (32.6%) for calcium pyrophosphate crystal deposition disease (CCPD). The first biotherapy used was anakinra for 14 patients (93.3%) with CCPD and 31 patients (100.0%) with gout. The first biotherapy course was more efficient in treating gout than in treating CCPD, with success in 28 patients (90.3%) and 5 patients (35.7%), respectively (p = 0.001). Six patients (42.9%) with CCPD stopped their first biotherapy course because of side effects. Among the patients with gout, urate-lowering therapy was more frequently used after (100%) than before the first biotherapy course (67.7%) (p = 0.002). CONCLUSION Anakinra was prescribed for cases of refractory crystal-associated arthritis or cases with contraindications for usual treatments. The efficacy of anakinra in treating CCPD was not obvious. Patients with CCPD had more side effects. The biotherapy was introduced with a long-term objective, while anti-IL-1 therapies are approved for acute crises only.
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Affiliation(s)
- Elise Doaré
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France
| | - François Robin
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France
| | - Hélène Racapé
- Rheumatology Department, CHU d'Angers, 49100, Angers, France
| | - Guillaume Le Mélédo
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France.,Rheumatology Department, University Hospital of Tours; EA 7501, GICC, University of Tours, Tours, France
| | | | - Pascal Guggenbuhl
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France
| | - Philippe Goupille
- Rheumatology Department, University Hospital of Tours; EA 7501, GICC, University of Tours, Tours, France
| | | | | | | | - Thierry Marhadour
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France
| | - Guillaume Coiffier
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France.,Rheumatology Unit, GHT Rance-Emeraude, CH, Dinan, France
| | - Alain Saraux
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France. .,Rheumatology Unit, Hôpital de la Cavale Blanche, BP 824, 29609, Brest Cedex, France.
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13
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Abstract
Gout is a disease in which the metabolic condition hyperuricemia leads to the formation of monosodium urate crystals, which provoke acute and chronic inflammatory responses through activation of the innate immune system. Recent advances in our knowledge of gout pathogenesis have emphasized the role of the kidneys in urate handling, the evolutionary loss of uricase as a necessary precondition for hyperuricemia, and the central role of IL-1ß in the pathogenesis of gouty inflammation. These, and other advances, have shaped our current strategies for managing gout. Here, we review the most current, evidence-based gout management approaches, including treating acute flares, addressing gout through the long-term regulation of serum urate, and prophylaxis against gouty flares during urate lowering.
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Affiliation(s)
- Michael H Pillinger
- The Division of Rheumatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States; The Section of Rheumatology, New York Harbor Health Care System, New York Campus of the U.S. Department of Veterans Affairs, New York, NY, United States.
| | - Brian F Mandell
- Rheumatic and Immunologic Diseases, The Cleveland Clinic, Cleveland, OH, United States
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14
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Ahmad MI, Masood S, Furlanetto DM, Nicolaou S. Urate Crystals; Beyond Joints. Front Med (Lausanne) 2021; 8:649505. [PMID: 34150794 PMCID: PMC8212931 DOI: 10.3389/fmed.2021.649505] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
Gout is the most common inflammatory arthropathy caused by the deposition of monosodium urate (MSU) crystals. The burden of gout is substantial with increasing prevalence of gout globally. The prevalence of Gout in the United States has increased by over 7% in the last two decades. Initially, it was believed that MSU crystal deposits occur only in the joints with the involvement of the periarticular soft tissues, but recent studies have shown the presence of MSU crystal deposition in extra-articular sites as well. Human plasma becomes supersaturated with uric acid at 6.8 mg/dl, a state called hyperuricemia. Beyond this level, uric acid crystals precipitate out of the plasma and deposit in soft tissues, joints, kidneys, etc. If left untreated, hyperuricemia leads to chronic gout characterized by the deposition of tophi in soft tissues such as the joints, tendons, and bursae. With the advent of newer imaging techniques such as DECT, MSU crystals can be visualized in various extra-articular sites. Extra-articular deposition of MSU crystals is believed to be the causative factor for the development of multiple comorbidities in gout patients. Here, we review the literature on extra-articular deposition of urate crystals and the role of dual-energy computed tomography (DECT) in elucidating multi-organ involvement. DECT has emerged as an invaluable alternative for accurate and efficient MSU crystal deposition detection. Future studies using DECT can help determine the clinical consequences of extra-articular deposition of MSU in gout patients.
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Affiliation(s)
- Muhammad Israr Ahmad
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Salman Masood
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Daniel Moreira Furlanetto
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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15
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Febuxostat-based amides and some derived heterocycles targeting xanthine oxidase and COX inhibition. Synthesis, in vitro and in vivo biological evaluation, molecular modeling and in silico ADMET studies. Bioorg Chem 2021; 113:104948. [PMID: 34052736 DOI: 10.1016/j.bioorg.2021.104948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
Various febuxostat derivatives comprising carboxamide functionalities and different substituted heterocycles were synthesized and evaluated for their biological activities as xanthine oxidase (XO) and cyclooxygenase (COX) inhibitors. All the tested compounds exhibited variable in vitro XO inhibitory activities (IC50 values 0.009-0.077 µM), among which the analog 17 has emerged as the most potent derivative (IC50 0.009 µM), representing nearly 3-times the potency of febuxostat (IC50 0.026 µM). The same analogs were further investigated for their in vitro COX-1 and COX-2 inhibitory activity, where fifteen analogs demonstrated recognizable COX-2 inhibitory potential (IC50 values range 0.04 - 0.1 µM), when correlated with celecoxib (IC50 0.05 µM), together with appreciable selectivity indices. Compounds 5a, 14b, 17, 19c, 19e and 21b that showed significant in vitro XO and/ or COX inhibitory potentials were further investigated for their in vivo hypouricemic as well as anti-inflammatory activities. Interestingly, the in vivo results were concordant with the collected in vitro data. Docking of compounds 5a, 14b, 17, 19c, 19e and 21b with the active sites of XO and COX-2 isozymes demonstrated superior binding profile compared with the reported ligands (febuxostat and celecoxib, respectively). Their docking scores were reasonable and cohering to a great extent with their corresponding in vitro IC50 values. Moreover, in silico computation of the predicted pharmacokinetic and toxicity properties (ADMET), together with the ligand efficiency (LE) of the same six compounds suggesting their liability to act as new orally active drug candidates with a predicted high safety profile.
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16
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Khanna PP, Khanna D, Cutter G, Foster J, Melnick J, Jaafar S, Biggers S, Rahman AKMF, Kuo HC, Feese M, Kivitz A, King C, Shergy W, Kent J, Peloso PM, Danila MI, Saag KG. Reducing Immunogenicity of Pegloticase With Concomitant Use of Mycophenolate Mofetil in Patients With Refractory Gout: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2021; 73:1523-1532. [PMID: 33750034 DOI: 10.1002/art.41731] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pegloticase is used for the treatment of severe gout, but its use is limited by immunogenicity. This study was undertaken to evaluate whether mycophenolate mofetil (MMF) prolongs the efficacy of pegloticase. METHODS Participants were randomized 3:1 to receive 1,000 mg MMF twice daily or placebo for 14 weeks, starting 2 weeks before receiving pegloticase and continuing while receiving intravenous pegloticase 8 mg biweekly for 12 weeks. Participants then received pegloticase alone from week 12 to week 24. The primary end points were the proportion of patients who sustained a serum urate level of ≤6 mg/dl at 12 weeks and the rate of adverse events (AEs). Secondary end points included 24-week durability of serum urate level ≤6 mg/dl. Fisher's exact test and Wilcoxon's 2-sample test were used for analyses, along with Kaplan-Meier estimates and log rank tests. RESULTS A total of 32 participants received ≥1 dose of pegloticase. Participants were predominantly men (88%), with a mean age of 55.2 years, mean gout duration of 13.4 years, and mean baseline serum urate level of 9.2 mg/dl. At 12 weeks, a serum urate level of ≤6 mg/dl was achieved in 19 (86%) of 22 participants in the MMF arm compared to 4 (40%) of 10 in the placebo arm (P = 0.01). At week 24, the serum urate level was ≤6 mg/dl in 68% of MMF-treated patients versus 30% of placebo-treated patients (P = 0.06), and rates of AEs were similar between groups, with more infusion reactions occurring in the placebo arm (30% versus 0%). CONCLUSION Our findings indicate that MMF therapy with pegloticase is well tolerated and shows a clinically meaningful improvement in targeted serum urate level of ≤6 mg/dl at 12 and 24 weeks. This study suggests an innovative approach to pegloticase therapy in gout.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | | | - Jeff Kent
- Horizon Therapeutics, Lake Forest, Illinois, USA
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17
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Saag KG, Khanna PP, Keenan RT, Ohlman S, Osterling Koskinen L, Sparve E, Åkerblad AC, Wikén M, So A, Pillinger MH, Terkeltaub R. A Randomized, Phase II Study Evaluating the Efficacy and Safety of Anakinra in the Treatment of Gout Flares. Arthritis Rheumatol 2021; 73:1533-1542. [PMID: 33605029 DOI: 10.1002/art.41699] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of anakinra compared to triamcinolone in the treatment of gout flares. METHODS Patients for whom nonsteroidal antiinflammatory drugs and colchicine were not suitable treatments were enrolled in this multicenter, randomized, double-blind study with follow-up for up to 2 years. The study was designed to assess superiority of anakinra (100 or 200 mg/day for 5 days) over triamcinolone (40 mg in a single injection) for the primary end point of changed patient-assessed pain intensity in the most affected joint (scored on a visual analog scale of 0-100) from baseline to 24-72 hours. Secondary outcome measures included: safety, immunogenicity, and patient- and physician-assessed global response. RESULTS One hundred sixty-five patients were randomized to receive anakinra (n = 110) or triamcinolone (n = 55). The median age was 55 years (range 25-83), 87% were men, the mean disease duration was 8.7 years, and the mean number of self-reported flares during the prior year was 4.5. A total of 301 flares were treated (214 with anakinra; 87 with triamcinolone). Anakinra in both doses and triamcinolone provided clinically meaningful reduction in patient-assessed pain intensity in the first and subsequent flares. For the first flare, the mean decline in pain intensity from baseline to 24-72 hours for total anakinra and triamcinolone was -41.2 and -39.4, respectively (P = 0.688). Anakinra performed better than triamcinolone for most secondary end points. There were no unexpected safety findings. The presence of antidrug antibodies was not associated with adverse events or altered pain reduction. CONCLUSION Anakinra was not superior to triamcinolone for the primary end point, but had comparable efficacy in pain reduction and was favored for most secondary end points. Anakinra is an effective option for gout flares when conventional therapy is unsuitable.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Robert Terkeltaub
- San Diego VA Healthcare Service and University of California San Diego, La Jolla
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18
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Toprover M, Pillinger MH. Remission in Gout: The Key to Patient Satisfaction? J Rheumatol 2021; 48:160-161. [PMID: 33526647 DOI: 10.3899/jrheum.200443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michael Toprover
- M. Toprover, MD, Clinical Instructor in Medicine, M.H. Pillinger, MD, Professor of Medicine and Biochemistry and Molecular Pharmacology, Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, and Rheumatology Section, Department of Medicine, New York Harbor Health Care System New York Campus, Department of Veterans Affairs, New York, New York, USA
| | - Michael H Pillinger
- M. Toprover, MD, Clinical Instructor in Medicine, M.H. Pillinger, MD, Professor of Medicine and Biochemistry and Molecular Pharmacology, Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, and Rheumatology Section, Department of Medicine, New York Harbor Health Care System New York Campus, Department of Veterans Affairs, New York, New York, USA.
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19
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Abstract
PURPOSE OF REVIEW Although gout is a common, well-recognized, and extensively researched rheumatologic disease, it continues to be underappreciated and undertreated. Although the prevalence of gout has been rising over the past several decades, adherence to urate lowering therapy continues to be suboptimal. Recent studies have underscored the potential success of guideline-directed therapy. RECENT FINDINGS Adherence to gout treatment continues to be suboptimal according to multinational metaanalyses. Moreover, studies measuring adherence are prone to overestimation and each methodologic approach has intrinsic limitations. Adherence may be analyzed from the perspective of patient adherence to taking a medication, or provider adherence to treatment guidelines. In addition to considering traditional risk factors, adherence should be viewed through the lens of healthcare disparities. The RAmP-Up trial and Nottingham Gout Treatment trial demonstrate the success of protocolized gout treatment using existing guidelines for reference. SUMMARY Standardized gout treatment protocols should be established for all primary care and specialty practices. Two successful methods of improving adherence include using nonphysician providers to coordinate urate lowering therapy titration and monitoring serum urate. Having more frequent outpatient visits to focus on direct patient care and education has also been successful.
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20
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Ren S, Meng F, Liu Y, Meng Y, Tao N, Liu R, Zhang J. Effects of external application of compound Qingbi granules on acute gouty arthritis with dampness-heat syndrome: a randomized controlled trial. Chin Med 2020; 15:117. [PMID: 33292329 PMCID: PMC7648992 DOI: 10.1186/s13020-020-00398-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background and aim The use of anti-inflammatory and analgesic drugs such as nonsteroidal anti-inflammatory drugs(NSAIDs) for treating acute gout has limitations, such as adverse reactions in the gastrointestinal tract and toxicity in the liver, kidney, and heart. Hence, a new safe and effective treatment approach needs to be explored to reduce the use of anti-inflammatory and analgesic drugs, incidence of adverse reactions, and patients’ burden. This randomized controlled clinical trial aimed to investigate the clinical efficacy and safety of the external application of compound Qingbi granules (CQBG) in treating acute gouty arthritis(AGA), providing evidence for designing a safe, effective, and optimized protocol for AGA comprehensive treatment. Methods A total of 90 patients in line with the diagnostic standard of AGA were recruited and randomly divided into control, T1, and T2 groups (30 in each group). All the participators in the three groups all received Western-medicine-basic treatment (low-purine diet, drinking water more than 2000 mL/days, oral loxoprofen, and NAHCO3). Besides, the T1 group received an external application of diclofenac diethylamine emulgel, while the T2 group received an external application of CQBG. The participants in the control group received single-use Western-medicine-basic treatment. With a treatment course of 7 days and a follow-up of 7 days, the three groups were compared in terms of primary outcome indicators, including swelling, pain improvement, and change in pain duration and secondary outcome indicators, including serum C-reactive protein (CRP) level, uric acid (UA) level, and change in the thickness of the inflammatory synovium of joints under ultrasound. Meanwhile, the safety of the protocol was evaluated. Results The three groups of patients had no apparent differences in age, body mass index, history of gout, complications, and so on before recruitment. A comparison between pretreatment and post-treatment revealed remarkable reductions in the arthralgia visual analog scale score(VAS) and the swelling score in the three groups after the treatment and the improvements in the T2 group were more significant than those in the T1 and control groups (P < 0.05). Regarding the onset time of pain improvement and pain duration, the T2 group had more significant efficacy compared with the other two groups (P < 0.05). The serum CRP and blood UA levels in the three groups significantly decreased after the treatment, but with no significant intergroup difference. The improvement in the thickness of the inflammatory synovium in joints tested by ultrasound was more significant in the T2 group than in the control group (P < 0.05). For safety evaluations, no significant difference in the incidence of adverse events was found. Conclusions The external application of CQBG combined with Western-medicine-basic treatment in patients with AGA improved arthralgia and swelling, shortened the period of taking NSAIDs, and reduced the levels of CRP and serum UA. Its therapeutic effect was significantly better than the effect of single-use Western-medicine-basic treatment. The study provided evidence for the clinical application of CQBG combined with Western medicine in treating AGA. Trial registration: ChiCTR, ChiCTR1800018020. Registered 27 August 2018, https://www.chictr.org.cn/showproj.aspx?proj=27138
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Affiliation(s)
- Shuang Ren
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China.,Key Laboratory of Ministry of Education for TCM Viscera-State Theory and Applications, Ministry of Education of China (Province-Ministry Co-Construct), Shenyang, China
| | - Fanyan Meng
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Yantong Liu
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Yun Meng
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Ning Tao
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Ruoshi Liu
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Jie Zhang
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, 110001, China.
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21
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Klück V, Liu R, Joosten LAB. The role of interleukin-1 family members in hyperuricemia and gout. Joint Bone Spine 2020; 88:105092. [PMID: 33129923 DOI: 10.1016/j.jbspin.2020.105092] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Interleukin (IL)-1 family cytokines and their receptors have important roles in innate and partly in adaptive immunity. The family consists of 11 members of which IL-1α, IL-1β, IL-18, IL-33, IL-36α, IL-36β and IL-36γ are considered pro-inflammatory and IL-1Ra, IL-36Ra, IL-37 and IL-38 anti-inflammatory. Whereas IL-1β has a known pivotal role in gout, increasing evidence suggests other IL-1 family members are also involved in the pathogenesis of hyperuricemia and gout flares. FINDINGS Studies indicate IL-1α, like IL-1β, plays an essential role in the pathogenesis of gout flares. IL-18, although elevated in patients with gout, does not contribute to MSU crystal-induced inflammation, but may be involved in the subsequent development of cardiovascular disease in individuals with gout. The role of the pro-inflammatory cytokine IL-36 in gout remains elusive. In contrast, IL-1Ra, IL-33, IL-37 and IL-38 inhibit MSU crystal-induced inflammation and therefore have therapeutic potential for treatment of gout flares. In addition to existing IL-1β blockers, several new therapeutics to treat gout are being developed either inhibiting the transcription or maturation of IL-1β. CONCLUSION In this review, IL-1 family cytokines are discussed in the context of hyperuricemia and gout. Finally, current and novel therapeutic options for targeting IL-1 are reviewed.
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Affiliation(s)
- Viola Klück
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands; Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands.
| | - Ruiqi Liu
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands; Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands.
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands; Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Geert Grooteplein Zuid, 8, 6525 GA, Nijmegen, The Netherlands; Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Street Pasteur nr. 6, 400349 Cluj-Napoca, Romania.
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22
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Systemic Urate Deposition: An Unrecognized Complication of Gout? J Clin Med 2020; 9:jcm9103204. [PMID: 33023045 PMCID: PMC7600842 DOI: 10.3390/jcm9103204] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
Gout, an inflammatory arthritis, affects over nine million people in the US with increasing prevalence. Some medical societies do not recommend treating gout unless it is recurrent. While soft tissue urate deposits (tophi), resultant bone erosions, and joint inflammation are frequently recognized in gout, urate crystal deposits in other sites have been thought to be rare. Recent diagnostic testing, such as dual energy computed tomography (DECT), has led to the recognition that urate deposits are not uncommon in other tissues including the vasculature. To understand the potential risks for untreated gout, we reviewed the literature on extra-articular urate deposition documented by autopsy, histopathology, surgery, and radiology, including the heart, blood vessels, kidney, spine, eye, skin, and gastrointestinal system. These studies extend the significance of gout beyond the rheumatologist and emphasize the need for physicians to follow the American College of Rheumatology guidelines to treat subjects with gout to a goal of achieving serum urate <6 mg/dl. Given the growing body of literature on extraarticular urate deposition, further studies and clinical trials are needed to determine the clinical consequences of systemic urate deposition, including if reducing cardiac and vascular urate deposits may provide a survival benefit for this at-risk population.
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23
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Adrenocorticotropic hormone: an effective "natural" biologic therapy for acute gout? Rheumatol Int 2020; 40:1941-1947. [PMID: 32715340 DOI: 10.1007/s00296-020-04659-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022]
Abstract
Treatment of acute gout consists of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and steroids. However, the typical patient with gout has multiple comorbidities such as cardiovascular disease, hypertension, renal dysfunction or diabetes/metabolic syndrome that represent contraindications to these therapeutic options. The aim of this study is to review the available evidence regarding the use of ACTH as an alternative therapeutic option for acute gout and explore potential mechanisms of action. We performed an electronic search (MEDLINE, Scopus and Web of Science) using the keywords ACTH or adrenocorticotropic hormone combined with gout or crystal-induced arthritis. ACTH appears suitable for patients with many comorbidities due to its good safety profile. Clinical evidence shows that ACTH is at least as effective as classic agents. The mechanism of action of ACTH in gout is not entirely known. Robust experimental evidence points to the direction that ACTH does not act solely by triggering the release of endogenous steroids but also appears to downregulate inflammatory responses by activating melanocortin receptors on innate immune cells, such as macrophages. Moreover, indirect evidence indicates that ACTH may have an IL-1 antagonistic effect. We propose that ACTH may be an alternative therapeutic option for gout in patients with multiple comorbidities. Large-scale studies assessing the efficacy and safety of ACTH compared to classic therapeutic options are needed.
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24
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Toprover M, Shah B, Oh C, Igel TF, Romero AG, Pike VC, Curovic F, Bang D, Lazaro D, Krasnokutsky S, Katz SD, Pillinger MH. Initiating guideline-concordant gout treatment improves arterial endothelial function and reduces intercritical inflammation: a prospective observational study. Arthritis Res Ther 2020; 22:169. [PMID: 32653044 PMCID: PMC7353742 DOI: 10.1186/s13075-020-02260-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
Background Patients with gout have arterial dysfunction and systemic inflammation, even during intercritical episodes, which may be markers of future adverse cardiovascular outcomes. We conducted a prospective observational study to assess whether initiating guideline-concordant gout therapy with colchicine and a urate-lowering xanthine oxidase inhibitor (XOI) improves arterial function and reduces inflammation. Methods Thirty-eight untreated gout patients meeting American College of Rheumatology (ACR)/European League Against Rheumatism classification criteria for gout and ACR guidelines for initiating urate-lowering therapy (ULT) received colchicine (0.6 mg twice daily, or once daily for tolerance) and an XOI (allopurinol or febuxostat) titrated to ACR guideline-defined serum urate (sU) target. Treatment was begun during intercritical periods. The initiation of colchicine and XOI was staggered to permit assessment of a potential independent effect of colchicine. Brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) assessed endothelium-dependent and endothelium-independent (smooth muscle) arterial responsiveness, respectively. High-sensitivity C-reactive protein (hsCRP), IL-1β, IL-6, myeloperoxidase (MPO) concentrations, and erythrocyte sedimentation rate (ESR) assessed systemic inflammation. Results Four weeks after achieving target sU concentration on colchicine plus an XOI, FMD was significantly improved (58% increase, p = 0.03). hsCRP, ESR, IL-1β, and IL-6 also all significantly improved (30%, 27%, 19.5%, and 18.8% decrease respectively; all p ≤ 0.03). Prior to addition of XOI, treatment with colchicine alone resulted in smaller numerical improvements in FMD, hsCRP, and ESR (20.7%, 8.9%, 13% reductions, respectively; all non-significant), but not IL-1β or IL-6. MPO and NMD did not change with therapy. We observed a moderate inverse correlation between hsCRP concentration and FMD responsiveness (R = − 0.41, p = 0.01). Subgroup analyses demonstrated improvement in FMD after achieving target sU concentration in patients without but not with established cardiovascular risk factors and comorbidities, particularly hypertension and hyperlipidemia. Conclusions Initiating guideline-concordant gout treatment reduces intercritical systemic inflammation and improves endothelial-dependent arterial function, particularly in patients without established cardiovascular comorbidities.
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Affiliation(s)
- Michael Toprover
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Binita Shah
- Section of Cardiology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Talia F Igel
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Aaron Garza Romero
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Virginia C Pike
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Fatmira Curovic
- Section of Cardiology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Daisy Bang
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Deana Lazaro
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA
| | - Svetlana Krasnokutsky
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA.,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA
| | - Stuart D Katz
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael H Pillinger
- Section of Rheumatology, VA New York Harbor Health Care System, New York, NY, USA. .,Division of Rheumatology, NYU Grossman School of Medicine, NYU Hospital for Joint Diseases Suite 1410, 301 East 17th Street, New York, NY, 10003, USA.
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25
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Gromova MA, Tsurko VV, Kislyak OA, Malysheva NV. [Evaluation of a 12-week allopurinol-lowering therapy in combination with the non-steroidal anti-inflammatory drug meloxicam in patients with gout]. TERAPEVT ARKH 2020; 92:60-68. [PMID: 33346494 DOI: 10.26442/00403660.2020.06.000704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate a 12-week course of combined alloturinol-lowering therapy with a prophylactic anti-inflammatory dose of movalis for the frequency of exacerbations and the quality of life of patients with gout. MATERIALS AND METHODS Allopurinol was administered orally, 1 time per day. Every 3 weeks, the dosage of the drug was increased by 50 mg to 300 mg per day under the control of the level of serum uric acid (sUA). The total daily dose of the drug movalis, used in the form of different dosage forms, was 7.515 mg. The clinical effectiveness of the treatment was evaluated after 3, 6, 9 and 12 weeks according to physical examination, the dynamics of joint pain at rest, during movement and palpation, according to the visual analogue scale (VAS) in millimeters, Likert scale, EuroQol-5D-5L questionnaire, care for oneself, habitual daily activities, the presence of anxiety and depression, assessment of satisfaction with treatment (on a scale of 1 to 5, where 1 is the complete absence of improvement or worsening, and 5 is a very good result); took into account the period of remission, as well as the time before the onset of relapse of gouty arthritis. An adverse event (AE) was recorded. RESULTS AND DISCUSSION On the background of treatment with movalis 7.5 mg per day more than two-thirds of patients showed no worsening of the articular syndrome with an increase in the dose of allopurinol to 300 mg per day. By the 12th week of observation, a significant difference was found between the severity of gouty arthritis characteristics in the direction of improving mobility, self-care, normal daily activities, reducing soreness, reducing anxiety and depression (p0.05). In addition, the ESR and sUA levels were significantly different initially and at the final observation point (p0.05), which indicates a positive effect on the inflammatory process. A 3-month course of combination therapy was not accompanied by significant increases in blood pressure, changes in creatinine clearance in blood serum. There were no adverse events from the gastrointestinal tract. 90.9% of patients rated the treatment result as very good. AE in the form of a skin allergic rash was observed in one patient; it did not require interruption of treatment and completely stopped without consequences after completion of the course. CONCLUSION 12 a week-long combined therapy of the allopurinol-reducing drug with the anti-inflammatory dose movalis prevents the exacerbation of the articular syndrome and improves the quality of life of patients with gout.
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Affiliation(s)
- M A Gromova
- Pirogov Russian National Research Medical University
| | - V V Tsurko
- Pirogov Russian National Research Medical University.,Sechenov First Moscow State Medical University (Sechenov University)
| | - O A Kislyak
- Pirogov Russian National Research Medical University
| | - N V Malysheva
- Pirogov Russian National Research Medical University
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26
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Kim SH, Lee SY, Kim JM, Son CN. Renal safety and urate-lowering efficacy of febuxostat in gout patients with stage 4-5 chronic kidney disease not yet on dialysis. Korean J Intern Med 2020; 35:998-1003. [PMID: 30959584 PMCID: PMC7373967 DOI: 10.3904/kjim.2018.423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The safety and efficacy of febuxostat in patients with stage 4-5 chronic kidney disease (CKD) are still unclear owing to a lack of studies in these patients. Therefore, we aimed to evaluate the effect of febuxostat on renal function, general safety, and efficacy in gout patients with stage 4-5 CKD. METHODS Among 739 patients who had been administered febuxostat from May 2012 to December 2016 at a single hospital in Korea, 370 patients who had been monitored for 1 year were analyzed. Serum uric acid levels and estimated glomerular filtration rate (eGFR) of patients with gouty arthritis were collected at baseline and 1 year after febuxostat administration. RESULTS Among the 370 patients, 280 patients were stage 1-3 CKD, 63 patients were stage 4-5 CKD, and 27 patients were on dialysis. The eGFR of 63 patients with stage 4-5 CKD, excluding dialysis patients, was 19.84 ± 7.08 mL/min/1.73 m2 when they began to take febuxostat and 23.49 ± 16.67 mL/min/1.73 m2 after 12 months (p = 0.13). The urate-lowering effect after 12 months of febuxostat medication showed statistical significance (8.96 ± 2.31 mg/dL at baseline and 4.88 ± 1.68 mg/dL after 12 months, p < 0.01). The difference in incidence of adverse events among patients with stage 1-3 CKD, those with stage 4-5 CKD, and those on dialysis was not significant. CONCLUSION Febuxostat demonstrated renal safety and good urate-lowering efficacy in gout patients with stage 4-5 CKD, who are not yet on dialysis.
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Affiliation(s)
- Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - So-Yeon Lee
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | | | - Chang-Nam Son
- Correspondence to Chang-Nam Son, M.D. Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-7611 Fax: +82-53-250-7434 E-mail:
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Bodofsky S, Merriman TR, Thomas TJ, Schlesinger N. Advances in our understanding of gout as an auto-inflammatory disease. Semin Arthritis Rheum 2020; 50:1089-1100. [PMID: 32916560 DOI: 10.1016/j.semarthrit.2020.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
Gout, the most common inflammatory arthritis, is the result of hyperuricemia and inflammation induced by monosodium urate (MSU) crystal deposition. However, most people with hyperuricemia will never develop gout, implying a molecular-genetic contribution to the development of gout. Recent genomic studies reveal links between certain genetic variations and gout. We highlight recent advances in our understanding of gout as an auto-inflammatory disease. We review the auto-inflammatory aspects of gout, including the inflammasome and thirteen gout-associated inflammatory-pathway genes and associated comorbidities. This information provides important insights into emerging immune-modulating targets in the management of gout, and future novel therapeutic targets in gout treatment. Cumulatively, this has important implications for treating gout as an auto-inflammatory disease, as opposed to a purely metabolic disease.
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Affiliation(s)
- Shari Bodofsky
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - T J Thomas
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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28
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Chen HL, Hsu YC, Chen CH, Wang PJ, Lin CL, Cheng SH, Chang KH. Gout and the risk of epilepsy: A population-based cohort study. Medicine (Baltimore) 2020; 99:e20823. [PMID: 32590769 PMCID: PMC7328940 DOI: 10.1097/md.0000000000020823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Gout is a chronic disease related to uric acid metabolism. It involves crystals of uric acid accumulating in the joints, causing joint pain and releasing cytokines that trigger inflammation. Inflammation is a key component in the pathogenesis of epilepsy. Thus, we conducted a cohort study to investigate if epilepsy is associated with gout and determine the risk of epilepsy in patients with gout.The gout cohort was obtained from the Registry of Catastrophic Illnesses Patient Database (RCIPD). We identified 104,238 patients who were aged 20 years or more and newly diagnosed with gout between 2000 and 2011 and 3 outpatient visits or history of gout-specific hospitalization between 2000 and 2011. Patients without gout were frequency matched with the gout cohort at a 2:1 ratio according to age, sex, comorbidities, and year of gout diagnosis.The gout cohort showed a 1.27-fold higher overall crude hazard ratio (HR) for epilepsy compared with the control cohort. After we adjusted the analyses by age, sex, and comorbidities the gout patients displayed an increased risk of epilepsy compared with the control group (adjusted HR = 1.25, 95% confidence interval = 1.15-1.36).This study revealed a significantly higher risk of epilepsy in patients with gout. It provides further evidence for the debate around the effect of gout on brain health.
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Affiliation(s)
- Hung-Lin Chen
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli Miao
| | - Yi-Chao Hsu
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei
| | - Chang-Hsu Chen
- Division of Nephrology, Tungs’ Taichung MetroHarbor Hospital
| | - Pei-Jen Wang
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Sheng-Han Cheng
- Division of Allergy, Immunology and Rheumatology, Tung's Taichung MetroHarbor Hospital
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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The development of a targeted and more potent, anti-Inflammatory derivative of colchicine: Implications for gout. Biochem Pharmacol 2020; 180:114125. [PMID: 32598947 DOI: 10.1016/j.bcp.2020.114125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colchicine is routinely used for its anti-inflammatory properties to treat gout and Familial Mediterranean fever. More recently, it was also shown to be of therapeutic benefit for another group of diseases in which inflammation is a key component, namely, cardiovascular disease. Whilst there is considerable interest in repurposing this alkaloid, it has a narrow therapeutic index and is associated with undesirable side effects and drug interactions. We, therefore, developed a derivatives of colchicine that preferentially target leukocytes to increase their potency and diminish their side effects. The anti-inflammatory activity of the colchicine derivatives was tested in experimental models of neutrophil activation by the etiological agent of gout, monosodium urate crystals (MSU). METHODS Using a rational drug design approach, the structure of colchicine was modified to increase its affinity for βVI-tubulin, a colchicine ligand preferentially expressed by immune cells. The ability of the colchicine analogues with the predicted highest affinity for βVI-tubulin to dampen neutrophil responses to MSU was determined with in vitro assays that measure MSU-induced production of ROS, release of IL-1 and CXCL8/IL-8, and the increase in the concentration of cytoplasmic calcium. The anti-inflammatory property of the derivatives was assessed in the air pouch model of MSU-induced inflammation in mice. RESULTS The most effective compound generated, CCI, is more potent than colchicine in all the in vitro assays. It inhibits neutrophil responses to MSU in vitro at concentrations 10-100-fold lower than colchicine. Similarly, in vivo, CCI inhibits the MSU-induced recruitment of leukocytes at a 10-fold lower concentration than colchicine when administered prior to or after MSU. CONCLUSIONS We provide evidence that colchicine can be rendered more potent atinhibiting MSU-induced neutrophil activation and inflammation using a rational drug design approach. The development of compounds such as CCI will provide more efficacious drugs that will not only alleviate gout patients of their painful inflammatory episodes at significantly lower doses than colchicine, but also be of potential therapeutic benefit for patients with other diseases treated with colchicine.
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30
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Lin X, Shao T, Huang L, Wen X, Wang M, Wen C, He Z. Simiao Decoction Alleviates Gouty Arthritis by Modulating Proinflammatory Cytokines and the Gut Ecosystem. Front Pharmacol 2020; 11:955. [PMID: 32670069 PMCID: PMC7327538 DOI: 10.3389/fphar.2020.00955] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Simiao decoction, a classical traditional Chinese medicine (TCM) formula, has been widely used for thousands of years due to its safety and efficiency in treating gouty arthritis. Utilizing serum proinflammatory cytokines and gut ecosystems, this study elucidated the mechanisms of alleviating gouty arthritis by Simiao decoction. Simiao decoction (4.0, 8.0, and 16.0 g/kg) was orally administered to gouty arthritis mice and febuxostat was given as a positive control. The spleen, kidney, and liver indexes indicated that Simiao decoction was safe for the treatment of gouty arthritis in C57BL/6 mice. Besides, our study demonstrated that Simiao decoction was effective for reducing the level of serum uric acid and decreasing MPO, XOD, and ADA activity, as well as alleviating gouty-related symptoms, such as foot swelling and pain. Moreover, Simiao decoction could also reduce some specific serum proinflammatory cytokines including IL-1β, IL-9, IFN-γ, MIP-1α and MIP-1β. We then surveyed the effects of Simiao decoction on the gut ecosystems in a systematic manner by combining network pharmacology, ELISA, western blot, and illumina sequencing. In the murine of model of gouty arthritis, Simiao decoction could suppress NLRP3 inflammasomes expression, reduce gut apoptosis through modulating TNF-α, Caspase 8, and AIFM1 protein expressions, affect lipid metabolism by regulating APOB, LPL, PPARα protein expressions and restore gut microbiota via reducing potential pathogens. Overall, these findings suggested that Simiao decoction was an effective therapeutic drug for gouty arthritis and the gut ecosystem might act as a potential anti-inflammatory target of Simiao decoction.
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Affiliation(s)
- Xiaoying Lin
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tiejuan Shao
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Huang
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xianghui Wen
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Mingzhu Wang
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengping Wen
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhixing He
- College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
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31
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Wang G, Zuo T, Li R. The mechanism of Arhalofenate in alleviating hyperuricemia―Activating
PPARγ
thereby reducing caspase‐1 activity. Drug Dev Res 2020; 81:859-866. [PMID: 32506648 DOI: 10.1002/ddr.21699] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Guihong Wang
- Department of Rheumatology and Immunology Anqing Hospital, affiliated Hospital of Anhui Medical University Anqing China
| | - Ting Zuo
- Department of Rheumatology and Immunology Anqing Hospital, affiliated Hospital of Anhui Medical University Anqing China
| | - Ran Li
- Department of Rheumatology and Immunology Anqing Hospital, affiliated Hospital of Anhui Medical University Anqing China
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32
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Hu AM, Brown JN. Comparative effect of allopurinol and febuxostat on long-term renal outcomes in patients with hyperuricemia and chronic kidney disease: a systematic review. Clin Rheumatol 2020; 39:3287-3294. [DOI: 10.1007/s10067-020-05079-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
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Latourte A, Pascart T, Flipo RM, Chalès G, Coblentz-Baumann L, Cohen-Solal A, Ea HK, Grichy J, Letavernier E, Lioté F, Ottaviani S, Sigwalt P, Vandecandelaere G, Richette P, Bardin T. 2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares. Joint Bone Spine 2020; 87:387-393. [PMID: 32422339 DOI: 10.1016/j.jbspin.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares. METHODS These evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and 2 Delphi rounds to finalize them. RESULTS A set of 4 overarching principles and 4 recommendations was elaborated. The overarching principles emphasize the importance of patient education, including the need to auto-medicate for gout flares as early as possible, if possible within the first 12h after the onset, according to a pre-defined treatment. Patients must know that gout is a chronic disease, often requiring urate-lowering therapy in addition to flare treatment. Comorbidities and the risk of drug interaction should be screened carefully in every patient as they may contraindicate some anti-inflammatory treatments. Colchicine must be early prescribed at the following dosage: 1mg then 0.5mg one hour later, followed by 0.5mg,2 to 3 times/day over the next days. In case of diarrhea, which is the first symptom of colchicine poisoning, dosage must be reduced. Colchicine dosage must also be reduced in patients with chronic kidney disease or taking drugs, which interfere with its metabolism. Other first-line treatment options are systemic/intra-articular corticosteroids, or non-steroidal anti-inflammatory agents (NSAIDs). IL-1 inhibitors can be considered as a second-line option in case of failure, intolerance or contraindication to colchicine, corticosteroids and NSAIDs. They are contraindicated in cases of infection and neutrophil blood count should be monitored. CONCLUSION These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares.
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Affiliation(s)
- Augustin Latourte
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | - Tristan Pascart
- Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France
| | - René-Marc Flipo
- Service de rhumatologie, université de Lille, CHU de Lille, Lille, France
| | | | | | - Alain Cohen-Solal
- Service de cardiologie, hôpital Lariboisière, AP-HP, Paris, France; Inserm U942 MASCOT, université de Paris, Paris, France
| | - Hang-Korng Ea
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Emmanuel Letavernier
- Service de physiologie, hôpital Tenon, AP-HP, Paris, France; Inserm U1155, UPMC Université Paris 6, Sorbonne Universités, Paris, France
| | - Frédéric Lioté
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Pierre Sigwalt
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Pascal Richette
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | - Thomas Bardin
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
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Klück V, Jansen TLTA, Janssen M, Comarniceanu A, Efdé M, Tengesdal IW, Schraa K, Cleophas MCP, Scribner CL, Skouras DB, Marchetti C, Dinarello CA, Joosten LAB. Dapansutrile, an oral selective NLRP3 inflammasome inhibitor, for treatment of gout flares: an open-label, dose-adaptive, proof-of-concept, phase 2a trial. THE LANCET. RHEUMATOLOGY 2020; 2:e270-e280. [PMID: 33005902 PMCID: PMC7523621 DOI: 10.1016/s2665-9913(20)30065-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
SUMMARY BACKGROUND Gout flares are driven by interleukin (IL)-1β. Dapansutrile inhibits the NLRP3 inflammasome and subsequent activation of IL-1β. In this study we aimed to investigate the safety and efficacy of orally administered dapansutrile in patients with a gout flare. METHODS In this open-label, proof-of-concept, phase 2a trial, adult patients (aged 18-80 years) with a monoarticular monosodium urate crystal-proven gout flare were enrolled at an outpatient clinic in the Netherlands and sequentially assigned using a dose-adaptive design to receive 100 mg/day, 300 mg/day, 1000 mg/day, or 2000 mg/day oral dapansutrile for 8 days. The coprimary outcomes were change in patient-reported target joint pain from baseline to day 3 and from baseline to day 7, assessed in the per-protocol population (all patients who received at least 80% of the study drug and had no major protocol deviations). Safety was assessed in the intention-to-treat population. This trial is registered with the EU Clinical Trials Register, EudraCT 2016-000943-14, and is completed. FINDINGS Between May 18, 2017, and Jan 21, 2019, 144 patients were assessed for eligibility, of whom 34 were enrolled and 29 were included in the per-protocol population (three patients were excluded due to receiving <80% of study drug and two had major protocol deviations): eight patients received 100 mg/day, seven received 300 mg/day, six received 1000 mg/day, and eight received 2000 mg/day. Between baseline and day 3, there was a mean reduction in patient-reported target joint pain of 52·4% (SD 32·94; p=0∙016) for the 100 mg/day group, 68·4% (34·29; p=0∙016) for the 300 mg/day group, 55·8% (44·90; p=0∙063) for the 1000 mg/day group, and 57·6% (38·72; p=0∙016) for the 2000 mg/day group. At day 7, there was a mean reduction of 82·1% (22·68; p=0∙031) for the 100 mg/day group, 84·2% (16·33; p=0∙016) for the 300 mg/day group, 68·9% (34·89; p=0∙031) for the 1000 mg/day group, and 83·9% (15·44; p=0∙008) for the 2000 mg/day group, compared to baseline. 25 (73·5%) of 34 patients reported a total of 45 treatment-emergent adverse events, most of which were metabolism and nutrition disorders (17 [37·8%]) and gastrointestinal disorders (ten [22·2%]). Two serious adverse events occurred during the study, admission to hospital because of worsening of gout flare at day 3, and admission to hospital because of coronary stenosis 18 days after the patient received their last dose; these were considered moderate in severity and unrelated to the study drug. INTERPRETATION Dapansutrile is a specific NLRP3 inflammasome inhibitor with a satisfactory safety profile and efficacy in the reduction of target joint pain in this study. Future studies are needed to confirm the clinical potential of dapansutrile.
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Affiliation(s)
| | | | - Matthijs Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Antoaneta Comarniceanu
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Monique Efdé
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Isak W Tengesdal
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Kiki Schraa
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Maartje C P Cleophas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Curtis L Scribner
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Damaris B Skouras
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Carlo Marchetti
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Charles A Dinarello
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (V Klück MD, K Schraa BSc, M C P Cleophas PhD, Prof C A Dinarello MD, Prof L A B Joosten PhD); Department of Rheumatology, VieCuri Medical Center, Venlo, Netherlands (T L Th A Jansen PhD, M Janssen PhD, A Comarniceanu MD, M Efdé MD); Olatec Therapeutics, New York, NY, USA (C L Scribner MD, D B Skouras MBA); Department of Medicine, University of Colorado, Aurora, CO, USA (I W Tengesdal MSc, C Marchetti PhD, Prof C A Dinarello); and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (Prof L A B Joosten)
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Scuiller A, Pascart T, Bernard A, Oehler E. [Gout]. Rev Med Interne 2020; 41:396-403. [PMID: 32201015 DOI: 10.1016/j.revmed.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
Gout is a chronic disease due to the deposition of monosodium urate microcrystals in joints and tissues. Its incidence and prevalence are increasing worldwide in close relation with the epidemic of obesity and metabolic syndrome. Gout is related to chronic hyperuricemia that should be treated to ensure the reduction or even the disappearance of acute attacks ("gout flares") and to reduce the size and number of tophi. If arthritis of the first metatarsophalangeal joint is the most typical form, other joints may be affected, including the spine. Demonstration of urate microcrystals arthritis allows diagnosis of gout but, in the absence of possibility of performing joint puncture, imaging may be useful for providing complementary diagnostic elements. Appropriate care is essential to reduce the number of flares and the evolution towards gouty arthropathy but also in terms of public health in order to reduce costs related to this pathology.
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Affiliation(s)
- A Scuiller
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - T Pascart
- Service de rhumatologie, hôpital Saint-Philibert, université de Lille, 59462 Lomme cedex, France
| | - A Bernard
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - E Oehler
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti.
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Sharma E, Pedersen B, Terkeltaub R. Patients Prescribed Anakinra for Acute Gout Have Baseline Increased Burden of Hyperuricemia, Tophi, and Comorbidities, and Ultimate All-Cause Mortality. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119890853. [PMID: 31839715 PMCID: PMC6902385 DOI: 10.1177/1179544119890853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Abstract
Objective: The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra. Methods: Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient’s first rheumatology encounter was studied by factor analysis for variables associated with later anakinra. Results: At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52], P = .003), serum urate ([10.6 mg/dL] vs controls [7.6 mg/dL], P < .0001), and East Asian descent ([7/13] vs [16/52], P = .041). The anakinra group had higher ultimate all-cause mortality ([6/13] vs controls [7/52], relative risk [RR] = 3.43, 95% confidence interval [CI] = 1.39-8.48, P = .0076). Factor analysis showed baseline visit palpable tophus and statin use to be most strongly associated with later anakinra use. Increased mortality of anakinra users, as per a factorial analysis, was linked more strongly to comorbidities than to anakinra. Conclusions: At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription.
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Affiliation(s)
- Ena Sharma
- Department of Medicine, San Diego Veterans Affairs Healthcare System, San Diego, CA, USA.,Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Brian Pedersen
- Department of Medicine, San Diego Veterans Affairs Healthcare System, San Diego, CA, USA.,Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Robert Terkeltaub
- Department of Medicine, San Diego Veterans Affairs Healthcare System, San Diego, CA, USA.,Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Fomin VV, Morosova TE, Tsurko VV. [Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice]. TERAPEVT ARKH 2019; 91:75-83. [PMID: 32598593 DOI: 10.26442/00403660.2019.12.000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 02/07/2023]
Abstract
In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.
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Affiliation(s)
- V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T E Morosova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Tsurko
- Sechenov First Moscow State Medical University (Sechenov University).,Pirogov Russian National Research Medical University
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Metamizole vs. ibuprofen at home after day case surgery: A double-blind randomised controlled noninferiority trial. Eur J Anaesthesiol 2019; 36:351-359. [PMID: 30946703 DOI: 10.1097/eja.0000000000000972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND NSAIDs and paracetamol are the cornerstones of pain treatment after day case surgery. However, NSAIDs have numerous contraindications and consequently are not suitable in up to 25% of patients. Metamizole is a non-opioid compound with a favourable gastro-intestinal and cardiovascular profile compared with NSAIDs. OBJECTIVES The study aimed to assess if a combination of metamizole and paracetamol is noninferior to a combination of ibuprofen and paracetamol in treating pain at home after painful day case surgery. DESIGN A double-blind randomised controlled trial. SETTING Single centre. PATIENTS Two hundred patients undergoing elective ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair. INTERVENTION Patients were randomly allocated to receive either metamizole and paracetamol (n = 100) or ibuprofen and paracetamol (n = 100) orally for four days. MAIN OUTCOME MEASURES Average postoperative pain intensity using a numerical rating scale and use of rescue medication were measured in the postanaesthesia care unit (PACU) and on postoperative days (POD) 1 to 3. A difference in mean numerical rating scale score of 1 point or less was considered noninferior. Adverse effects of study medication and satisfaction with study medication were measured on PODs 1 to 3 by telephone follow-up. RESULTS In the PACU, the difference in mean ± SD pain score between metamizole and paracetamol and ibuprofen and paracetamol was 0.85 ± 0.78. From POD 1 to 3, this difference was lower than 1, resulting in noninferiority. Rescue opioid consumption in the PACU and on PODs 1 and 3 was not significantly different between treatment groups. Rescue opioid consumption on POD2 was significantly higher in the ibuprofen and paracetamol group (P = 0.042). Adverse effects of study medication and overall patient satisfaction were similar in both groups. CONCLUSION Paracetamol/metamizole and paracetamol/ibuprofen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction levels. TRIAL REGISTRATION European Union Clinical Trials Register 2015-003987-35.
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Slobodnick A, Krasnokutsky S, Lehmann RA, Keenan RT, Quach J, Francois F, Pillinger MH. Colorectal Cancer Among Gout Patients Undergoing Colonoscopy. J Clin Rheumatol 2019; 25:335-340. [PMID: 31764494 DOI: 10.1097/rhu.0000000000000893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE The connection between gout and various cancers remains unclear. We assessed the relationship between gout and colorectal cancer in a population of veterans. METHODS We reviewed the Computerized Patient Record System of the VA New York Harbor Health Care System to assess the 10-year occurrence of colorectal cancer in patients with gout undergoing colonoscopy, versus patients with osteoarthritis but no gout. RESULTS Gout and osteoarthritis subjects were similar in age, ethnicity, body mass index, and smoking history. Among 581 gout and 598 osteoarthritis subjects with documented colonoscopies, the 10-year prevalence of colorectal cancer was significantly lower in gout (0.8%) versus osteoarthritis (3.7%) (p = 0.0008) patients. Differences in colorectal cancer rates remained significant after stratifying for nonsteroidal anti-inflammatory drug use. Among gout subjects, use of colchicine and/or allopurinol, as well as the presence/absence of concomitant osteoarthritis, did not influence colorectal cancer occurrence. On subanalysis, differences in colorectal cancer occurrence between gout and osteoarthritis subjects persisted among those who underwent diagnostic (0.5% in gout vs 4.6% in osteoarthritis subjects, p < 0.001) but not screening (0.9% in gout subjects vs 1% in osteoarthritis subjects, p = 1.0) colonoscopy. There was no significant difference in nonmalignant colorectal polyp occurrence between gout and osteoarthritis subjects. CONCLUSIONS Subjects with gout had decreased colonoscopy-documented occurrence of colorectal cancer compared with osteoarthritis subjects, suggesting a possible protective effect.
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Affiliation(s)
- Anastasia Slobodnick
- From the Section of Rheumatology, VA New York Harbor Health Care System, New York Campus
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY
| | - Svetlana Krasnokutsky
- From the Section of Rheumatology, VA New York Harbor Health Care System, New York Campus
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY
| | - Robert A Lehmann
- From the Section of Rheumatology, VA New York Harbor Health Care System, New York Campus
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY
| | - Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham, NC
| | - Jonathan Quach
- Section of Gastroenterology, VA New York Harbor Health Care System, New York Campus
- Division of Gastroenterology, New York University School of Medicine, New York, NY
| | - Fritz Francois
- Section of Gastroenterology, VA New York Harbor Health Care System, New York Campus
- Division of Gastroenterology, New York University School of Medicine, New York, NY
| | - Michael H Pillinger
- From the Section of Rheumatology, VA New York Harbor Health Care System, New York Campus
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY
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Variation in methods, results and reporting in electronic health record-based studies evaluating routine care in gout: A systematic review. PLoS One 2019; 14:e0224272. [PMID: 31648282 PMCID: PMC6812805 DOI: 10.1371/journal.pone.0224272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To perform a systematic review examining the variation in methods, results, reporting and risk of bias in electronic health record (EHR)-based studies evaluating management of a common musculoskeletal disease, gout. METHODS Two reviewers systematically searched MEDLINE, Scopus, Web of Science, CINAHL, PubMed, EMBASE and Google Scholar for all EHR-based studies published by February 2019 investigating gout pharmacological treatment. Information was extracted on study design, eligibility criteria, definitions, medication usage, effectiveness and safety data, comprehensiveness of reporting (RECORD), and Cochrane risk of bias (registered PROSPERO CRD42017065195). RESULTS We screened 5,603 titles/abstracts, 613 full-texts and selected 75 studies including 1.9M gout patients. Gout diagnosis was defined in 26 ways across the studies, most commonly using a single diagnostic code (n = 31, 41.3%). 48.4% did not specify a disease-free period before 'incident' diagnosis. Medication use was suboptimal and varied with disease definition while results regarding effectiveness and safety were broadly similar across studies despite variability in inclusion criteria. Comprehensiveness of reporting was variable, ranging from 73% (55/75) appropriately discussing the limitations of EHR data use, to 5% (4/75) reporting on key data cleaning steps. Risk of bias was generally low. CONCLUSION The wide variation in case definitions and medication-related analysis among EHR-based studies has implications for reported medication use. This is amplified by variable reporting comprehensiveness and the limited consideration of EHR-relevant biases (e.g. data adequacy) in study assessment tools. We recommend accounting for these biases and performing a sensitivity analysis on case definitions, and suggest changes to assessment tools to foster this.
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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42
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Kamel B, Williams KM, Graham GG, Norris RL, Stocker SL, Carland JE, Pile KD, Day RO. Determination of febuxostat in human plasma by high performance liquid chromatography (HPLC) with fluorescence-detection. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1126-1127:121764. [DOI: 10.1016/j.jchromb.2019.121764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/28/2023]
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43
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Keenan RT. Is It Time for Gout Flare Treatment to Move into the 21st Century? J Rheumatol 2019; 46:667-669. [PMID: 31262752 DOI: 10.3899/jrheum.181249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Robert T Keenan
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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44
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Pascart T, Norberciak L, Ea HK, Graf S, Guggenbuhl P, Lioté F. Difficult-to-treat gout flares: eligibility for interleukin-1 inhibition in private practice is uncommon according to current EMA approval. Rheumatology (Oxford) 2019; 58:2181-2187. [DOI: 10.1093/rheumatology/kez203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/10/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Objective
The objective was to determine the proportion of patients with difficult-to-treat or difficult-to-prevent acute gout attacks eligible for IL-1 inhibition.
Methods
Participants included in the French cross-sectional GOSPEL cohort (n = 1003 gout patients) were examined for contraindications and intolerance to standard of care (SoC) drugs of gout flares (colchicine, non-steroidal anti-inflammatory drugs and systemic glucocorticoids). Patients were classified as definitely eligible for first-line IL-1 inhibition (canakinumab) according to European summary of product characteristics (contraindications/intolerance to SoC and at least three flares per year) without any other anti-inflammatory options (contraindications/intolerance only), or potentially eligible (precaution of use). Eligibility to receive IL-1 during an on-going flare related to insufficient efficacy was assessed (second-line eligibility).
Results
Definite first-line eligibility for IL-1 therapy was found in 10 patients (1%) and contraindication to all SoC therapies in nine patients who had presented <3 flares in the past 12 months. At least precaution of use for SoC therapies was noted for 218/1003 patients (21.7%). Of 487 patients experiencing flares at baseline, 114 (23.4%) were still experiencing pain scored ⩾4/10 numeric scale on day 3, one of whom could not receive further SoC drugs. Only nine of them had three or more flares in the past year and were eligible for second-line IL-1 inhibition.
Conclusion
Despite significant numbers of patients without any SoC anti-inflammatory therapeutic options for gout flares, eligibility for IL-1 inhibition therapy according to current European approval is rare.
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Affiliation(s)
- Tristan Pascart
- Service de rhumatologie, Hôpital Saint-Philibert, Université de Lille, Lomme, France
- Laboratoire PMOI, Université de Lille, Lille, France
| | - Laurène Norberciak
- Département de recherche médicale, Hôpital Saint-Philibert, Université de Lille, Lomme, France
| | - Hang-Korng Ea
- Sorbonne Paris Cité, Université Paris Diderot, Paris, France
- AP-HP, Hôpital Lariboisière, pôle appareil locomoteur, service de Rhumatologie, centre Viggo Petersen, Paris, France
- Inserm, UMR 1132, centre Viggo Petersen, Hôpital Lariboisière, Paris, France
| | - Sahara Graf
- Département de recherche médicale, Hôpital Saint-Philibert, Université de Lille, Lomme, France
| | - Pascal Guggenbuhl
- Service de rhumatologie, CHU de Rennes, Rennes, France
- Institut NUMECAN, INSERM U 1241, INRA U 1341, Rennes, France
- Université de Rennes 1, Rennes, France
| | - Frédéric Lioté
- Sorbonne Paris Cité, Université Paris Diderot, Paris, France
- AP-HP, Hôpital Lariboisière, pôle appareil locomoteur, service de Rhumatologie, centre Viggo Petersen, Paris, France
- Inserm, UMR 1132, centre Viggo Petersen, Hôpital Lariboisière, Paris, France
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Abstract
A significant part of patients with gout has contraindications to taking nonsteroidal anti-inflammatory drugs, colchicine and glucocorticoids. Such therapy is often ineffective, particularly in patients with the severe tophaceous gout what hampers treatment of acute arthritis attack assuming the need for other methods of therapy. During the last years several medications have been introduced the mechanism of anti-inflammatory action of which is associated with inhibition of interleukin 1 (IL1) playing a key role in the development of acute gouty arthritis. To date, the most well-studied and the only registered drug for relief of acute arthritis attack is canakinumab, recommended for use in situations where other therapy options are unacceptable. Despite these limitations, the use of IL1 inhibitors, in particular canakinumab, seems promising due to the high efficiency of the drug, the ability to use it in patients with comorbid diseases, as well as a favorable effect on the risk of cardiovascular disease.
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Affiliation(s)
| | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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46
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Dalbeth N, Choi HK, Terkeltaub R. Review: Gout: A Roadmap to Approaches for Improving Global Outcomes. Arthritis Rheumatol 2019; 69:22-34. [PMID: 27389665 DOI: 10.1002/art.39799] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 12/30/2022]
Affiliation(s)
| | - Hyon K Choi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Robert Terkeltaub
- VA San Diego Healthcare System and University of California, San Diego
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You W, Wang J, Zou Y, Che K, Hou X, Fei H, Wang Y. Modified Chuanhu anti-gout mixture, a traditional Chinese medicine, protects against potassium oxonate-induced hyperuricemia and renal dysfunction in mice. J Int Med Res 2019; 47:1927-1935. [PMID: 30832523 PMCID: PMC6567774 DOI: 10.1177/0300060519831182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Acute gout is a painful, inflammatory arthritis that features a rapidly escalating inflammatory response resulting from the formation of monosodium urate crystals in the affected joint space. Previously, we found that Chuanhu anti-gout mixture (CAGM) had similar effects as colchicine against gout in the clinic. Subsequently, to improve its effectiveness and efficacy, we modified the original formulation of CAGM. The current study evaluated the effectiveness of the modified formulation in mice. Methods Potassium oxonate (PO) was used to establish a mouse model of hyperuricemia. Plasma levels of uric acid and creatine were determined using the respective test kits. Hepatic xanthine oxidase (XOD) expression was examined by enzyme-linked immunosorbent assay. To explore the underlying mechanism, renal urate transporter 1 (URAT1) mRNA levels were evaluated by quantitative real-time PCR. Allopurinol and benzbromarone were used as reference drugs. Results The original CAGM and its modified high-dose formulation significantly reduced serum uric acid and creatine levels in hyperuricemic mice. In addition, the CAGM-treated groups displayed lower mRNA levels of hepatic XOD and renal URAT1. Conclusions CAGM and its modified formulation significantly ameliorated PO-induced hyperuricemia in mice, which might be partially attributable to reductions of hepatic XOD and renal URAT1 levels.
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Affiliation(s)
- Wenjun You
- 1 Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,2 Department of Endocrinology, Jining First People's Hospital, Jining, Shandong, China
| | - Jie Wang
- 1 Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yaowu Zou
- 3 Department of Endocrinology, Heze Hospital of Traditional Chinese Medicine, Heze, Shandong, China
| | - Kui Che
- 1 Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xu Hou
- 1 Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Honghua Fei
- 4 Department of Endocrinology, Rizhao First People's Hospital, Rizhao, Shandong, China
| | - Yangang Wang
- 1 Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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48
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Golenbiewski J, Keenan RT. Moving the Needle: Improving the Care of the Gout Patient. Rheumatol Ther 2019; 6:179-193. [PMID: 30826988 PMCID: PMC6514038 DOI: 10.1007/s40744-019-0147-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
Gout is a the most common inflammatory arthritis in the United States. It is a significant cause of morbidity, disability, lost work days, and high healthcare utilization due to intermittent attacks, chronic inflammation, and joint damage. Despite our understanding of the prelude and pathophysiology of gout, hyperuricemia, it is still poorly misunderstood by patients and poorly managed by healthcare providers. Several parallel treatment paradigms have been developed by professional societies around the world based on the understanding of how hyperuricemia occurs, gout epidemiology, expert opinion, and clinical trials data in order to lower uric acid and eventually eliminate the patient's crystal burden. This review focuses on both the treatment of acute attacks, and more importantly, the long-term management of gout and the lowering of serum uric acid levels to a goal of < 6 mg/dl (0.360 mmol/l) or treating to target. Treating to a target serum uric acid goal is an opportunity to decrease morbidity and improve the quality of care of every gout patient.
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Affiliation(s)
- Jon Golenbiewski
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert T Keenan
- Duke Gout and Crystal Arthropathies Clinic, Durham, NC, USA. .,Duke Specialty Infusion Centers, Durham, NC, USA. .,Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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49
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Abeles AM, Pillinger MH. Gout and cardiovascular disease: crystallized confusion. Curr Opin Rheumatol 2019; 31:118-124. [DOI: 10.1097/bor.0000000000000585] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Cleophas MCP, Crişan TO, Klück V, Hoogerbrugge N, Netea-Maier RT, Dinarello CA, Netea MG, Joosten LAB. Romidepsin suppresses monosodium urate crystal-induced cytokine production through upregulation of suppressor of cytokine signaling 1 expression. Arthritis Res Ther 2019; 21:50. [PMID: 30728075 PMCID: PMC6366029 DOI: 10.1186/s13075-019-1834-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
Background Acute gouty arthritis currently is the most common form of inflammatory arthritis in developed countries. Treatment is still suboptimal. Dosage of urate-lowering therapy is often too low to reach target urate levels, and adherence to therapy is poor. In this study, we therefore explore a new treatment option to limit inflammation in acute gout: specific histone deacetylase (HDAC) inhibition. Methods Peripheral blood mononuclear cells (PBMCs) were cultured with a combination of monosodium urate crystals (MSU) and palmitic acid (C16.0) in order to activate the NLRP3 inflammasome and induce IL-1β production. HDAC inhibitors and other compounds were added beforehand with a 1-h pre-incubation period. Results The HDAC1/2 inhibitor romidepsin was most potent in lowering C16.0+MSU-induced IL-1β production compared to other specific class I HDAC inhibitors. At 10 nM, romidepsin decreased IL-1β, IL-1Ra, IL-6, and IL-8 production. IL-1β mRNA was significantly decreased at 25 nM. Although romidepsin increased PTEN expression, PBMCs from patients with germline mutations in PTEN still responded well to romidepsin. Romidepsin also increased SOCS1 expression and blocked STAT1 and STAT3 activation. Furthermore, experiments with bortezomib showed that blocking the proteasome reverses the cytokine suppression by romidepsin. Conclusions Our results show that romidepsin is a very potent inhibitor of C16.0+MSU-induced cytokines in vitro. Romidepsin upregulated transcription of SOCS1, which was shown to directly target inflammatory signaling molecules for proteasomal degradation. Inhibiting the proteasome therefore reversed the cytokine-suppressive effects of romidepsin. HDAC1/2 dual inhibition could therefore be a highly potent new treatment option for acute gout, although safety has to be determined in vivo. Electronic supplementary material The online version of this article (10.1186/s13075-019-1834-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M C P Cleophas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - T O Crişan
- Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - V Klück
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - N Hoogerbrugge
- Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Human Genetics, Radboud university medical center, Nijmegen, the Netherlands
| | - R T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Dinarello
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, Aurora, CO, 80045, USA
| | - M G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands.,Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115, Bonn, Germany
| | - L A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. .,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands. .,Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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