Are non-steroidal anti-inflammatory drugs safe and effective in patients with acute gout? A Cochrane review summary with commentary

Clinical Benefits of Ibuprofen Arginine: A Narrative Review

Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibuprofen. Clinical studies consistently demonstrate that IBA achieves meaningful pain relief within a shorter timeframe while maintaining a favorable safety profile. IBA's rapid action is particularly valuable in managing acute exacerbations of chronic pain and preventing central sensitization, thus improving patient comfort, adherence, and overall quality of life. By addressing both the inflammatory and nociceptive components of pain, IBA offers an effective and well-tolerated alternative in multimodal pain management strategies. This review explores the clinical benefits of IBA in pain management among various clinical settings.

Assessment of electronic health literacy and its association with self-management among gout patients: A cross-sectional study

Objectives

This study aimed to assess electronic health (eHealth) literacy and self-management ability among gout patients in China and analyze their correlation.

Patients and methods

A cross-sectional study was conducted on 168 male gout patients (mean age: 44.5±13.8 years, range, 22 to 76 years) using a gout patient self-management assessment scale and the Chinese version of eHealth Literacy Scale between August 2020 and February 2021. The correlation between eHealth literacy and gout self-management was examined. Multivariate regression analysis was conducted to identify the predictors of gout patients' self-management ability.

Results

The scores of eHealth literacy and self-management were 28.56±1.72 and 3.59±0.78, respectively, which were both in the medium level, with the lowest score in the lifestyle management dimension. Pearson's correlation analysis showed that eHealth literacy was significantly and positively associated with the total score of gout self-management and its four dimensions. Literacy in eHealth (β=0.399, p<0.001, 95% confidence interval [CI]: 0.023-0.069), living with family members (β=0.336, p=0.001, 95% CI: 0.313-1.234), living in an urban area (β=0.312, p=0.005, 95% CI: 0.191- 1.022), and having college or a higher level of education (β=0.268, p=0.016, 95% CI: 0.032-0.302) were the significant predictors of gout patients' self-management ability, explained 30.6% of the total variance.

Conclusion

Literacy in eHealth was the most significant predictor of gout self-management ability. Gout patients had the lowest score in the perceived ability of searching and applying online health-related information, indicating that both the quantity and quality of gout-specific information needs to be enlarged in electronic resources. Healthcare providers could design and implement eHealth literacy interventions to strengthen patients' gout self-management ability.

Revealing the potential bioactive components and mechanism of Qianhua Gout Capsules in the treatment of gouty arthritis through network pharmacology, molecular docking and pharmacodynamic study strategies

Recent clinical studies have confirmed the effectiveness of Qianhua Gout Capsules (QGC) in the treatment of gouty arthritis (GA). However, the specific regulatory targets and mechanisms of action of QGC are still unclear. To address this gap, we utilized network pharmacology, molecular docking, and pharmacodynamic approaches to investigate the bioactive components and associated mechanisms of QGC in the treatment of GA. By employing UPLC-Q Exactive-MS, we identified the compounds present in QGC, with active ingredients defined as those with oral bioavailability ≥30 % and drug similarity ≥0.18. Subsequently, the targets of these active compounds were determined using the TCMSP database, while GA-related targets were identified from DisGeNET, GeneCards, TTD, OMIM, and DrugBank databases. Further analysis including PPI analysis, GO analysis, and KEGG pathway enrichment was conducted on the targets. Validation of the predicted results was performed using a GA rat model, evaluating pathological changes, inflammatory markers, and pathway protein expression. Our results revealed a total of 130 components, 44 active components, 16 potential shared targets, GO-enriched terms, and 47 signaling pathways related to disease targets. Key active ingredients included quercetin, kaempferol, β-sitosterol, luteolin, and wogonin. The PPI analysis highlighted five targets (PPARG, IL-6, MMP-9, IL-1β, CXCL-8) with the highest connectivity, predominantly enriched in the IL-17 signaling pathway. Molecular docking experiments demonstrated strong binding of CXCL8, IL-1β, IL-6, MMP9, and PPARG targets with the top five active compounds. Furthermore, animal experiments confirmed the efficacy of QGC in treating GA in rats, showing reductions in TNF-α, IL-6, and MDA levels, and increases in SOD levels in serum. In synovial tissues, QGC treatment upregulated CXCL8 and PPARG expression, while downregulating IL-1β, MMP9, and IL-6 expression. In conclusion, this study applied a network pharmacology approach to uncover the composition of QGC, predict its pharmacological interactions, and demonstrate its in vivo efficacy, providing insights into the anti-GA mechanisms of QGC. These findings pave the way for future investigations into the therapeutic mechanisms underlying QGC's effectiveness in the treatment of GA.

Celecoxib Decreases the Need for Rescue Analgesics after Total Knee Arthroplasty: A Meta-Analysis

This systematic review and meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of celecoxib after total knee arthroplasty. Keywords in the PubMed and Scopus databases were used to find article abstracts. Each included clinical trial was assessed using the Cochrane Collaboration risk of bias tool, and we extracted data on postoperative pain assessment using the Visual Analogue Scale (VAS) at rest, ambulation, and active range of motion, rescue analgesic intake, and adverse effects. Inverse variance tests with mean differences were used to analyze the numerical variables. The Mantel-Haenszel statistical method and the odds ratio were used to evaluate the dichotomous data. According to this qualitative assessment (n = 482), two studies presented conclusions in favor of celecoxib (n = 187), one showed similar results between celecoxib and the placebo (n = 44), and three clinical trials did not draw conclusions as to the effectiveness of celecoxib versus the placebo (n = 251). Moreover, the evaluation of the rescue analgesic intake showed that the patients receiving celecoxib had a lower intake compared to patients receiving a placebo (n = 278, I2 = 82%, p = 0.006, mean difference = -6.89, 95% IC = -11.76 to -2.02). In conclusion, the pooled analysis shows that administration of celecoxib alone results in a decrease in rescue analgesic consumption compared to a placebo after total knee surgery.

Association between patient adherence and treat-to-target in gout: A cross-sectional study

The implementation of a treat-to-target (T2T) approach has been widely recommended for achieving optimal outcomes in gout treatment, as substantiated by a wealth of compelling evidence. However, a paucity of knowledge exists regarding the barriers hindering effective T2T management in China. This study seeks to investigate the factors contributing to treatment failure within the context of the T2T strategy. A cross-sectional, multi-center investigation was conducted, involving the completion of electronic questionnaires by outpatients undergoing urate-lowering treatment for a duration exceeding 6 months. These questionnaires encompassed demographic information, disease-related conditions, comorbid conditions, and management. The study analyzed factors associated with serum uric acid levels exceeding 360 µmol/L, poor disease control, and poor medication adherence. A total of 425 valid questionnaires were collected, representing 90.8% of the patients. The T2T implementation rate was 26.82% (n = 114). Factors linked to serum uric acid levels surpassing 360 µmol/L included moderate medication adherence (odds ratio (OR) = 2.35; 95% confidence interval (CI) 1.17-4.77; P = .016), poor medication adherence (OR = 4.63; 95% CI 2.28-9.51; P < .001), and management by general practitioners (OR = 0.60; 95% CI 0.37-0.97; P = .036). The rate of well-controlled patients was 14.35% (n = 61). Predictors of not well controlled encompassed the presence of tophi (OR = 2.48; 95% CI 1.17-5.61; P = .023), general medication adherence (OR = 2.78; 95% CI 1.28-6.05; P = .009), poor medication adherence (OR = 6.23; 95% CI 2.68-14.77; P < .001), and poor patient's perception of gout (OR = 4.07; 95% CI 1.41-13.91; P = .015). A poor medication adherence rate of 55.29% (n = 235) was observed, with lower rates of poor medication adherence associated with the use of febuxostat (OR = 0.35; 95% CI 0.14-0.83; P = .02), uric acid levels exceeding 360 µmol/L (OR = 3.05; 95% CI 1.84-5.12; P = .00), moderate patient education (OR = 2.28; 95% CI 1.29-4.15; P = .01), moderate diet control (OR = 1.98; 95% CI 1.17-3.41; P = .01), and poor diet control (OR = 3.73; 95% CI 1.26-12.83; P = .02). The rate of T2T implementation in China is notably low among patients undergoing urate-lowering treatment of gout beyond 6 months. Importantly, medication adherence demonstrates a significant association with T2T outcomes.