Gout: Can management be improved?

Current Opinion in Rheumatology

Volumn 13, Issue 3, 2001, Pages 240-244

  Schlesinger, Naomi ^a   Schumacher Jr , H Ralph ^b  

^a RUTGERS NEW JERSEY MEDICAL SCHOOL   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ALLOPURINOL; AZATHIOPRINE; COLCHICINE; CORTICOSTEROID; CORTICOTROPIN; DIURETIC AGENT; INSULIN; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; NONSTEROID ANTIINFLAMMATORY AGENT; PROBENECID; URIC ACID;

ALCOHOL CONSUMPTION; CLINICAL PROTOCOL; CLINICAL TRIAL; CORTICOSTEROID THERAPY; DIETARY INTAKE; DIURETIC THERAPY; DRUG EFFICACY; DRUG MECHANISM; DRUG WITHDRAWAL; GOUT; HUMAN; INSULIN SENSITIVITY; LONG TERM CARE; PATHOPHYSIOLOGY; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; RISK FACTOR; TREATMENT OUTCOME; TREATMENT PLANNING; URIC ACID BLOOD LEVEL; WEIGHT GAIN;

ACUTE DISEASE; CAUSALITY; CYCLOSPORINE; GOUT; GOUT SUPPRESSANTS; HUMANS; IMMUNOSUPPRESSIVE AGENTS; URIC ACID;

EID: 0035025099     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: 10.1097/00002281-200105000-00016     Document Type: Review

References (41)

1. 1 Schlesinger N, Baker DG, Schumacher HR Jr: Interventions for hyperuricemic gout [Cochrane Review]. In The Cochrane Library, Issue 1. Oxford: Update software, 2000.
2. 2 Schlesinger N, Baker DG, Schumacher HR, Jr. Gout: How well have diagnostic tests and therapies been evaluated? Curr Opin Rheumatol 1999, 11:441-445.
3. 3 Lin KC, Lin HY, Chou P: Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kimmen. J Rheumatol 2000, 27:1045-1050. Alcohol consumption and central obesity were found to be independent predictors of gout among hyperuricemic patients irrespective of SUA level.
4. 4 Lin KC, Lin HY, Chou P: The interaction between SUA level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 2000, 27:1501-1505. SUA level, alcohol consumption, use of diuretics, and excessive weight gain were found to be independent factors affecting the onset of gout among hyperuricemic men.
5. 5 Dessein PH, Shipton AE, Stanwix AE, et al: Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000, 59:539-543. This was accompanied by a 67% reduction in frequency of monthly gouty attacks. The authors advocate limitation of carbohydrate intake, an increased proportional intake of protein, and the use of unsaturated fat because they all enhance insulin sensitivity and therefore may promote a reduction in SUA. Mean SUA decreased by 18% in gouty patients after 4 months of dietary intervention that enhanced insulin sensitivity.
6. 6 Yu TF, Gutman AB: Study of the paradoxical effects of salicylate in low, intermediate, and high dosage on the renal mechanisms of excretion of urate in man. J Clin Invest 1959, 38:1298-1313.
7. 7 Caspi D, Lubart E, Graff E, et al: The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum 2000, 43:103-108. The ingestion of minidose aspirin results in a modest increase in SUA in older patients. Given the widespread (and often unmonitored) use of minidose aspirin, clinicians' alertness to the use of minidose aspirin in the patient with gout is warranted.
8. 8 Harris M, Bryant R, Danaher P, et al: Effect of low dose daily aspirin on serum urate levels and urinary excretion in patients receiving probenecid for gouty arthritis. J Rheumatol 2000, 27:2873-2876.
9. 9 Shadick NA, Kim R, Weiss S, et al: Effect of low level lead exposure on hyperuricemia and gout among middle aged and elderly men: the normative aging study. J Rheumatol 2000, 27:1708-1712.
10. 10 Ball GV, Sorensen LB: Pathogenesis of hyperuricemia in saturnine gout. N Engl J Med 1969, 280:1199-1202.
11. 11 Clive DM: Renal transplant-associated hyperuricemia and gout. J Am Soc Nephrol 2000, 11:974-979. Hyperuricemia and gout are common problems among renal transplant recipients. This article explores the metabolic basis of gout in transplant patients as well as treatment of gout in these patients.
12. 12 Wluka AE, Ryan PF, Miller AM, et al: Post cardiac transplantation gout: incidence of therapeutic complications. J Heart Lung Transplant 2000, 19:951-956. Gout is common among cardiac transplant recipients. NSAID treatment should be avoided. Colchicine treatment should be supervised. Short courses of corticosteroids can be safely used. The combination of azathioprine and allopurinol should be avoided when possible.
13. 13 Simkin PA, Gardner GC: Colchicine use in cyclosporine treated transplant recipients: how little is too much? J Rheumatol 2000, 27:1334-1337.
14. 14 Harris KP, Jenkins D, Walls J: Non-steroidal anti-inflammatory drugs and cyclosporine: a potentially serious adverse interaction. Transplantation 1988, 46:598-599.
15. 15 Myers BD, Sibley R, Newton L, et al: The long-term course of cyclosporine-associated chronic nephropathy. Kidney Int 1988, 33:590-600.
16. 16 Schnieder A, Stahl RAK: Cyclooxygenase-2 (COX-2) and the kidney: implications for renal function. Am J Physiol 1998, 272:F460-F468.
17. 17 Braun WE, Richmond BJ, Protiva DA, et al: The incidence of management of osteoporosis, gout and avascular necrosis in recipients of renal allografts functioning more than 20 years treated with prednisone and azathioprine. Transplant Proc 1999, 31:1366-1369.
18. 18 Braun WE: Modification of the treatment of gout in renal transplant recipients. Transplant Proc 2000, 32:199.
19. 19 Ippolito G, Negri M, Campana C, et al: Urate oxidase in hyperuricemic heart transplant recipients treated with azathioprine. Transplantation 1997, 63:1370-1371.
20. 20 Zurcher RM, Bock HA, Theil G: Excellent uricosuric efficacy of benzobramone in cyclosporine-A treated renal transplant patients: a prospective study. Nephrol Dial Transplant 1994, 9:549-551.
21. 21 Pittman JR, Bross MH: Prognosis and management of gout. Am Fam Physician 1999, 59:1799-1806.
22. 22 Carew M, Roberts K: Care of the patient with gout. Geriatr Nurs 2000, 20:156-157.
23. 23 Ellis S, Isenberg D: Controlling hyperuricemia. Practitioner 1999, 249:886-891.
24. 24 Ben-Chetrit E, Levy M: Colchicine: 1998 update. Semin Arthritis Rheum 1998, 28:48-59.
25. 25 Ahbern MJ, Reid C, Gordon TP: Does colchicine work? Results of the first controlled study in gout. Aust NZ J Med 1987, 17:301-304.
26. 26 Paulus HE, Schlosstein LH, Godfrey RC, et al: Prophylactic colchicine therapy in intercritical gout. Arthritis Rheum 1987, 17:609-614.
27. 27 Guazzo E: Use of intravenous colchicine for podagra. Am Fam Physician 1999, 60:2504-2505.
28. 28 Stephan WH: Use of intravenous colchicine in patients with acute gout. Am Fam Physician 2000, 61:2343-2344.
29. 29 Evans IT, Wheeler MT, Small RE, et al: A comprehensive investigation of inpatient colchicine use shows more education is needed. J Rheumatol 1996, 23:143-148.
30. 30 Wallace SL, Singer JZ: Review: systemic toxicity associated with the intravenous administration of colchicine: guidelines for use. J Rheumatol 1988, 15:495-499.
31. 31 Roberts WN, Liang MH, Stern SH: Colchicine and acute gout: reassessment of risks and benefits. JAMA 1987, 257;1920-1922.
32. 32 Mullins ME, Carrico EA, Horowitz Z: Fatal cardiovascular collapse following acute colchicine ingestion. Clin Toxicol 2000, 38:51-54.
33. 33 Gordon GV, Schumacher: Management of gout. Am Fam Physician 1969, 10:62-66.
34. 34 Gray RG, Tenenbaum J, Gottlieb NL: Local corticosteroid injection treatment in rheumatic disorders. Semin Arthritis Rheum 1979, 10:231-254.
35. 35 Fernandez C, Noguera R, Gonzalez JA, et al: Treatment of acute attacks of gout with small doses of intraarticular triamcinolone acetonide. J Rheumatol 1999, 26:2285-2286.
36. 36 Groff GD, Franck WA, Raddatz DA: Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Semin Arthritis Rheum 1999, 19:329-336.
37. 37 Alloway JA, Moriarty MJ, Hoogland YT, et al: Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis J Rheumatol 1993, 20:111-113.
38. 38 Wortmann RL: Effective treatment of gout: an analogy. Am J Med 1998, 105:513-514.
39. 39 Fam AG: Should patients with interval gout be treated with urate lowering drugs? [editorial] J Rheumatol 1995, 22:1621-1623.
40. 40 Ferraz MB: An evidence based appraisal of the management of tophaceous interval gout. J Rheumatol 1995, 22:1618-1620.
41. 41 Ferraz MB, O'Brien B: A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis. J Rheumatol 1995, 22:908-914.