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Objectives: The objectives of this study were to observe the Efficacy of unani pharmacopoeial formulation Boozidan (Pyrethrum indicum) for the management of Niqris Muzmin (Chronic gout) and to observe any concomitant and adverse effects of formulation. Methods: This single blind, randomized and standard control clinical study was conducted between April 2021 to October 2021 for a period of 28 days. 60 patients diagnosed with chronic gout were divided into two groups, 30 Test group and 30 Control group. The test group was administered with 5g boozidaan in powder form once daily with water and the patients of control group were given tablet febuxostat 80mg once daily. Patients were followed up and improvements in subjective parameters were assessed weekly at 7th, 14th, 21st, and 29th day. Objective parameters were assessed at the baseline and at 29th day. The data obtained was subjected to statistical analysis. Results: Both the test and control drug were effective in reducing Serum uric acid level, ESR and CRP levels. A significant improvement in subjective and objective parameters was observed in both test and control groups and no adverse effects were observed during and after the study. However, the test drug had superior efficacy in reducing the objective parameters and it was statistically significant (p-value<0.0001). Conclusion: Both Boozidaan and Febuxostat were safe and significantly effective in resolving the symptoms and signs of gouty arthritis and both have significant effect on reducing serum uric acid level. [ABSTRACT FROM AUTHOR]

Introduction: Gout is the most common rheumatic disease in adults, with prevalence ranging from 0.1% to about 10%. It results from the accumulation of monosodium urate crystals (MUC) in the joints and tissues. A thorough understanding of the clinical presentation, diagnostic factors and available treatment options can significantly reduce the prevalence of gout attacks, minimize joint damage and improve patients' physical function. The aim of this article is to provide clinicians and patients with a summary of the most recent information regarding this condition in order to decrease risk of joint damage and ultimately enhance patient’s quality of life. Review methods: A review of the literature from PubMed (2010-2023) was conducted. The articles were selected based on specific keywords and then evaluated for their significance and suitability for inclusion in this review. Description the state of knowledge: Gout is an inflammatory arthritis associated with hyperuricemia, defined as elevated level of uric acid in the blood (> 7 mg/dl (420 µmol/l)). Initially, acute gouty arthritis is characterised by sudden onset of severe pain, erythema and swelling, significantly reducing range of movement. However, as disease progresses, chronic, tophaceous gout can develop potentially leading to bone deformities and other complications. Treatment of gout includes management of the attacks and chronic uric acid-lowering therapy. Summary: Gout is a complex disease with various factors contributing to its clinical presentation. Its management requires a multidisciplinary approach including medication management, dietary counselling and lifestyle modification. Early diagnosis as well as appropriate treatment are essential to optimise patient outcomes and maintain patients' physical function.

An osteolytic lesion on imaging can be considered malignancy until proven otherwise. However, advanced stages of gout have presented with sclerotic rims and lytic lesions thought to be due to overexpression of osteoclasts. Patients have been found to demonstrate osteolytic lesions in patellar regions, which are common locations for gout to manifest; however, to our knowledge, no other cases of osteolytic gout in the acromioclavicular joint have been reported at this time. We report a rare case of a 56-year-old male who presented with acute-on-chronic left upper extremity pain and was found to have an osteolytic lesion of the shoulder on imaging. This lesion was later biopsied and found to be histologically consistent with gout. This case report aims to elucidate further understanding of the various ways that gout can present, to diagnose and treat these patients more effectively.

Rheumatoid arthritis (RA) and gout are two distinct types of inflammatory arthritis with significant morbidity. While RA is characterized by autoimmune synovitis, gout is defined by the deposition of urate crystals. Diagnosing these conditions becomes particularly challenging in patients with negative serological markers for RA, compounded by the patient's advanced age and potential for malignancy. This case involves a 77-year-old male with chronic gout, hypertension, chronic atrial fibrillation on edoxaban, diastolic congestive heart failure, and chronic kidney disease stage 3B, presenting with left knee pain and limited mobility. Despite negative serology for RA (rheumatoid factor (RF) <20.0 IU/ml, anti-CCP2 antibodies 1.2 U/mL), the clinical presentation raised suspicion for RA. Imaging revealed significant synovial hypertrophy and multiple periarticular lesions suggestive of chronic gouty tophi rather than RA or malignancy. The patient was managed with allopurinol, prednisolone, and colchicine and referred to rheumatology for further evaluation. Approximately 30% of RA patients may present with negative serological markers, complicating the diagnosis. Differentiating RA from gout is crucial due to differences in management strategies. Imaging modalities such as MRI and CT are essential in identifying characteristic changes of both conditions, such as synovial hypertrophy in RA and tophi in gout. In elderly patients, the possibility of malignancy should also be considered. This case highlights the complexity of diagnosing gouty arthritis mimicking seronegative RA, especially in elderly patients where the risk of malignancy must be considered. It underscores the need for comprehensive clinical and imaging evaluations and personalized treatment plans in managing patients with multiple comorbidities., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Keelapattu et al.)

Introduction: Pegloticase, a potent uricolytic biologic enzyme, has been shown to be an effective therapeutic option in patients with uncontrolled gout. However, there are limited data on clinical response after a gap in therapy and retreatment with pegloticase.Case Series: This report describes four patients with chronic gout who were successfully managed with pegloticase and were retreated following a gap in therapy. Patient charts from a practice-based rheumatology clinic were retrospectively analyzed; four male patients, aged 70-75 years, with chronic gout and a more than 4-week gap in pegloticase therapy were reviewed. Before pegloticase treatment, patients had received allopurinol or febuxostat, but they continued exhibiting symptoms, including visible tophi and serum uric acid (SUA) levels of 5.2-10.2 mg/dL (309-607 μmol/L), despite oral urate-lowering therapy. The first pegloticase treatment (8-mg infusion every 2 weeks) lasted 22-124 weeks. Pegloticase resolved tophi and improved SUA to below 1.5 mg/dL (less than 89 μmol/L); however, patients discontinued pegloticase because of symptom resolution, poor adherence, or personal reasons. Following treatment gaps (12-156 weeks), symptoms and SUA levels increased and patients were retreated with pegloticase (4-147 weeks). In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0 mg/dL (less than 59 μmol/L) and resolved symptoms. One patient experienced an infusion reaction and discontinued; no infusion reactions, gout flares, or adverse events occurred among the other three patients.Conclusion: Retreatment with pegloticase after a gap in therapy appears to be an effective and tolerated option in prior responders.Funding: Horizon Pharma. [ABSTRACT FROM AUTHOR]

Gout is the most common type of arthritis in developed countries that is often inadequately managed. Evidence regarding role of hyperuricaemia in poor outcomes in gout patients (e.g., disability, recurrent hospital admissions) with/without other chronic cardiometabolic comorbidities prompts the search of newer and more effective drugs. Current management of gout is limited to NSAIDS and intra-articular corticosteroids in acute gout and Allopurinol or Febuxostat with or without probenecid in chronic gout. Other drugs used as add-on therapy in refractory cases of gout who fail on monotherapy include benzbromarone and pegloticase but with limited role. Though these drugs have been available for several years, significant proportion of compliant patients fail to achieve consistent control of uric acid levels resulting in acute gout flares. Recent advances in the role of urate transporters in proximal tubules of kidney have resulted in the development of new generation uricosuric drugs including lesinurad. It is recently approved by US Food and Drug Administration (US FDA) and European Medicines Agency (EMA) in patients with uncontrolled gout along with Allopurinol or Febuxostat. Hopefully, it will contribute to fulfill the unmet goals in management of gout. This review aims at exploring the current therapeutic strategies for the management of chronic gout patients as well as their limitations and the role of Lesinurad in patients who have failed on monotherapy. The published studies and poster presentations were identified by conducting a literature search from electronic database from 1980 till January 2017, using various medical subject headings and terminologies. These studies were screened and publications considered relevant to the topic were included in the study.

Gout develops in four stages beginning with an asymptomatic increase in blood levels of uric acid. An acute gout attack is an expression of an underlying inflammatory process, which in the course of time is self-limiting. Without therapy monosodium urate crystals remain in the synovial fluid and synovial membrane and trigger more acute attacks. In the course of the disease monosodium urate crystals form deposits (tophi) leading in severe forms to irreversible joint deformities with loss of functionality. In 20% of cases gout leads to involvement of the kidneys. Overproduction of uric acid can cause nephrolithiasis. These stones can be composed of uric acid or calcium phosphate. Another form of kidney disease caused by gout is uric acid nephropathy. This is a form of abacterial chronic inflammatory response with deposition of sodium urate crystals in the medullary interstitium. Acute obstructive nephropathy is relatively rare and characterized by renal failure due to uric acid precipitation in the tubules because of rapid cell lysis that occurs, for example, with chemotherapy. There is a causal interdependence between the occurrence of hyperuricemia and hypertension. Uric acid activates the renin-angiotensin-aldosterone (RAA) system and inhibits nitric oxide (NO) with the possible consequence of a rise in systemic vascular resistance or arteriolar vasculopathy; however, uric acid is also an apparently independent risk factor for atherosclerosis. In contrast to young patients, the diagnosis of an acute gout attack in the elderly can be a challenge for the physician. Polyarticular manifestations and obscure symptoms can make it difficult to differentiate it from rheumatoid arthritis and calcium pyrophosphate deposition disease (CPPD). Aspiration of synovial fluid with visualization of urate crystals using compensated polarized light microscopy is the gold standard for diagnosis of acute gout. Moreover, analysis of synovial fluid enables a distinction from septic arthritis by Gram staining and bacterial culture. Soft tissue ultrasonography is useful to detect affected synovial tissue and monosodium urate crystals within the synovial fluid. Involvement of bone occurs relatively late in the disease so that x‑ray images are not useful in the early stages but might be helpful in differential diagnostics. Dual energy computed tomography (CT) and magnetic resonance imaging (MRI) can be used for certain indications. [ABSTRACT FROM AUTHOR]

Gout is the most common type of arthritis in developed countries that is often inadequately managed. Evidence regarding role of hyperuricaemia in poor outcomes in gout patients (e.g., disability, recurrent hospital admissions) with/without other chronic cardiometabolic comorbidities prompts the search of newer and more effective drugs. Current management of gout is limited to NSAIDS and intra-articular corticosteroids in acute gout and allopurinol or febuxostat with or without probenecid in chronic gout. Other drugs used as add-on therapy in refractory cases of gout who fail on monotherapy include benzbromarone and pegloticase but with limited role. Though these drugs have been available for several years, significant proportion of compliant patients fail to achieve consistent control of uric acid levels resulting in acute gout flares. Recent advances in the role of urate transporters in proximal tubules of kidney have resulted in the development of new generation uricosuric drugs including lesinurad. It is recently approved by US Food and Drug Administration (US FDA) and European Medicines Agency (EMA) in patients with uncontrolled gout along with allopurinol or febuxostat. Hopefully, it will contribute to fulfill the unmet goals in management of gout. This review aims at exploring the current therapeutic strategies for the management of chronic gout patients as well as their limitations and the role of lesinurad in patients who have failed on monotherapy. The published studies and poster presentations were identified by conducting a literature search from electronic database from 1980 till January 2017, using various medical subject headings and terminologies. These studies were screened and publications considered relevant to the topic were included in the study. [ABSTRACT FROM AUTHOR]

Introduction: Gout is characterized by recurrent episodes of acute inflammation of joint structures, called gout flares, and flares are commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs). The objective of the study was to evaluate risk factors associated with acute kidney injury (AKI) attributed to NSAIDs in a cohort of patients who were exposed to NSAIDs to treat gout flares prior to urate-lowering therapy. Methods: Retrospective analysis of a nested cohort of 983 gout patients in whom general variables (age, gender, renal function, ethanol intake, hypertension, hyperlipidemia, diabetes, vascular events, diuretic use) and also variables related to gout and severity of gout (serum urate levels, number for flares per year, presence of tophi, joint distribution, X-ray involvement, previous urate-lowering therapy) were available for analysis. Outcomes considered were loss of renal function attributed to NSAID prescription following the RIFLE classification for (risk, injury, and failure) for acute renal events. Variables associated with increased risk in Kaplan-Meier survival analysis were tested with multivariable Cox survival analysis, using time from onset of gout to the event as time exposed to NSAIDs. Results: Of 983 patients, 55 (5.6%) experienced AKI; the number of flares in the year previous to the renal event and polyarticular joint distribution were associated with higher risk of renal events. Other variables previously described in the literature, such as previous chronic renal disease, use of diuretics, and presence of previous vascular events, were also independently associated with increased risk of AKI. Interestingly, patients who had been previously prescribed allopurinol showed a lower risk of acute renal events. Conclusion: In addition to classic risk factors, the number of flares and extensive joint distribution were associated with higher risk for renal injury in patients with gout, while previous prescription of allopurinol was associated with lower risk. [ABSTRACT FROM AUTHOR]

Gout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in the elderly, including some unusual sites; its incidence is similar in both genders in the elderly even if the latency period between its initial diagnosis and the onset of tophi is higher in men; and vertebral localizations are rising and often solitary. The components of metabolic syndrome are the most common medical conditions associated with tophaceous gout. In conclusion, tophaceous gout in the elderly may be a growing medical problem and cause of disability in years, partly because of the new sites involved. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship of steroid use with tophus formation and other comorbid conditions among male gout patients. Methods: Review of medical records of Filipino gout patients under the care of rheumatologists was conducted. Univariate analysis (chi-square, Student’s t-test) and multiple logistic regression analysis were performed to establish the risk for tophus formation among glucocorticoid users. Bivariate analysis was separately done to determine the confounding effect of steroid use in the association of comorbidities and tophi formation. Results: There were 295 Filipino men with a mean age of 56 years and a mean duration of 12 years of gouty arthritis who were included in the study. Multivariate analysis showed a five times higher likelihood (OR 4.81 95% CI 1.92–12.04, P < 0.001) for tophus formation among prolonged steroid users. Confounders identified were disease duration of gout (≥ 10 years), presence of chronic kidney disease (CKD) and elevated serum creatinine level (SCr). Bivariate analysis of comorbidities showed that steroid use introduced a considerable bias in the relationship of hypertension, elevated SCr, CKD and dyslipidemia. Conclusion: Patients with equivalent prednisone intake of at least 15 mg/week for ≥ 3 months is associated with tophi formation. In the presence of hypertension, renal impairment, and elevated serum creatinine level, use of steroids confounds the individual risk that each factor carries. [ABSTRACT FROM AUTHOR]

Febuxostat is an antihyperuricemic drug used for the treatment of hyperuricemia in patients with chronic gout. Hence, in this work, there was an impetus to construct a sensitive electrochemical sensor for the detection of febuxostat (FBX) drug in human plasma of patients. A novel electrochemical sensor was successfully fabricated based on gold nanoparticles decorated functionalized carbon nanofibers AuNPs@f-CNFs modified pencil graphite rod electrode (PGRE) to determine FBX drug. The new sensor showed a superior performance in terms of a wide linear range (0.03–77 µM) with high sensitivity (5.9 μA μM−1 cm−2). The limits of detection (LOD) and quantification (LOQ) of FBX were deliberated to be 12.7 nM and 42.5 nM, respectively. Furthermore, electrochemical sensing of FBX in the presence of ascorbic acid, dopamine and uric acid was examined. The fabricated electrode directly paved the new way for the electrochemical quantification of FBX in pharmaceutical formulations, plasma of patients with gout and human biological fluids. Finally, the ultra-high performance liquid chromatography (UHPLC) method was performed to validate the reliability of the proposed method. [Display omitted] • A novel AuNPs@f-CNFs nanocomposite modified PGRE was successfully fabricated for the first time. • The new sensor exhibited superior performance toward electrosensing of FBX with high sensitivity. • The designed sensor is a promising tool for the simultaneous detection of the AA, DA, UA and FBX. • The determination of FBX drug in plasma of patients with gout was achieved using the offered electrochemical sensor. [ABSTRACT FROM AUTHOR]

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect., (Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis. Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout. Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs. The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.