Hiperuricemia y gota: el papel de la dieta / Hyperuricemia ang gout: the role of diet

Desde la antigüedad se ha relacionado a la gota con los excesos en el comer y en el beber; sin embargo, ha sido en la última década cuando se ha llegado a un mayor conocimiento sobre los factores dietéticos asociados con el desarrollo de hiperuricemia y gota. La obesidad, el abuso en la ingesta de carnes y las bebidas alcohólicas ya eran vistos como culpables desde la antigüedad. Las legumbres y las verduras ricas en purinas han sido exculpadas tras los estudios. Se han descrito nuevos factores de riesgo, no reconocidos anteriormente, como la fructosa y las bebidas edulcoradas. Finalmente, también se han descrito factores protectores, como los lácteos desnatados. La gota se caracteriza no sólo por el aumento del ácido úrico, eventuales episodios de artritis y el daño crónico articular, sino también por su asociación con diversas comorbilidades y con el aumento del riesgo cardiovascular. La adopción de hábitos dietéticos más sanos puede contribuir a un mejor control de la uricemia y también a una reducción de las enfermedades asociadas. Se recogen las recomendaciones prácticas más habituales según los conocimientos actuales y siguiendo los consejos de las principales guías de tratamiento. Son necesarios más estudios sobre la eficacia real en la práctica clínica de la adopción de unas y otras medidas dietéticas en el tratamiento y evolución de los pacientes con hiperuricemia y gota (AU)

From ancient times, gout has been related with excessive eating and drinking; however, it has not been until the last decade that a broader knowledge on dietary factors associated with hyperuricemia and gout has been achieved. Obesity, excessive intake of red meats and alcoholic beverages were already recognized as causal factors from Antiquity. Legumes and purine rich vegetables have been exculpated after the studies. New risk factors, not previously recognized, have been described such as fructose and sweetened beverages. Finally, protective factors have also been described, such as skimmed dairy products. Gout is characterized not only by an increase in uric acid, eventual episodes of arthritis, and chronic joint damage, but also by association with several comorbidities and increased cardiovascular risk. The adoption of more healthier dietary habits may contribute to better management of uricemia and also to a reduction of associated disea ses. The most common practice recommendations according to current knowledge and the main treatment guidelines are reviewed. Additional studies are needed on the actual efficacy in clinical practice of the adoption of specific dietary measures on the management and clinical course of patients with hyperuricemia and gout (AU)

[Treatment and metaphylaxis of gout complicated by nephropathy and urolithiasis].

The evaluation of clinical efficacy of combined treatment and metaphylaxis in 58 patients with gout complicated by nephropathy and urolithiasis was performed. The study included 41 (71%) men and 27 (29%) women aged 44 to 88 years (mean age - 58 +/- 7 years). All patients received parenteral therapy with trometamol H, 5 -10 infusion for the course, an average of 7 infusions. For the metaphylaxis, all patients received biologically active supplement urisan 2 tablets 2 times a day during next three months against the background of drug therapy. Findings indicate a high clinical efficacy of the trometamol H in the combined treatment of patients with gout, complicated by nephropathy and urolithiasis, considering that improvement of renal function, microcirculation in the renal parenchyma, increased glomerular filtration rate, normalization of nitrogenous wastes levels, partial or complete dissolution of concretions of the kidneys, a significant decrease in the tophs size, an increase in motor activity were observed, which ultimately improves the quality of life for these patients. Metaphylaxis using urisan for 3 months on a background of traditional therapy contributed to a stable normalization of blood uric acid levels, which prevented the exacerbation of underlying disease and recurrent stone formation. These data allow to recommend reducing the dose of traditional anti-gout drugs and conducting repeated course of metaphylaxis with the urisan after 5-6 months during 3 months.

[Effects of serial gout granules on insulin-resistance in primary gout patients].

OBJECTIVE: To clarify the correlation between primary gout and insulin-resistance (IR), and to observe the effect of serial gout granules (SGGs) on IR in patients with primary gout. METHODS: Pearson's correlation analysis and multiple stepwise correlation analysis were conducted between 60 patients and 60 healthy volunteers in terms of blood pressure (BP), blood levels of uric acid (sUA), fasting plasma glucose (FPG), fasting insulin (FINS), fasting leptin (FL), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and C-peptide (CP), body mass index (BMI), waist-to-hip ratio (WHR), insulin resistance index (IRI) and insulin sensitivity index (ISI). Besides, the 60 primary gout patients were equally randomized into two groups, the treatment group treated with SGGs (huzhang gout granule and yinlian gout granule), and the control group treated with diclofenac sodium dual release enteric-coated capsules and Benzbromarone. bove-mentioned indexes in them were assessed before and after 12 weeks of treatment. RESULTS: The levels of sUA, FPG, TC, TG, LDL-C, FINS, CP, FL, IRI, BMI, and WHR were higher while the levels of HDL-C and ISI was lower in gout patients than those in healthy controls (all P < 0.05); Pearson's correlation analysis showed that level of sUA was positively correlated with levels of FPG, FINS, IRI, BMI, TC, TG, LDL-C, CP, FL, systolic pressure and diastolic pressure (r = 0.444, 0.496, 0.660, 0.542, 0.414, 0.467, 0.344, 0.470, 0.419, 0.275, 0.330 respectively, P < 0.05), but negatively correla- ted with levels of ISI and HDL-C (r = -0.569, -0.264 respectively, P < 0.05). Multiple stepwise correlation analysis showed that sUA was also positively correlated with IRI, TG and BMI (r = 5.758, 2.849, 3. 425 respectively, P < 0.05). After 12 weeks of treatment, the lowed range of TC, TG, FINS, FPG and IRI, and the increased amplitude of HDL-C and ISI in the treatment group were superior to those in the control group respectively (P < 0.05). CONCLUSION: Patients with primary gout are low in insulin sensitivity and indicating the existence of IR. SGGs could enhance patients' insulin sensitivity and improve IR to a certain extent.

Diabetes and rheumatic diseases.

PURPOSE OF REVIEW: This review summarizes recent advances in the field of diabetes and rheumatic disease. These conditions exert a significant healthcare burden on our society and much remains to be learned regarding their pathophysiology and treatment. RECENT FINDINGS: We summarize new insights into diabetes and its association with osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, osteoporosis, diffuse idiopathic skeletal hyperostosis, crystalline arthropathy, neuropathic arthropathy, and tendinopathy. Diabetes has major effects on connective tissues, which have significant impact on both the development and outcome of these diseases of cartilage, bone, ligament, and tendon. An improved understanding of the mechanisms through which diabetes alters connective tissue metabolism should lead to better preventive and therapeutic interventions. SUMMARY: Incremental progress has been made in understanding the interactions between diabetes and common musculoskeletal syndromes. Although this review highlights exciting areas of future interest, more work in this field is certainly warranted.

Clinical effect and action mechanism of Weicao Capsule in treating gout.

OBJECTIVE: To study the therapeutic effect of Weicao Capsule (WCC) on gout. METHODS: Two hundred gout patients were assigned to two groups. The treated group was treated with WCC and the control group was treated with Tongfengding Capsule. Both groups were given the respective treatments orally 3 times a day, 2 capsules each time with 2 weeks as one course and all patients received 2 successive courses of treatment. Changes of blood beta(2)-microglobulin (beta(2)-M), hemoglobin (Hb), 24 h urinary protein (24 h UP), pH value of urine and blood uric acid (BUA) as well as kidney function were observed. RESULTS: After treatment, level of beta(2)-M got lowered significantly, Hb and 24 h UP, blood urea nitrogen, serum creatinine and the clearance rate of creatinine, as well as blood lipids all improved obviously in the treated group (all P<0.01), while these parameters remained unchanged in the control group (P>0.05). The pH value of urine was improved in both groups showing an insignificant difference between them (P>0.05). BUA was decreased in both groups with a decrease to a larger extent in the treated group (P<0.01). The total effective rate was 87% in the treated group, which was superior to that in the control group (62%, P<0.05). CONCLUSION: WCC has a favorable therapeutic effect on gout and its mechanism of action for improving renal function and reducing urinary protein could be related with the lowering of blood beta(2)-M, BUA and lipids.

[Research on relationship of syndrome type and parameters of hemorheology and platelet activation in patients with acute gout arthritis of dampness-heat blockage type and stasis-heat accumulate type].

OBJECTIVE: To study the relationship between syndrome type and the parameters of hemorrheology and platelet activation in patients with acute gout arthritis of dampness-heat blockage (DHB) type and stasis-heat accumulation (SHA) type. METHODS: Forty patients with acute gouty arthritis were divided into 2 groups according to TCM syndrome differentiation, the DHB group (n=24) and the SHA group (n=16), and 20 healthy people were taken as the control group. Hemorrheological parameters, platelet activating factor (PAC-1) and P-selection (CD62p) in them were detected. RESULTS: Plasma viscosity, outcome of erythrocyte sedimentation and K value of its equation, levels of PAC-1 and CD62p were higher, erythrocyte electrophoresis index was significantly lower in gout patients of both types than those in the control group (all P < 0.01), and the levels of PAC-1 and CD62p in the SHA group were higher than those in the DHB group (P < 0.05). CONCLUSION: DHB type and SHA syndrome type of acute gout arthritis are correlated with parameters of hemorrheology and platelet activation, and the different levels of these pameters showed in the two types, may be the internal factors for their genesis.

[Evaluation of influence of selenium, copper, zinc and iron concentrations on thyroid gland size in school children with normal ioduria]. / Ocena zaleznosci miedzy stezeniem selenu, miedzi, cynku oraz zelaza w surowicy krwi a wielkoscia tarczycy u dzieci szkolnych z prawidlowym wydalaniem jodu w moczu.

UNLABELLED: Proper diet with regard to quantity and quality of meals is of vital importance for normal development and functioning of the organism. There are many proofs that environmental factors play an important role in the pathogenesis of goiter. Iodine deficit in diet is best known of all factors contributing to goiter. Deficit of other elements like, iron, selenium, copper and zinc is also essential. The purpose of this study was to evaluate the influence of chosen environmental factors, i.e., iron and trace elements of selenium, zinc and copper--essential for the thyroid functioning on the development of goiter in school children aged 6-13 years with normal ioduria in the Polish population. MATERIAL AND METHODS: In 2002, the study was performed in 4 elementary schools chosen randomly in Bialystok and in the Children's Outpatient Clinic of Endocrinology of the Specialist Regional Hospital. The study included 400 children aged 7-13 years from schools and 120 patients at the same age treated with KJ and/or tyroxine for minimum 12 months due to goiter in the Out-patient Clinic of Endocrinology. Basing on the assessment of the thyroid size as well as the criteria of WHO from 1997 year for body surface and sex, children were divided into 2 subgroups: with goiter and the thyroid gland within the norm. Children aged 9-11 years were qualified and chosen from subgroups to further examinations. In both subgroups, blood samples were taken to determine concentrations of iron, selenium, copper and zinc. RESULTS: The mean concentration of selenium in the blood was statistically significantly lower in children with goiter in comparison with children with the thyroid gland within the norm (44.4 +/- 7.8 microg/L vs. 49.2 +/- 9.1 microg/L, p = 0.044) in the study population of school children and the Outpatient Clinic of Endocrinology. No differences of serum iron concentrations were observed in children with goiter and with the thyroid gland within the norm. However, nearly the half (45.5%) of patients with the lower serum concentration of iron (< 60 microg/dL) had goiter despite average 22-month therapy with KJ and/or tyroxine. CONCLUSION: Observed, in spite of proper iodine prophylaxis, 7% rate of goiter occurring in school children suggests other than iodine deficiency factors that influence goiter development. The study proved that the low concentration of iron and/or selenium deficit found in the serum of children with goiter in spite of their treatment with KJ and/or tyroxine may be additional factors influencing the effectiveness of this treatment.

Clinicopathology of gout in growing layers induced by high calcium and high protein diets.

1. An experiment was conducted to test the independent and combined effects of high dietary calcium and protein concentrations on the induction of visceral gout in growing birds of a layer strain. 2. One hundred and sixty healthy birds were randomly divided into 4 groups at 35 d of age. The different groups were given 4 diets containing normal or high concentrations of dietary calcium or crude protein in a 2 x 2 factorial experiment for 30 d. The diets contained normal calcium (Ca) and crude protein (CP) (NCNP, 8.5 g Ca/kg and 175g CP/kg), high calcium and normal protein (HC, 36.3 g Ca/kg and 175 g CP/kg), normal calcium and high protein (HP, 8.8 g Ca/kg and 245 g CP/kg) or high calcium and high protein (HCHP, 36.8 g Ca/kg and 242 g CP/kg), respectively. 3. Typical visceral gout was induced by the HCHP diet. The HCHP and HC diet caused severe kidney damage. The HP diet did not cause kidney damage, but significantly increased plasma uric acid and inorganic phosphorus concentrations. 4. The HC diet significantly increased plasma uric acid, calcium and sodium, but significantly decreased plasma inorganic phosphorus, potassium and magnesium concentrations. The HCHP diet significantly increased plasma uric acid, calcium and sodium. 5. Urine volumes were significantly higher on the HCHP and HC diets than on the control. The growers raised on HC and HCHP diets had significantly higher total quantity of 24 h urinary excretion of uric acid, calcium, magnesium, inorganic phosphorus and potassium and a significantly lower 24 h urinary excretion of sodium. The growers fed on the HP diet had a higher 24 h urinary excretion of uric acid and inorganic phosphorus than the control. 6. It is concluded that growing layer birds should not be fed on layer rations.

Comparative study of serum and synovial fluid interleukin-11 levels in patients with various arthritides.

OBJECTIVE: To determine the levels of serum and synovial fluid (SF) interleukin (IL)-11 in patients with various arthritides and estimate the contribution of IL-11 to acute phase response (APR). DESIGN AND METHODS: Serum and SF IL-11 were measured by ELISA in patients with rheumatoid arthritis (RA, n = 31), seronegative spondyloarthritis (SSA, n = 23), gout (GT, n = 14) and osteoarthritis (OA, n = 20) and were correlated with ESR and acute phase proteins as well as with cytokines IL-1 alpha, IL-1 beta, IL-6, and TNF alpha. RESULTS: IL-11 was detected in both serum and SF in each group, with IL-11 being statistically higher in SF than serum in all groups, suggesting reduced catabolism or increased synthesis of IL-11 intra-articularly. Median SF IL-11 levels were higher in OA patients than in other groups and in the treated than in the untreated RA subgroup. Moreover, serum and SF IL-11 were correlated significantly with each other, and moderately with the other cytokines examined in RA, SSA, and GT, but not in OA patients, while a significant negative correlation was found with a few of the inflammatory markers examined in each group. CONCLUSIONS: Our findings provide evidence of extensive intra-articular expression of IL-11 in arthritides, especially in OA and treated RA patients, suggesting a protective role for IL-11 in joints, probably through the induction of tissue inhibitor of metalloproteinases.