Gout is on the rise – so why do so few patients get treatment they need?

The Irish News 11, November, 2022

Cases of gout are on the rise, but the condition is misunderstood, and few patients get the treatment they need, writes Julie Cook

AS an active young man in his 20s, Harry Tyndall was both shocked and scared to wake up one morning with an intense shooting pain in his right foot.

“It was the worst pain ever – I thought I’d broken it. I couldn’t even walk, yet I had done nothing to injure it,” recalls Harry, who was then just 27.

A trip to A&E followed, where Harry was diagnosed with gout, a form of arthritis that causes sudden, severe joint pain and is often associated with elderly men paying the price for over-indulging in rich food and port.

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Occurrence of gout in rheumatoid arthritis: it does happen! A population-based study

Aim

It has been a popular belief that gout does not typically occur in patients with rheumatoid arthritis (RA). Our aim was to assess the occurrence, prevalence, clinical presentation and possible risk factors for gout in patients with RA.

Patients & methods

We retrospectively reviewed a population-based incidence cohort of patients who fulfilled 1987 ACR criteria for RA between 1980 and 2007. The cumulative prevalence of gout in RA adjusted for the competing risk of death was estimated.

Executive summary

Background

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Gout Comes With Increased Heart Risk

Incident gout and risk of first-time acute coronary syndrome: a prospective, population-based, cohort study in Sweden

Panagiota Drivelegka MD, PhD,Lennart T.H. Jacobsson MD,Ulf Lindström MD,Karin Bengtsson MD, PhD,Mats Dehlin MD

First published: 12 September 2022

https://doi.org/10.1002/acr.25018

Abstract

Objective

To investigate the risk of first-time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout, compared to the general population.

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Ultrasonography in the prediction of gout flares: a 12-month prospective observational study

Abstract

Objectives: To evaluate whether ultrasound (US) findings indicating monosodium urate (MSU) deposits and US-detected inflammation [i.e. power Doppler (PD) signal] predict gout flares over 12 months.

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‘Horribly mismanaged’: Debate over gout treatment rages as cases surge

All around the world, gout prevalence is growing at an alarming pace, while gout treatment remains as “horribly mismanaged” as ever.

This rapid growth has spurred on a worldwide “gout epidemic,” James ODell, MD, Robert L. Grissom professor of internal medicine and vice chair and chief of rheumatology at the University of Nebraska Medical Center, in Omaha, who, told the attendees at the American College of Rheumatology Covergence 2021 annual meeting.

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Diuretics and Gout: Is there a connection?

High Blood Pressure, Prescription Diuretics, and Gout

What is high blood pressure?

High Blood Pressure, also called hypertension, is when blood puts too much pressure against the walls of your arteries. About 1 in 3 adults have high blood pressure, usually with no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack, and kidney disease.

What lifestyle changes can help lower high blood pressure?

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Stress accelerates immune aging, study finds

Traumatic life events, discrimination prematurely weaken body’s mix of immune cells

Date: June 13, 2022

Source: University of Southern California

Summary: Stress — in the form of traumatic events, job strain, everyday stressors and discrimination — accelerates aging of the immune system, potentially increasing a person’s risk of cancer, cardiovascular disease and illness from infections such as COVID-19, according to a new study. The research could help explain disparities in age-related health, including the unequal toll of the pandemic, and identify possible points for intervention.

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Native Hawaiians have higher risk for gout, UH study finds

May 31, 2022, 12:30 PM HST Maui News

An analysis of nearly two decades of data of 92,000 people revealed Native Hawaiians had more than twice the risk of Whites participants of developing gout as older adults.

The new study by University of Mānoa researchers — and one of the largest multiethnic gout studies to date — was published in The Journal of Rheumatology.

Gout, a common and painful form of arthritis, is becoming more prevalent in the United States. But the differences in risk between populations remains largely understudied, especially for Native Hawaiians. This study helped shed some light on these differences. It also revealed black participants had the second highest risk, followed by Japanese participants.

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Uric Acid & Gout News: Hereditary Fructose Intolerance




Hereditary fructose intolerance is a disorder in which a person lacks the protein needed to break down fructose. Fructose is a fruit sugar that naturally occurs in the body. Man-made fructose is used as a sweetener in many foods, including baby food and drinks.

Causes



This condition occurs when the body is missing an enzyme called aldolase B. This substance is needed to break down fructose.

If a person without this substance eats fructose or sucrose (cane or beet sugar, table sugar), complicated chemical changes occur in the body. The body cannot change its stored form of sugar (glycogen) into glucose. As a result, blood sugar falls and dangerous substances build up in the liver.

Hereditary fructose intolerance is inherited, which means it can be passed down through families. If both parents carry a nonworking copy of the aldolase B gene, each of their children has a 25% (1 in 4) chance of being affected.

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Gout: The Other Gene That Affects Urate Levels and Gout Development

The ABCG2 gene belongs to a group of genes called the ATP-binding cassette family; genes in this family provide instructions for making proteins that transport molecules across cell membranes. In the intestines, the ABCG2 protein helps release (secrete) a substance called urate into the urine. Urate is a byproduct of certain normal biochemical reactions in the body. In the bloodstream it acts as an antioxidant, protecting cells from the damaging effects of unstable molecules called free radicals. Urate levels are regulated by the kidneys and, to a lesser extent, by the intestines.

The ABCG2 protein also transports certain drugs out of cells. For example, this protein clears some chemotherapy drugs from organs and tissues. Transport of these drugs allows them to have their intended effects and be eliminated from the body.

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