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Gout: HELP
Articles from Japan
Based on 142 articles published since 2008

These are the 142 published articles about Gout that originated from Japan during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Japanese guideline for the management of hyperuricemia and gout: second edition. 2011

Yamanaka, Hisashi / Anonymous420712. ·Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku-Ku, Tokyo, Japan. yamanaka@ior.twmu.ac.jp ·Nucleosides Nucleotides Nucleic Acids · Pubmed #22132951.

ABSTRACT: Gout is a urate deposition disease caused by persistent hyperuricemia. Because gout patients present with a variety of clinical symptoms, it is necessary to have a guideline for the standard management and care of gout and hyperuricemia. The Japanese Society of Gout and Nucleic Acid Metabolism, a scientific society committed to study nucleic acid metabolism and related diseases, established the first edition of the "Guideline for the Management of Hyperuricemia and Gout" in 2002, and published the revised version in January 2010. This second edition is not only evidence based on a search of systemic literature, but also includes consensus levels by a Delphi exercise to determine the strength of the recommendations. A draft version of this guideline was reviewed by internal and external reviewers as well as a patient. In this guideline, key messages from each chapter are listed as statements together with the evidence level, consensus level, and strength of the recommendation. In this proceeding, several selected chapters on the clinical management of gout and hyperuricemia are described. We hope this guideline is appropriately used for the standard management and care of patients with hyperuricemia and gout in daily practice.

2 Review Recent  decreasing  trends  of  exposure  to  PCDDs/PCDFs/dioxin-like  PCBs  in  general  populations,  and  associations with  diabetes,  metabolic  syndrome,  and  gout/hyperuricemia. 2018

Arisawa, Kokichi. ·Department of Preventive Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School. ·J Med Invest · Pubmed #30282853.

ABSTRACT: The author reviewed recent reports about the blood levels and dietary intake of polychlorinated dibenzo-p-dioxins (PCDDs)/furans (PCDFs)/dioxin-like polychlorinated biphenyls (DL-PCBs) to investigate the trends of dioxin exposure, and epidemiologic studies on the associations of blood levels of dioxins with metabolic diseases. In recent years, dietary intake of dioxins has been decreasing, and the means are equal to or less than 1.0 pg Toxic Equivalents (TEQ)/kg/day in the general populations of several countries. The blood levels of dioxins are also decreasing, probably because of reduced dietary intake. Many cross-sectional studies reported positive associations between blood levels of some isomers or TEQ-based concentrations of PCDDs/PCDFs/DL-PCBs and diabetes in general populations. Three cohort studies on populations with heavy exposure and two nested case-control studies on general populations have also been published, but the results are inconsistent. Three large-scale cross-sectional studies and two cohort studies reported an association between blood levels of some isomers or TEQ-based concentrations of PCDDs/PCDFs/DL-PCBs and metabolic syndrome. In addition, three cross-sectional studies reported significant positive associations with gout/hyperuricemia. Further prospective studies and experimental studies are needed to establish cause-effect relationships, and to clarify the biological mechanisms for the association between background exposure to dioxins and potential health effects. J. Med. Invest. 65:151-161, August, 2018.

3 Review The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis. 2018

Zhang, Qingyu / Gao, Fuqiang / Sun, Wei / Ma, Jinhui / Cheng, Liming / Li, Zirong. ·Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Chaoyang District, Beijing, China. · Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China. · Graduate School of Peking Union Medical, Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China. · Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Institute of Clinical Medicine, Beijing, China. ·PLoS One · Pubmed #29979706.

ABSTRACT: BACKGROUND: Musculoskeletal ultrasound is widely used in diagnosing gout, but its accuracy is debatable. We conducted a systematic review and meta-analysis to quantitatively evaluate the value of ultrasound in the diagnosis of gout. METHODS: We systematically searched for publications using Cochrane Library, PubMed/Medline and Embase and manually screened the references of eligible articles for additional relevant publications. Studies were included in this systematic review if they assessed the diagnostic accuracy of ultrasound in gout compared to that of the gold standard, demonstration of monosodium urate crystals in joint fluid or tophi. We then conducted quantitative analyses by extracting data from each study and calculating the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). The summary receiver operating characteristic curves (sROCs) were constructed to obtain the Q*-index and the area under the curve (AUC). RESULTS: Thirteen studies were included in this meta-analysis. The diagnostic performances of three distinctive ultrasonographic features of gout, double contour sign (DCS), the presence of tophi and the snowstorm sign, were evaluated. For person-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 66% (95% confidence interval (CI) 62%-69%), 92% (95% CI 90%-94%), 25.91 (95% CI 11.80-56.89), 0.8163 and 0.7503, respectively; for the presence of tophi, 56% (95% CI 52%-60%), 94% (95% CI 92%-96%), 21.11 (95% CI 7.84-56.89), 0.8928 and 0.8236, respectively; for the snowstorm sign, 31% (95% CI 27%-36%), 91% (95% CI 88%-93%), 4.54(95% CI 3.13-6.58), 0.5946 and 0.5712, respectively; and for simultaneous consideration of these ultrasonographic features, 80% (95% CI 76%-83%), 83% (95% CI 79%-86%), 19.03 (95% CI 13.97-25.93), 0.889 and 0.8197, respectively. For the joint-/location-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 75% (95% CI 68%-80%), 65% (95% CI 59%-70%), 16.90 (95% CI 5.10-56.03), 0.871 and 0.8014, respectively; and for the presence of tophi, 48% (95% CI 40%-57%), 96% (95% CI 91%-99%), 30.20 (95% CI 9.23-98.87), 0.8776 and 0.8081, respectively. CONCLUSIONS: In this meta-analysis, relatively high specificity but modest or low sensitivity were demonstrated in the diagnosis of gout using each of the three ultrasonographic features for person-based evaluations. Simultaneous consideration of these ultrasound findings may improve the diagnostic sensitivity. However, the double contour sign alone is weak in the differentiation of gout and non-gout for joint-/location-based evaluations. Further well-designed studies are still needed to support the current findings.

4 Review Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis. 2018

Yu, Zhange / Mao, Tianli / Xu, Yaping / Li, Tengqi / Wang, Yanhua / Gao, Fuqiang / Sun, Wei. ·Department of Acupuncture, China-Japan Friendship Hospital, Beijing, 100029, China. · Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. · Department of Trauma and Orthopedics, Peking University People's Hospital, South Xizhimen Street No. 11, Xicheng District, Beijing, 100044, China. · Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. gaofuqiang0604@163.com. · Department of Orthopedics, China-Japan Friendship Institute of Clinical Medicine, Peking Union Medical College, Beijing, 100029, China. gaofuqiang0604@163.com. · Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. 18901267995@163.com. · Department of Orthopedics, China-Japan Friendship Institute of Clinical Medicine, Peking Union Medical College, Beijing, 100029, China. 18901267995@163.com. ·Skeletal Radiol · Pubmed #29725712.

ABSTRACT: OBJECTIVE: Dual-energy CT (DECT) is being widely used in suspected gout patients in recent years. Many clinicians tend to use DECT instead of aspiration biopsy in the diagnosis of gout, but its accuracy has shown controversial results. In this systematic review and meta-analysis, we sought to evaluate the accuracy of DECT in the diagnosis of gout. MATERIALS AND METHODS: We performed a systematic review of the literature published in Medline, Embase, PubMed, and Cochrane databases. Studies included are all clinical trials of DECT in the diagnosis of gout. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). We recorded sensitivity and specificity of algorithms and calculated positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odd ratio (DOR), and respective confidence intervals (CI). The summary receiver operating characteristic curve (sROC) was drawn to get the Cochran Q-index and the area under the curve (AUC). RESULTS: Seven studies were included in this review and showed high homogeneity. The analysis results presented the pooled sensitivity was 88% (95% CI 84-90%) and specificity was 90% (95% CI 85-93%). Then, we figured out that the pooled PLR was 8.48 (95% CI 5.89-12.22) and NLR was 0.10 (95% CI 0.04-0.24) respectively. In addition, Cochran-Q was 0.90 and AUC was 0.9565 in sROC curve. CONCLUSIONS: DECT showed relatively high sensitivity and specificity in the diagnosis of gout. Synthetically considering these DECT abnormalities could improve the diagnostic sensitivity. More rigorous and standardized studies are still needed to support these findings.

5 Review ABCG2 as a therapeutic target candidate for gout. 2018

Fujita, Kyoko / Ichida, Kimiyoshi. ·a Department of Pathophysiology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan. ·Expert Opin Ther Targets · Pubmed #29264928.

ABSTRACT: INTRODUCTION: Hyperuricemia (chronically elevated serum uric acid) is the main pathology underlying the development of gout, the most common inflammatory arthropathy. Management of these conditions therefore relies on controlling serum uric acid levels. ATP-binding cassette transporter, sub-family G, member 2 (ABCG2/BCRP) is a well-studied urate transporter expressed on apical membranes in several tissues, including the intestine, liver, and kidney. Here, we discuss the potential of future gout therapies targeting ABCG2. Areas covered: ABCG2 regulates serum uric acid via physiologically important roles in both renal and extra-renal urate excretion. ABCG2 dysfunction, which promotes onset of hyperuricemia, often results in decreased urate excretion through the extra-renal (principally intestinal), rather than the renal pathway. This review covers recent attempts to establish the basis of ABCG2 function according to genetic diathesis, its molecular structure, and the effects of medication. Furthermore, the possibility of treating gout and hyperuricemia by upregulating intestinal ABCG2 expression is examined. Expert opinion: ABCG2 holds great promise as a therapeutic target for these conditions, particularly considering its involvement in extra-renal urate excretion. Manipulation of ABCG2, including controlling the level and location of its expression, has the potential to prevent gout by promoting uric acid excretion as effectively as general uricosuric drugs. ABBREVIATIONS: ATP-binding cassette (ABC), transmembrane domain (TMD), nucleotide binding domain (NBD), single nucleotide polymorphism (SNP), single nucleotide polymorphisms (SNPs).

6 Review Use of ultrasound for diagnosis and monitoring of outcomes in crystal arthropathies. 2015

Grassi, Walter / Okano, Tadashi / Filippucci, Emilio. ·aClinica Reumatologica, Università Politecnica delle Marche, Ospedale C Urbani Via dei Colli, Jesi (Ancona), Italy bDepartment of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Japan. ·Curr Opin Rheumatol · Pubmed #25633243.

ABSTRACT: PURPOSE OF REVIEW: In the latest recommendations for the diagnosis and management of gout and calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, the diagnostic potential of ultrasound has been recognized. This review highlights the recent advances of research on ultrasound in gout and CPPD crystal deposition disease. RECENT FINDINGS: Ultrasound allows highly sensitive, noninvasive and quick detection of microcrystal aggregates in multiple anatomic areas. Ultrasound can be used as a safe and reliable guide to aspirate even minimal fluid collections suitable for microscopic analysis, and as a tool for monitoring monosodium urate crystal dissolution induced by urate-lowering therapy. The first metatarsophalangeal joint and the knee should be regarded as the anatomic regions with the highest probability of being respectively positive for monosodium urate and CPPD crystal aggregates. SUMMARY: The detection of highly evocative signs in patients with equivocal clinical findings may have a deep impact on the clinical decision-making process, narrowing the differential diagnostic spectrum and avoiding time-consuming and expensive diagnostic procedures. Ultrasound differential diagnosis between gout and CPPD crystal deposition disease is based on the characteristics of crystal aggregates and their preferential localization in different anatomical areas.

7 Review Mechanistic insights into xanthine oxidoreductase from development studies of candidate drugs to treat hyperuricemia and gout. 2015

Nishino, Takeshi / Okamoto, Ken. ·Department of Biochemistry and Molecular Biology, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo, 113-8602, Japan, nishino@nms.ac.jp. ·J Biol Inorg Chem · Pubmed #25501928.

ABSTRACT: Xanthine oxidoreductase (XOR), which is widely distributed from humans to bacteria, has a key role in purine catabolism, catalyzing two steps of sequential hydroxylation from hypoxanthine to xanthine and from xanthine to urate at its molybdenum cofactor (Moco). Human XOR is considered to be a target of drugs not only for therapy of hyperuricemia and gout, but also potentially for a wide variety of other diseases. In this review, we focus on studies of XOR inhibitors and their implications for understanding the chemical nature and reaction mechanism of the Moco active site of XOR. We also discuss further experimental or clinical studies that would be helpful to clarify remaining issues.

8 Review Inflammasome activation in response to dead cells and their metabolites. 2014

Kono, Hajime / Kimura, Yoshitaka / Latz, Eicke. ·Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan. Electronic address: kono@med.teikyo-u.ac.jp. · Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan; Department of Allergy and Rheumatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan. · Institute of Innate Immunity, University Hospital, University of Bonn, 53127 Bonn, Germany; Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; German Center for Neurodegenerative Diseases, 53175 Bonn, Germany. ·Curr Opin Immunol · Pubmed #25282339.

ABSTRACT: Cell death cannot go unnoticed. It demands that the surrounding cells clear away the corpses in a manner appropriate to the type of cell death. Dying cells represent a threat to the body that should be eliminated by the host immune response. Inflammasome activation followed by IL-1alpha release and IL-1beta maturation is crucial for tackling pathological conditions, including infections, whereas inflammasome activation precedes inflammatory pyroptotic cell death. On the other hand, recent studies have shown that the inflammasome plays an important role in the pathogenesis of metabolic diseases, including obesity, diabetes, and atherosclerosis. Here, we review current knowledge of the association between cell death, excess metabolites, and inflammasome activation as it relates to chronic inflammatory diseases.

9 Review Type 1 sodium-dependent phosphate transporter acts as a membrane potential-driven urate exporter. 2013

Miyaji, Takaaki / Kawasaki, Tatsuya / Togawa, Natsuko / Omote, Hiroshi / Moriyama, Yoshinori. ·Advanced Science Research Center, Okayama University, Okayama 700-8530, Japan. tmiyaji@pharm.okayama-u.ac.jp ·Curr Mol Pharmacol · Pubmed #23876149.

ABSTRACT: SLC17A1 protein (NPT1) was the first identified member of the SLC17 phosphate transporter family, and is known to mediate Na(+)/inorganic phosphate (Pi) co-transport when expressed in Xenopus oocytes. Although this protein was suggested to be a renal polyspecific anion exporter, its transport properties were not well characterized. The clean biochemical approach revealed that proteoliposomes comprising purified NPT1 as the only protein source transport various organic anions such as urate, p-aminohippuric acid (PAH), and acetylsalicylic acid (aspirin) in a membrane potential (Δψ)-driven and Cl(-) -dependent manner. Human NPT1 carrying an SNP mutation, Thr269Ile, known to increase the risk of gout, exhibited 32% lower urate transport activity compared to the wild type protein, leading to the conclusion that NPT1 is the long searched for transporter responsible for renal urate excretion. In the present article, we summarized the history of identification of the urate exporter and its possible involvement in the dynamism of urate under physiological and pathological conditions.

10 Review [Urate exporter gene ABCG 2/BCRP and gout risk]. 2011

Takada, Tappei / Matsuo, Hirotaka. ·Department of Pharmacy, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. ·Seikagaku · Pubmed #22352045.

ABSTRACT: -- No abstract --

11 Review [Hyperuricemia and gout]. 2011

Hikita, Miho / Ohno, Iwao / Hosoya, Tatsuo. ·Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine. ·Nihon Rinsho · Pubmed #21766634.

ABSTRACT: -- No abstract --

12 Review A new standard of care? Studies on febuxostat in the management of hyperuricemia with and without gout. 2011

Kamatani, Naoyuki / Hosoya, Tatsuo. ·Center for Genomic Medicine, RIKEN, 2 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan. kamatani@msb.biglobe.ne.jp ·J Clin Rheumatol · Pubmed #21654264.

ABSTRACT: -- No abstract --

13 Review Gout and hyperuricemia in young people. 2011

Yamanaka, Hisashi. ·Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. yamanaka@ior.twmu.ac.jp ·Curr Opin Rheumatol · Pubmed #21169841.

ABSTRACT: PURPOSE OF REVIEW: Although gout and hyperuricemia have received considerable attention recently, there is limited information on the two conditions in young people. The molecular mechanisms of hyperuricemia have been investigated extensively in recent years, with this knowledge providing new insights and a better understanding of the precocious onset of gout and hyperuricemia. RECENT FINDINGS: Serum uric acid levels are higher in the younger generation compared with the older generation. A proportion of gout and hyperuricemia in childhood is due to inborn errors in purine metabolism. Extensive investigation has demonstrated genetic polymorphisms in the urate transporter associated with hyperuricemia and gout. Whether or not polymorphisms affect the onset of gout and hyperuricemia in young people is unclear. Uric acid levels in childhood have also been shown to correlate with the development of the metabolic syndrome. SUMMARY: Elevations in serum uric acid levels in childhood are often associated with other diseases and allied conditions. Hyperuricemia in young individuals is often a marker of the metabolic syndrome. Gout is not common in childhood compared with adulthood, and careful consideration of inborn errors of metabolism should be considered in these cases.

14 Review [Treatment of hyperuricemia and gout based on the guideline for the management of hyperuricemia and gout]. 2010

Taniguchi, Atsuo. ·amtanigu@ior.twmu.ac.jp ·Nihon Yakurigaku Zasshi · Pubmed #21139283.

ABSTRACT: -- No abstract --

15 Review [Molecular mechanism of renal urate transport: urate transporters as novel targets for drug development]. 2010

Anzai, Naohiko. ·anzai-path@umin.ac.jp ·Nihon Yakurigaku Zasshi · Pubmed #21139280.

ABSTRACT: -- No abstract --

16 Review [Genetic testing of hyperuricemia and gout]. 2010

Taniguchi, Atsuo. ·Institute of Rheumatology, Tokyo Women's Medical University. ·Nihon Rinsho · Pubmed #20976911.

ABSTRACT: -- No abstract --

17 Review [Calcium antagonists: current and future applications based on new evidence. The mechanisms on lowering serum uric acid level by calcium channel blockers]. 2010

Mizuta, Einosuke / Hamada, Toshihiro / Igawa, Osamu / Shigemasa, Chiaki / Hisatome, Ichiro. ·Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Japan. ·Clin Calcium · Pubmed #20048433.

ABSTRACT: In hypertensive subjects, their serum uric acid levels tend to be higher because of decreasing urinary secretion or overproduction of uric acid. Among calcium channel blockers (CCBs) , long acting nifedipine and cilnidipine reveal serum uric acid lowering action. They decrease the production of uric acid precursor in skeletal muscles under anaerobic condition induced by hypertension or insulin resistance. Hyperuricemia is considered to be a risk factor of not only gout but also renal and cardiovascular diseases, thus, it is important to use CCBs without adverse effect on uric acid metabolisms.

18 Review [Triggering receptor expressed on myeloid cells-1 as an inflammation amplifier]. 2009

Murakami, Yousuke / Kohsaka, Hitoshi. ·Dearptment of Medicine and Rheumatology, Graduate school of Medicine, Tokyo Medical and Dental University. ·Nihon Rinsho Meneki Gakkai Kaishi · Pubmed #19721344.

ABSTRACT: Triggering receptor expressed on myeloid cells (TREM)-1 is inducible on monocyte/macrophages and neutrophils and accelerates tissue destruction by propagating inflammatory responses in diseases related to bacterial infection. Its blockade suppressed fatal immune responses in mice models of sepsis without impairing the host defense. However, the influence of TREM-1 on non-bacterial diseases was not elucidated. We describe here that TREM-1 expression was up-regulated by prostaglandin (PG) E(2) as well as lipopolysaccharide. Activation of TREM-1 expressed on PGE(2)-pretreated peripheral blood mononuclear cells by an agonistic TREM-1 mAb significantly enhanced the production of TNFalpha. Indeed, monosodium urate monohydrate (MSU) crystals induced TREM-1 expression in vitro and in vivo. MSU crystals and an anti-TREM-1 agonistic antibody synergistically increased the production of interleukin-1beta compared with stimulation with the crystals alone. Furthermore, TREM-1 was expressed on CD14+ cells in rheumatoid synovial tissue and synovial macrophages from mice with collagen-induced arthritis (CIA). Blockade of TREM-1 ameliorated CIA without affecting T cell and B cell immune responses to the inducing antigen. These results provide evidence that TREM-1 may contribute the development of non-microbial inflammatory diseases through the enhancement of inflammatory responses.

19 Review [Other antihyperuricemic agents]. 2008

Ogino, Kazuhide / Igawa, Osamu / Hisatome, Ichiro. ·Center for Clinical Residency Program, Tottori University Hospital. ·Nihon Rinsho · Pubmed #18409527.

ABSTRACT: It has been reported that hyperuricemia might be responsible for cardiovascular diseases as well as gout and renal injury. Hypertension and hyperlipidemia, which are also responsible for cardiovascular diseases, are often associated with hyperuricemia. Thus, the treatment of hypertension and hyperlipidemia associated with hyperuricemia is also important. Losartan, an antihypertensive agent, and fenofibrate, an antihyperlipidemic agent, are known to have uric acid lowering effects. Both agents are useful for hyperuricemia with associated with hypertension and hyperlipidemia. In this section, we reported the characteristics and usefulness of these two agents in hyperuricemic patients with hypertension and hyperlipidemia.

20 Review [Inhibitors of xanthine oxidoreductase]. 2008

Okamoto, Ken. ·Department of Biochemistry and Molecular Biology, Nippon Medical School. ·Nihon Rinsho · Pubmed #18409526.

ABSTRACT: Inhibitors of xanthine oxidoreductase decrease production of uric acid, thus they act as hypouricemic drugs. Allopurinol, a prototypical xanthine oxidoreductase inhibitor, has been widely prescribed for treatment of gout and hyperuricemia. However, severe side effects of allopurinol may occur in patients with renal insufficiency. Recently, novel nonpurine selective inhibitors of xanthine oxidoreductase have been developed as potential alternatives to allopurinol. They have different inhibition mechanisms, utilizing the enzyme structure and the reaction mechanism. Such variation of the inhibition mechanism affects/in vivo/hypouricemic effects of the inhibitors.

21 Review [Uricosuric agent]. 2008

Ohno, Iwao. ·Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine. ·Nihon Rinsho · Pubmed #18409525.

ABSTRACT: Urate lowering treatment is indicated in patients with recurrent acute attacks, tophi, gouty arthropathy, radiographic changes of gout, multiple joint involvement, or associated uric acid nephrolithiasis. Uricosuric agents like benzbromarone and probenecid are very useful to treat hyperuricemia as well as allopurinol (xanthine oxidase inhibitor). Uricosuric agents act the urate lowering effect through blocking the URAT1, an urate transporter, in brush border of renal proximal tubular cells. In order to avoid the nephrotoxicity and urolithiasis due to increasing of urinary urate excretion by using uricosuric agents, the proper urinary tract management (enough urine volume and correction of aciduria) should be performed.

22 Review [Practical strategies for lifestyle modification in people with hyperuricemia and gout treatment through diet, physical activity, and reduced alcohol consumption]. 2008

Mineo, Ikuo / Kamiya, Hiroki / Tsukuda, Akiko. ·Department of Internal Medicine, Izumiotsu Municipal Hospital. ·Nihon Rinsho · Pubmed #18409524.

ABSTRACT: There has been an explosive increase in the prevalence of hyperuricemia and gout in Japan, suggesting the recent lifestyle change may be a key factor leading to this pathophysiological condition. In addition, people with hyperuricemia are often associated with various morbid conditions constituting the metabolic syndrome, such as abdominal obesity, hypertension, dyslipidemia and impaired glucose tolerance. Therefore, healthy lifestyle interventions would be a basic therapeutic approach not only to hyperuricemia but to metabolic syndrome, though it is not easy to promote behaviour changes. This review focuses on strategies for lifestyle intervention for clinical practice, including how we advise patients on appropriate diets, physical activity and alcoholic beverage consumption.

23 Review [Establishment of therapeutic goal and plan of gout and asymptomatic hyperuricemia]. 2008

Fujimori, Shin. ·Department of Internal Medicine, Teikyo University School of Medicine. ·Nihon Rinsho · Pubmed #18409523.

ABSTRACT: Gout is a crystal deposition disease. European and Japanese guidelines of management for gout recommend that serum urate concentration should be maintained below 6.0 mg/dL to promote crystal dissolution leading to prevention of recurrent gouty attack. Although allopurinol is recommended to be an adequate drug for urate lowering therapy in all gouty patients by European guideline, it is desirable that allopurinol is indicated in patients with overproduction type and benzbromarone in patients with underexcretion type, recommended by Japanese guideline. Asymptomatic hyperuricemia dose not equate to gout. As there is no evidence to support treatment of isolated hyperuricemia with urate lowering therapy currently, it is difficult to establish lowering goal of serum urate level in patients with asymptomatic hyperuricemia. Advice regarding lifestyle and treatment of associated comorbidity should be preferred to urate lowering therapy. However, urate lowering therapy may be indicated in high risk patients with hyperuricemia who are suffered from hypertension, diabetes mellitus, ischemic heart disease and renal insufficiency.

24 Review [Urolithiasis and nephropathy complicated with gout]. 2008

Shimizu, Toru. ·Department of Rheumatology, Midorigaoka Hospital. ·Nihon Rinsho · Pubmed #18409521.

ABSTRACT: Urolithiasis is a clinically important complication of gout. For effective prevention of this complication, it is necessary to comprehend the factors known to be important in its development. Our analysis of stones in gout patients revealed that the incidence of common calcium salt stones was over 60%, while that of uric acid stones was only about 30%. This implies that the disruption of uric acid metabolism promotes not only uric acid stones but also calcium salt stones. Twenty-four per cent of gout patients showed acidic urine throughout the day. Urinary management, which consists of hydration and alkalization of urine, is indispensable along with control of the serum urate level in the treatment of gout.

25 Review [Tophaceous gout]. 2008

Moriwaki, Yuji. ·Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine. ·Nihon Rinsho · Pubmed #18409520.

ABSTRACT: Identification of tophi indicates a definitive diagnosis of gout. However, recently they are rarely encountered. Tophi are most often seen in tissues that have a poor blood supply and low temperature, such as the ear helix and first MP joint. The nodules are yellowish-white, and non-tender, and range in size from 1 mm to 7 cm. Aspiration yields a chalky-like material that appears as needle-like crystals under light microscopy. In more advanced cases, tophi have a "punched-out" appearance with an "overhanging" margin on X-ray images. Differential diagnoses include rheumatoid nodules, xanthoma tuberosa, and CPPD crystal deposition diseases. Tophi respond well to anti-hyperuricemic therapy, during which they gradually decrease in size. However, a huge nodule may need to be surgically removed.