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Gout: HELP
Articles from New York area
Based on 157 articles published since 2010
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These are the 157 published articles about Gout that originated from New York area during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline Autosomal dominant tubulointerstitial kidney disease: diagnosis, classification, and management--A KDIGO consensus report. 2015

Eckardt, Kai-Uwe / Alper, Seth L / Antignac, Corinne / Bleyer, Anthony J / Chauveau, Dominique / Dahan, Karin / Deltas, Constantinos / Hosking, Andrew / Kmoch, Stanislav / Rampoldi, Luca / Wiesener, Michael / Wolf, Matthias T / Devuyst, Olivier / Anonymous4640822. ·Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. · Divisions of Nephrology and Molecular and Vascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. · INSERM U1163, Laboratory of Hereditary Kidney Diseases, Paris, France. · Paris Descartes University, Imagine Institute, Paris, France. · Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. · Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France. · Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium. · Department of Biological Sciences, Molecular Medicine Research Center and Laboratory of Molecular and Medical Genetics, University of Cyprus, Nicosia, Cyprus. · UKD Foundation, New York, New York, USA. · Institute for Inherited Metabolic Disorders, Charles University in Prague, Prague, Czech Republic. · Molecular Genetics of Renal Disorders Unit, Division of Genetics and Cell Biology, Dulbecco Telethon Institute c/o IRCCS San Raffaele Scientific Institute, Milan, Italy. · Division of Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. · Institute of Physiology, University of Zurich, Zurich, Switzerland. ·Kidney Int · Pubmed #25738250.

ABSTRACT: Rare autosomal dominant tubulointerstitial kidney disease is caused by mutations in the genes encoding uromodulin (UMOD), hepatocyte nuclear factor-1β (HNF1B), renin (REN), and mucin-1 (MUC1). Multiple names have been proposed for these disorders, including 'Medullary Cystic Kidney Disease (MCKD) type 2', 'Familial Juvenile Hyperuricemic Nephropathy (FJHN)', or 'Uromodulin-Associated Kidney Disease (UAKD)' for UMOD-related diseases and 'MCKD type 1' for the disease caused by MUC1 mutations. The multiplicity of these terms, and the fact that cysts are not pathognomonic, creates confusion. Kidney Disease: Improving Global Outcomes (KDIGO) proposes adoption of a new terminology for this group of diseases using the term 'Autosomal Dominant Tubulointerstitial Kidney Disease' (ADTKD) appended by a gene-based subclassification, and suggests diagnostic criteria. Implementation of these recommendations is anticipated to facilitate recognition and characterization of these monogenic diseases. A better understanding of these rare disorders may be relevant for the tubulointerstitial fibrosis component in many forms of chronic kidney disease.

2 Editorial Editorial: The Sound and the Fury: Musculoskeletal Ultrasound in the Diagnosis of Gout. 2017

Kissin, Eugene Y / Pillinger, Michael H. ·Boston University School of Medicine, Boston, Massachusetts. · New York University School of Medicine, New York, New York. ·Arthritis Rheumatol · Pubmed #27748075.

ABSTRACT: -- No abstract --

3 Review Tophaceous Gout of the Middle Ear: Case Reports and Review of the Literature. 2019

Saliba, Joe / Sakano, Hitomi / Friedman, Rick A / Harris, Jeffrey P. ·Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, University of California - San Diego, San Diego, California, USA. · Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, USA. · Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, University of California - San Diego, San Diego, California, USA, jpharris@ucsd.edu. ·Audiol Neurootol · Pubmed #31167187.

ABSTRACT: Tophaceous gout of the middle ear is a rare occurrence that presents as a granular white-colored mass. It is frequently misdiagnosed as cholesteatoma or tympanosclerosis in patients who otherwise may not manifest any clinical or biochemical signs of gout. While uncommon, it can lead to clinically significant disease such as conductive hearing loss. The present report describes 2 cases of middle ear gouty tophi initially mistaken for another entity. Both patients underwent surgery, and the diagnosis of gout was revealed after final histopathological analysis. A review of the literature is also presented.

4 Review Gout and cardiovascular disease: crystallized confusion. 2019

Abeles, Aryeh M / Pillinger, Michael H. ·Division of Rheumatology, University of Connecticut Health Center, Meriden. · Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. ·Curr Opin Rheumatol · Pubmed #30601229.

ABSTRACT: PURPOSE OF REVIEW: Gout is associated with the risk of cardiovascular morbidity and mortality, but the biological relationship between the two remains uncertain. The demonstration of reduction of cardiovascular risk with appropriate gout treatment would argue for a causal role for gout in cardiovascular disease. We reviewed recent studies that address the relationship between gout and cardiovascular disease. RECENT FINDINGS: Studies are conflicting; some show that lowering serum uric acid levels leads to better cardiovascular outcomes, whereas others show no such benefit. Inconsistencies in study design may contribute to these variations in outcome. Additionally, different gout treatment strategies may affect cardiovascular outcomes differently. SUMMARY: Despite an abundance of data generated in the last 5 years, it remains unclear whether treating gout with urate-lowering therapy provides a cardiovascular benefit. Additionally, further studies are needed to clarify whether different urate-lowering drugs confer different cardiovascular risks or benefits. Nonurate-lowering agents used for gout or commonly used in gout patients, such as colchicine and statins, may also improve cardiovascular outcomes in this population.

5 Review The Challenges of Approaching and Managing Gout. 2019

Fields, Theodore R. ·Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, Suite 848G, New York, NY 10021, USA. Electronic address: fieldst@hss.edu. ·Rheum Dis Clin North Am · Pubmed #30447743.

ABSTRACT: Despite many effective treatments for gout, its management remains a challenge internationally. Options for optimizing gout management may differ in different practice sizes and settings. Gout incidence is rising and it continues to be associated with increased mortality. Education of patients and medical providers is essential, and newer gout medications need to be used in the most appropriate ways for cost-effective therapy. Special consideration needs to be given to such populations as the elderly and those with renal and cardiovascular disease in gout management. New agents are in development, which may add to the armamentarium for gout management.

6 Review An update on the genetics of hyperuricaemia and gout. 2018

Major, Tanya J / Dalbeth, Nicola / Stahl, Eli A / Merriman, Tony R. ·Department of Biochemistry, University of Otago, Dunedin, New Zealand. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Biochemistry, University of Otago, Dunedin, New Zealand. tony.merriman@otago.ac.nz. ·Nat Rev Rheumatol · Pubmed #29740155.

ABSTRACT: A central aspect of the pathogenesis of gout is elevated urate concentrations, which lead to the formation of monosodium urate crystals. The clinical features of gout result from an individual's immune response to these deposited crystals. Genome-wide association studies (GWAS) have confirmed the importance of urate excretion in the control of serum urate levels and the risk of gout and have identified the kidneys, the gut and the liver as sites of urate regulation. The genetic contribution to the progression from hyperuricaemia to gout remains relatively poorly understood, although genes encoding proteins that are involved in the NLRP3 (NOD-, LRR- and pyrin domain-containing 3) inflammasome pathway play a part. Genome-wide and targeted sequencing is beginning to identify uncommon population-specific variants that are associated with urate levels and gout. Mendelian randomization studies using urate-associated genetic variants as unconfounded surrogates for lifelong urate exposure have not supported claims that urate is causal for metabolic conditions that are comorbidities of hyperuricaemia and gout. Genetic studies have also identified genetic variants that predict responsiveness to therapies (for example, urate-lowering drugs) for treatment of hyperuricaemia. Future research should focus on large GWAS (that include asymptomatic hyperuricaemic individuals) and on increasing the use of whole-genome sequencing data to identify uncommon genetic variants with increased penetrance that might provide opportunities for clinical translation.

7 Review How Can We Improve Disease Education in People with Gout? 2018

Fields, Theodore R / Batterman, Adena. ·Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St., Suite 848-West, New York, NY, 10021, USA. fieldst@hss.edu. · Weill Cornell College of Medicine, New York, NY, USA. fieldst@hss.edu. · Department of Social Work Programs, Hospital for Special Surgery, New York, NY, USA. ·Curr Rheumatol Rep · Pubmed #29516200.

ABSTRACT: PURPOSE OF REVIEW: Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts. RECENT FINDINGS: Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education. An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

8 Review Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation. 2018

Johnson, Richard J / Bakris, George L / Borghi, Claudio / Chonchol, Michel B / Feldman, David / Lanaspa, Miguel A / Merriman, Tony R / Moe, Orson W / Mount, David B / Sanchez Lozada, Laura Gabriella / Stahl, Eli / Weiner, Daniel E / Chertow, Glenn M. ·University of Colorado, Denver, CO. · University of Chicago Medicine, Chicago, IL. · University of Bologna, Bologna, Italy. · National Kidney Foundation, New York City, NY. · University of Otago, Dunedin, NZ. · University of Texas Southwestern Medical Center, Dallas, TX. · Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Instituto Nacional de Cardiología, Ignacio Chávez, Mexico City, Mexico. · Mount Sinai School of Medicine, New York City, NY. · Tufts Medical Center, Boston, MA. · Stanford University, Stanford, CA. Electronic address: gchertow@stanford.edu. ·Am J Kidney Dis · Pubmed #29496260.

ABSTRACT: Urate is a cause of gout, kidney stones, and acute kidney injury from tumor lysis syndrome, but its relationship to kidney disease, cardiovascular disease, and diabetes remains controversial. A scientific workshop organized by the National Kidney Foundation was held in September 2016 to review current evidence. Cell culture studies and animal models suggest that elevated serum urate concentrations can contribute to kidney disease, hypertension, and metabolic syndrome. Epidemiologic evidence also supports elevated serum urate concentrations as a risk factor for the development of kidney disease, hypertension, and diabetes, but differences in methodologies and inpacts on serum urate concentrations by even subtle changes in kidney function render conclusions uncertain. Mendelian randomization studies generally do not support a causal role of serum urate in kidney disease, hypertension, or diabetes, although interpretation is complicated by nonhomogeneous populations, a failure to consider environmental interactions, and a lack of understanding of how the genetic polymorphisms affect biological mechanisms related to urate. Although several small clinical trials suggest benefits of urate-lowering therapies on kidney function, blood pressure, and insulin resistance, others have been negative, with many trials having design limitations and insufficient power. Thus, whether uric acid has a causal role in kidney and cardiovascular diseases requires further study.

9 Review Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature. 2018

Bieber, Amir / Schlesinger, Naomi / Fawaz, Abdallah / Mader, Reuven. ·Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. Electronic address: amir.bieber@gmail.com. · Division of Rheumatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ. · Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. · Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel; The Technicon Institute of Technology, Haifa, Israel. ·Semin Arthritis Rheum · Pubmed #29275830.

ABSTRACT: OBJECTIVES: Acute gout is a common arthritis that may eventually develop into chronic tophaceous gout (CTG). CTG usually is manifested by recurrent gout attacks. The diagnosis and treatment of CTG is challenging. Although the emergence of CTG without previous gout attacks is uncommon, it is important to recognize this unusual gout presentation. METHODS: Herein, we present two cases of CTG, occurring in elderly patients with chronic kidney disease (CKD) on diuretics, who presented without a prior history of acute gout attacks. We also searched PUBMED, Ovid MEDLINE, and Google scholar (1970-2017), for "tophi as the initial manifestation of gout" and "chronic gout without previous attacks", and extracted relevant data. RESULTS: The search disclosed one retrospective study and several case reports and case series describing 96 patients. Clinical and laboratory data was extracted from 34 patients. We found that a specific group of patients, e.g., elderly patients, most often female patients, suffering from CKD, and treated with diuretics, are specifically reported in the English medical literature to present with CTG as their first manifestation of gout. CONCLUSION: The two cases and our literature review try to emphasize the many faces of chronic gout, in particular, its presentation without previous gout attacks.

10 Review Update on colchicine, 2017. 2018

Slobodnick, Anastasia / Shah, Binita / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine. · Rheumatology and Cardiology Sections, VA New York Harbor Health Care System, U.S. Department of Veterans Affairs. · Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA. ·Rheumatology (Oxford) · Pubmed #29272515.

ABSTRACT: Colchicine is an ancient medication that is currently approved for the treatment of gout and FMF. However, colchicine has a wide range of anti-inflammatory activities, and studies indicate that it may be beneficial in a variety of other conditions. This paper reviews the evidence for the well-established use of colchicine in gout, as well as several other rheumatic diseases. In addition, we highlight the potential benefit of colchicine in cardiac disease, including coronary artery disease in patients both with and without gout.

11 Review Gout Keratitis: A Case of Peripheral Ulcerative Keratitis Secondary to Gout With a Review of the Literature. 2018

Yazdanyar, Amirfarbod / Rizzuti, Allison E / Mechel, Elzbieta / Denisova, Ksenia / Lazzaro, Douglas R. ·Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY. ·Cornea · Pubmed #29053564.

ABSTRACT: PURPOSE: To report a case of peripheral ulcerative keratitis secondary to gout. METHODS: A 41-year-old man with a history of severe gout disease presented with pain and redness of the right eye. Physical examination revealed 2 areas of peripheral corneal thinning with overlying epithelial defects. Adjacent to these areas, reflective crystals were identified in the corneal stroma. Anterior segment optical coherence tomography demonstrated stromal corneal deposits. RESULTS: Systemic workup was negative aside from an elevated serum uric acid level. The patient was administered oral prednisone, allopurinol, and colchicine. At his 2-month follow-up visit, the patient was asymptomatic and his corneal thinning had significantly improved. CONCLUSIONS: Gout is the most common type of inflammatory arthritis in adults with rising incidence and prevalence. Ocular findings in gout are common, but patients are usually asymptomatic. Monosodium urate crystal deposition has been reported to occur in various parts of the eye, with and without ocular inflammation. Crystal deposition in the cornea is extremely rare and may be a cause of peripheral ulcerative keratitis.

12 Review Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations. 2017

Guttmann, Allison / Krasnokutsky, Svetlana / Pillinger, Michael H / Berhanu, Adey. ·Crystal Disease Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA. · Division of Rheumatology, George Washington University School of Medicine, Medical Faculty Associates, Suite 307, 2300 M Street Northwest, Washington, DC 20037, USA. ·Ther Adv Drug Saf · Pubmed #29204266.

ABSTRACT: Gout is a common rheumatic condition, with increasing prevalence in recent decades. The mainstay of treatment for gout is oral urate-lowering therapy (ULT), typically with xanthine oxidase inhibitors (XOIs). Unfortunately, a proportion of patients have persistent gout that is refractory to ULT. Pegloticase, a recombinant pegylated uricase, has been approved by the US Food and Drug Administration for the treatment of refractory gout. However, concern has been raised regarding the risk of infusion reactions, which are now understood to be largely due to the development of antipegloticase antibodies. Discontinuation of pegloticase upon failure to lower serum urate has been shown to markedly reduce infusion reaction risk, but deprives patients of what, in many cases, is a last-resort treatment. In this manuscript, we review the rationale, mechanism of action, efficacy and safety of pegloticase. Additionally, we focus on potential strategies to reduce pegloticase immunogenicity and potentially make this important agent available to a wider group of patients requiring treatment.

13 Review Gout and Metabolic Syndrome: a Tangled Web. 2017

Thottam, Gabrielle E / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Department of Medicine, Roger Williams Medical Center, Providence, RI, USA. · Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. · Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA. · Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. michael.pillinger@nyumc.org. · Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA. michael.pillinger@nyumc.org. ·Curr Rheumatol Rep · Pubmed #28844079.

ABSTRACT: PURPOSE OF REVIEW: The complexity of gout continues to unravel with each new investigation. Gout sits at the intersection of multiple intrinsically complex processes, and its prevalence, impact on healthcare costs, and association with important co-morbidities make it increasingly relevant. The association between gout and type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, renal disease, and obesity suggest that either gout, or its necessary precursor hyperuricemia, may play an important role in the manifestations of the metabolic syndrome. In this review, we analyze the complex interconnections between gout and metabolic syndrome, by reviewing gout's physiologic and epidemiologic relationships with its major co-morbidities. RECENT FINDINGS: Increasing evidence supports gout's association with metabolic syndrome. More specifically, both human studies and animal models suggest that hyperuricemia may play a role in promoting inflammation, hypertension and cardiovascular disease, adipogenesis and lipogenesis, insulin and glucose dysregulation, and liver disease. Fructose ingestion is associated with increased rates of hypertension, weight gain, impaired glucose tolerance, and dyslipidemia and is a key driver of urate biosynthesis. AMP kinase (AMPK) is a central regulator of processes that tend to mitigate against the metabolic syndrome. Within hepatocytes, leukocytes, and other cells, a fructose/urate metabolic loop drives key inhibitors of AMPK, including AMP deaminase and fructokinase, that may tilt the balance toward metabolic syndrome progression. Preliminary evidence suggests that agents that block the intracellular synthesis of urate may restore AMPK activity and help maintain metabolic homeostasis. Gout is both an inflammatory and a metabolic disease. With further investigation of urate's role, the possibility of proper gout management additionally mitigating metabolic syndrome is an evolving and important question.

14 Review Updates on the treatment of gout, including a review of updated treatment guidelines and use of small molecule therapies for difficult-to-treat gout and gout flares. 2017

Soskind, Rose / Abazia, Daniel T / Bridgeman, Mary Barna. ·a Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers , The State University of New Jersey , Piscataway , NJ , USA. · b Department of Pharmacy Practice and Administration , Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , Piscataway , NJ , USA. · c Department of Pharmacy , Capital Health Regional Medical Center , Trenton , NJ , USA. · d Department of Pharmacy , Robert Wood Johnson University Hospital , New Brunswick , NJ , USA. ·Expert Opin Pharmacother · Pubmed #28658988.

ABSTRACT: INTRODUCTION: Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues. Areas covered: In this article, we describe the role of currently available drug therapies for managing acute gout flares and used in reducing serum urate levels. Further, we explore the role of novel small molecular therapies and biologic agents in the treatment of refractory or severe gout symptoms. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-June 2017) was conducted utilizing the key words 'gout', 'interleukin-1 inhibitors', 'acute gout', 'gout treatment', 'urate lowering therapies', 'hyperuricemia', 'colchicine', 'pegloticase', 'lesinurad', 'xanthine oxidase', 'xanthine oxidase inhibitors', 'allopurinol', 'febuxostat', 'uricosurics', 'probenecid', and 'benzbromarone'. All published articles regarding therapeutic management of gout and hyperuricemia were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. Expert opinion: Numerous therapies are currently available to managing acute gout flares and for lowering serum urate levels; advances in the understanding of the pathophysiology of this disorder has led to the emergence of targeted therapies and novel biologic preparations currently in development which may improve the clinical management of severe or refractory cases of disease that fail to respond to traditional therapies.

15 Review Nonhealing Ulcers in Patients with Tophaceous Gout: A Systematic Review. 2017

Lam, Gretl / Ross, Frank L / Chiu, Ernest S. ·Gretl Lam, BA • Fourth-year Medical Student (graduates to MD in May 2017) • New York University School of Medicine • New York, New York Frank L. Ross, MD • Associate Professor • Department of Surgery • New York University School of Medicine • New York, New York • Associate Director • Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center • New York, New York Ernest S. Chiu, MD • Associate Professor • Department of Surgery • New York University School of Medicine • New York, New York • Director • Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center • New York, New York. ·Adv Skin Wound Care · Pubmed #28426572.

ABSTRACT: GENERAL PURPOSE: To provide information from a review of the literature about chronic ulcers associated with tophaceous gout. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Identify the pathophysiology of tophaceous gout, its presentation, phases, and common comorbidities.2. Evaluate the findings in this review regarding effectiveness of interventions for chronic tophaceous ulcers. ABSTRACT: OBJECTIVE: Treating chronic ulcers associated with tophaceous gout is an uncommon but important clinical challenge. However, treatments vary greatly from topical therapies, to debridements, to free flap wound coverage. To the authors' knowledge, this is the first study to assemble and compare these different approaches in order to guide effective treatment. DATA SOURCES: An electronic search of MEDLINE (PubMed) was conducted. Search terms included (gout and ulcer) not "peptic ulcer," and (gout, chronic wound) or (gout, nonhealing wound). STUDY SELECTION: Studies that discussed the presentation, characterization, or treatment of gout-associated wounds were included. The literature search yielded 9 case reports and case series; there were no randomized controlled studies or reviews. DATA EXTRACTION: Patient and wound characteristics, treatment approaches, and outcomes were noted. DATA SYNTHESIS: The 82% of 22 patients were male, aged 36 to 95 years. Three patients had not been previously diagnosed with gout, whereas others had received a diagnosis 2 to 35 years prior to presentation with an ulcer. Many patients had comorbidities including diabetes and peripheral vascular disease. Most of the 43 total ulcers occurred on the feet. Treatments included topical 3% citric acid in petroleum jelly, allogeneic culture dermal substitute, silver-containing dressing and heterologous lyophilized collagen, debridements, and free flap coverage. CONCLUSIONS: Chronic tophaceous wounds are a worldwide problem. Although physicians report some successes with different treatments, controlled studies are needed to determine the most effective approach and to identify risk factors and preventive strategies.

16 Review Recent advances in understanding and managing gout. 2017

Igel, Talia F / Krasnokutsky, Svetlana / Pillinger, Michael H. ·The Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA; The School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. · The Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA. ·F1000Res · Pubmed #28357052.

ABSTRACT: Gout is the most common crystal arthropathy and the leading cause of inflammatory arthritis. It is associated with functional impairment and, for many, a diminished health-related quality of life. Numerous studies have demonstrated the impact of gout and its associated conditions on patient morbidity and mortality. Unfortunately, gout remains under-diagnosed and under-treated in the general community. Despite major advances in treatment strategies, as many as 90% of patients with gout are poorly controlled or improperly managed and their hyperuricemia and recurrent flares continue. The introduction of novel urate-lowering therapies, new imaging modalities, and a deeper understanding of the pathogenesis of gout raise the possibility of better gout care and improved patient outcomes. Here, we spotlight recent advances in the diagnosis and management of gout and discuss novel therapeutics in gout treatment.

17 Review Role of Dual Energy Computed Tomography Imaging in the Diagnosis of Gout. 2017

Jayakumar, Divya / Sehra, Shiv T / Anand, Suneesh / Stallings, Gary W / Danve, Abhijeet. ·Westchester Medical Center, New York Medical College. · Mount Auburn Hospital, Harvard Medical School. · Covenant Medical Center, Central Michigan University. · New York Medical College. · Yale New Haven Hospital, Yale University School of Medicine. ·Cureus · Pubmed #28229032.

ABSTRACT: Gout is a well-known inflammatory arthritis and affects four percent of the United States population. It results from the deposition of uric acid crystals in joints, tendons, bursae, and other surrounding tissues. Prevalence of gout has increased in the recent decade. Gout is usually seen in conjunction with other chronic comorbid conditions like cardiac disease, metabolic syndrome, and renal disease. The diagnosis of this inflammatory arthritis is confirmed by visualization of monosodium urate (MSU) crystals in the synovial fluid. Though synovial fluid aspiration is the standard of care, it is often deferred because of inaccessibility of small joints, patient assessment during intercritical period, or procedural inexperience in a primary care office. Dual energy computed tomography (DECT) is a relatively new imaging modality which shows great promise in the diagnosis of gout. It is a good noninvasive alternative to synovial fluid aspiration. DECT is increasingly useful in diagnosing cases of gout where synovial fluid fails to demonstrate monosodium urate crystals. In this article, we will review the mechanism, types, advantages, and disadvantages of DECT.

18 Review The safety of treatment options available for gout. 2017

Schlesinger, Naomi. ·a Department of Medicine Rutgers , Robert Wood Johnson Medical School , New Brunswick , NJ , USA. ·Expert Opin Drug Saf · Pubmed #28095258.

ABSTRACT: 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.

19 Review Gout and Osteoarthritis: Associations, Pathophysiology, and Therapeutic Implications. 2016

Yokose, Chio / Chen, Meng / Berhanu, Adey / Pillinger, Michael H / Krasnokutsky, Svetlana. ·From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. · From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. Svetlana.KrasnokutskySamuels@nyumc.org. · NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. Svetlana.KrasnokutskySamuels@nyumc.org. ·Curr Rheumatol Rep · Pubmed #27686950.

ABSTRACT: Osteoarthritis (OA), the most common type of arthritis worldwide, is a degenerative disease of diarthrodial joints resulting in pain, reduced quality of life, and socioeconomic burden. Gout, the most common form of inflammatory arthritis, is a consequence of persistently elevated levels of urate and the formation of proinflammatory monosodium urate crystals in joints. Clinicians have long noted a predilection for both diseases to occur in the same joints. In this review, we provide an overview into research elucidating possible biochemical, mechanical, and immunological relationships between gout and OA. We additionally consider the potential implications of these relationships for OA treatment.

20 Review Beyond Joints: a Review of Ocular Abnormalities in Gout and Hyperuricemia. 2016

Sharon, Yael / Schlesinger, Naomi. ·Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, 39 Jabotinsky St., Petach Tikva, 494149, Israel. yaelpauker@gmail.com. · Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, 08903-0019, NJ, USA. ·Curr Rheumatol Rep · Pubmed #27138165.

ABSTRACT: Gout is a common inflammatory arthritis among middle-aged men and postmenopausal women and can be a debilitating disease. Gout results from an elevated body uric acid pool, which leads to deposition of monosodium urate (MSU) crystals, mainly in and around the joints. The MSU crystals trigger release of proinflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. Ocular manifestations have been uncommonly reported in patients with gout. These include descriptions of tophaceous deposits in different locations of the eye including the eyelids, conjunctiva, cornea, iris, sclera, and orbit. Some depositions were coincidentally diagnosed in asymptomatic patients, while the majority were symptomatic. Other ocular abnormalities include dry eye syndrome, red eye, uveitis, intraocular hypertension, glaucoma, and cataracts. Herein, we review the medical literature pertaining to ocular manifestations in gout and hyperuricemia and propose a possible association between ocular abnormalities, hyperuricemia, and gout, including their common risk factors and comorbidities.

21 Review New and Pipeline Drugs for Gout. 2016

Keenan, Robert T / Schlesinger, Naomi. ·Department of Medicine, Duke University School of Medicine, Durham, NC, USA. robert.keenan@duke.edu. · Division of Rheumatology, Duke University Medical Center, 200 Trent Drive DUMC 3544, Durham, NC, USA. robert.keenan@duke.edu. · Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. ·Curr Rheumatol Rep · Pubmed #27097819.

ABSTRACT: Gout is the most common inflammatory arthropathy in the western world. Affecting millions and accounting for lost wages, increased health care costs, and significant disability, it remains a burden for those afflicted, their families, and the health care system. Despite the availability of a number of effective therapies, gout is often inadequately treated, and its impact on the patients overall health and well-being is underestimated by physicians and patients alike. For many decades, controlling acute flares was the priority in the management of gout. More recently, however, a deeper understanding of gout pathophysiology has resulted in a new appreciation that gout impacts the patient with consequences well beyond the episodes of acute inflammatory arthritis. Reflecting the chronic nature of the disease, gout treatment needs to be chronic as well, and aimed at reducing the underlying cause of gout-hyperuricemia-as well as the symptom of acute attacks. Therapy therefore requires both urate lowering and anti-inflammatory strategies. Unfortunately, the most commonly used urate lowering and anti-inflammatory treatments may be problematic in some gout patients, who often have multiple comorbidities that establish relative contraindications. Novel urate lowering therapies, and new medications to treat and prevent acute gouty flares, can not only improve care of the individual; they can also lead to a better discourse for the edification of those who manage and are managed for this underestimated disease. In this paper, we discuss new and pipeline drugs for acute gout, prophylactic anti-inflammatory therapies as well as urate lowering therapies.

22 Review Repositioning of drugs using open-access data portal DTome: A test case with probenecid (Review). 2016

Ahmed, Mohammad U / Bennett, Dylan J / Hsieh, Tze-Chen / Doonan, Barbara B / Ahmed, Saba / Wu, Joseph M. ·Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, NY 10595, USA. ·Int J Mol Med · Pubmed #26572802.

ABSTRACT: The one gene-one enzyme hypothesis, first introduced by Beadle and Tatum in the 1940s and based on their genetic analysis and observation of phenotype changes in Neurospora crassa challenged by various experimental conditions, has witnessed significant advances in recent decades. Much of our understanding of the association between genes and their phenotype expression has benefited from the completion of the human genome project, and has shown continual transformation guided by the effort directed at the annotation and characterization of human genes. Similarly, the idea of one drug‑one primary disease indication that traditionally has been the benchmark for the labeling and usage of drugs has also undergone evident progressive refinements; in recent years the science and practice of pharmaceutical development has notable success in the strategy of drug repurposing. Drug repurposing is an innovative approach where, instead of de novo synthesis and discovery of new drugs with novel indications, drug candidates with the desired usage are identified by a process of re‑profiling using an open‑source database or knowledge of known or failed drugs already in existence. In the present study, the repurposing drug strategy employing open‑access data portal drug‑target interactome (DTome) is applied to the uncovering of new clinical usage for probenecid.

23 Review Gout in the Spine: Imaging, Diagnosis, and Outcomes. 2015

Toprover, Michael / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. · Rheumatology Section, Department of Medicine, VA New York Harbor Health Care System, New York Campus, New York, NY, 10010, USA. · Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. Michael.Pillinger@nyumc.org. · Rheumatology Section, Department of Medicine, VA New York Harbor Health Care System, New York Campus, New York, NY, 10010, USA. Michael.Pillinger@nyumc.org. ·Curr Rheumatol Rep · Pubmed #26490179.

ABSTRACT: Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.

24 Review Hyperuricemia and gout in solid-organ transplant: update in pharmacological management. 2015

Sullivan, Peter M / William, Asch / Tichy, Eric M. ·Memorial Sloan-Kettering Cancer Center, New York, New York (PMS), Yale University School of Medicine (AW), Yale-New Haven Hospital (EMT), New Haven, Connecticut. ·Prog Transplant · Pubmed #26308787.

ABSTRACT: Hyperuricemia is a common comorbid condition experienced by up to 28% of kidney transplant recipients. These patients are at elevated risk of acute flare-ups of gout because of transplant-specific risk factors such as impaired renal function, chronic contributing pharmacotherapy (eg, calcineurin inhibitors, diuretics), and associated comorbid conditions. After transplant, treatment is often complicated by drug-drug interactions, renal impairment, and toxic effects of drugs with the use of first-line recommended agents. A number of therapeutic options remain available for transplant recipients, including dose modifications of historic agents and newer pharmacotherapeutic options. Notably, the Kidney Disease Improving Global Outcomes guidelines address the management of hyperuricemia and gout, but these guidelines were last published in 2009, and new data and treatment options have emerged since then. The management of hyperuricemia and acute and chronic gout is described, including the use of novel agents including urate oxidases, interleukin 1 inhibitors, and human urate transporter 1 inhibitors and alternative immunosuppressive therapy strategies.

25 Review Febuxostat for the treatment of gout. 2015

Bridgeman, Mary Barna / Chavez, Benjamin. ·Rutgers, The State University of New Jersey, Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration , 160 Frelinghuysen Road, Piscataway, NJ 08854 , USA +1 848 445 6815 ; +1 732 445 2533 ; mary.bridgeman@pharmacy.rutgers.edu. ·Expert Opin Pharmacother · Pubmed #25556668.

ABSTRACT: INTRODUCTION: Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues. The xanthine oxidase inhibitor, allopurinol, has historically been the principle agent utilized for reducing elevated uric acid levels and treating underlying cause of gout symptoms; the availability of febuxostat, a newer non-purine selective xanthine oxidase inhibitor, represents an alternative therapy for those patients with contraindications or intolerance to allopurinol. AREAS COVERED: This article reviews the published literature on the pharmacologic characteristics and clinical safety and efficacy data on the use of febuxostat in the treatment of gout. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-November 2014) was conducted utilizing the key words 'febuxostat', 'allopurinol', and 'gout'. All published articles regarding febuxostat were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. EXPERT OPINION: Febuxostat has shown benefit with respect to symptomatic relief and uric acid level reduction. The safety profile of this agent makes it an ideal alternative in those patients with contraindications to or who are intolerant of allopurinol.

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