BACKGROUND: To assess the efficacy of fenofibrate treatment in combination with urate lowering agents in patients with gout. METHODS: Fourteen male patients with chronic tophaceous or recurrent acute attacks of gout were evaluated in an open-label pilot study of the hypolipidemic agent, fenofibrate (Lipidil Supra(R) 160 mg/d). Patients were stable on urate lowering agents (allopurinol or benzbromarone) for > or =three months without acute attack for the most recent one month before participating. All patients were being treated with established doses of urate lowering agents without modification throughout the study. Clinical and biochemical assessments including serum uric acid, creatinine, liver function test and fasting serum lipid were measured at (1) baseline (2) after two months of fenofibrate treatment and (3) two months after fenofibrate was withdrawn. RESULTS: Serum uric acid was lowered by 23% after two months of fenofibrate treatment (6.93+/-2.16 vs. 5.22+/-1.16 mg/dL; p=0.016). Triglyceride levels were also reduced after fenofibrate treatment (p=0.001). However, this effect was reversed after the withdrawal (p=0.002) of the drug. Alkaline phosphatase was reduced after fenofibrate treatment (p=0.006), but increased 21% after the withdrawal of the drug (p=0.002). By contrast, serum levels of high density lipoprotein and creatinine were increased 9% (p=0.018) and 12% (p=0.006), respectively; however, both levels were significantly decreased to the baseline levels upon withdrawal of fenofibrate. CONCLUSIONS: Fenofibrate can effectively reduce uric acid levels in addition to its known hypolipidemic effect. Fenofibrate may be used as a potential urate lowering agent in patients with gout, especially in those with coexisting hyperlipidemia.
Uricosuric Agents/*administration & dosage ; Uric Acid/blood ; Procetofen/*administration & dosage ; Middle Aged ; Male ; Lipids/blood ; Humans ; Gout/blood/*drug therapy ; Aged ; Adult

OBJECTIVETo explore a more effective therapy for acute gouty arthritis.

METHODSSixty cases were randomly divided into an observation group and a control group, 30 cases in eachgroup. On the basis of diet intervention, the observation group was treated with electroacupuncture at local points combined with blood-letting puncture and cupping, and the control group with oral administration of Probenecid. Their therapeutic effects were ob served.

RESULTSThe effective rate was 96.7% in the observation group which was better than 86.7% in the control group (P < 0.01). After treatment, blood uric acid decreased significantly in the two groups (both P < 0.01), the observed group being lower than the control group (P < 0.01).

CONCLUSIONOn the basis of diet intervention, electroacupuncture plus blood-letting puncture and cupping is a better therapy for acute gouty arthritis.

Adult ; Aged ; Arthritis, Gouty ; diet therapy ; drug therapy ; therapy ; Bloodletting ; Combined Modality Therapy ; Electroacupuncture ; Humans ; Male ; Middle Aged ; Probenecid ; therapeutic use ; Uricosuric Agents ; therapeutic use

Gout is the most common inflammatory arthritis in men over 40 years old and the prevalence is increasing. Asymptomatic hyperuricemia is predisposing condition of gout but the frequency of progression to acute gout is not high enough to need prophylactic treatment. In acute gout flare, first line therapy is non-steroid anti-inflammatory agents (NSAIDs) or corticosteroids, depending on comorbidities. Colchicine is now second line therapy. Urate lowering therapy for gout needs to be initiated when the second attack occurs in a year. Allopurinol, a xanthine oxidase inhibitor, has been the most widely used agent for the treatment of chronic gout. Now, febuxostat has emerged as a new xanthine oxidase inhibitor that is expected to be useful in patients with mildly decreased renal function. Uricosuric agents are alternative therapies for patients with preserved renal function and no history of nephrolithiasis. During urate lowering therapy, the dose should be titrated upward until the serum uric acid level is kept less than 6mg/dL. When initiating urate lowering therapy, concurrent prophylactic therapy with NSAIDs or low dose colchicine for more than six months is recommended for reducing flare-ups. In chronic gout treatment, dietary modification seems to have minimal effect, but alcohol drinking and weight control can be recommended.
Adrenal Cortex Hormones ; Alcohol Drinking ; Allopurinol ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Gouty ; Colchicine ; Comorbidity ; Complementary Therapies ; Food Habits ; Gout ; Humans ; Hyperuricemia ; Male ; Nephrolithiasis ; Prevalence ; Thiazoles ; Uric Acid ; Uricosuric Agents ; Xanthine Oxidase ; Febuxostat

There is an increasing incidence of gout and hyperuricemia worldwide. It is because the population is getting older, their life style is sedentary, and they take protein-enriched food. Gout is one of the most common but best controllable chronic diseases of adult. There have been recent advances in the understanding of underlying mechanisms and treatment of gout and hyperuricemia. This article is aimed to provide the practical review of the currently recommended practice of care and also to introduce some recently approved drugs. The management concept of hyperuricemia is changing because not only the gout but also the hyperuricemia appear to be independent risk factors for hypertension, renal disease and cardiovascular disease. Gout causes a significant individual and social burden and loss of working force. Still hyperuricemia in the gout patient is often under-treated by the patients themselves and by the physicians also. Once the acute gout attack is controlled, patients should be followed with goal-oriented treatment of hyperuricemia and other risk factors. Allopurinol has remained as a first-line treatment for chronic hyperuricemia, but uricosuric agents may also be considered in some patients. These drugs have provided good control of the disease in most gout patients until now but the elderly patients with gout often carry co-medications, contra-indication to these drugs, and risk of adverse drug reaction. Febuxostat is a nonpurine xanthine-oxidase inhibitor. It is a new agent approved by the US FDA and Korean FDA for the treatment of hyperuricemia in patients with gout which may be used when allopurinol is not tolerated or contraindicated. Pegloticase is the PEGylated urate oxidase which is very potent and so recently approved by the US FDA for the gout refractory to conventional treatment.
Adult ; Aged ; Allopurinol ; Arthritis, Gouty ; Cardiovascular Diseases ; Chronic Disease ; Drug Toxicity ; Gout ; Humans ; Hypertension, Renal ; Hyperuricemia ; Incidence ; Life Style ; Polyethylene Glycols ; Risk Factors ; Thiazoles ; Urate Oxidase ; Uricosuric Agents ; Febuxostat

OBJECTIVETo optimize the extracting process of ethanol extract with hypouricemic effect from Rhizoma Alismatis.

METHODOrthogonal design was utilized to optimize the preparing conditions including the concentration of ethanol, amount of ethanol, extraction times and extraction duration per time while alisol B 23-acetate was selected as the evaluation index. Both the alisol B 23-acetate and the serum uric acid levels were measured by HPLC.

RESULTThe ethanol extract had hypouricemic action. Only extraction times had significant effect on the content of alisol B 23-acetate in ethanol extract.

CONCLUSIONThe optimal extraction process is to extract two times using sevenfold 70% ethanol and 1 h per time.

Alismataceae ; chemistry ; Animals ; Chemical Fractionation ; methods ; Disease Models, Animal ; Ethanol ; chemistry ; Humans ; Hyperuricemia ; blood ; drug therapy ; Mice ; Plant Extracts ; administration & dosage ; Rhizome ; chemistry ; Uric Acid ; blood ; Uricosuric Agents ; administration & dosage

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA> or =6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.
Adult ; Allopurinol/therapeutic use ; Antimetabolites/therapeutic use ; Benzbromarone/therapeutic use ; Cardiovascular Diseases/epidemiology/prevention & control ; Comorbidity ; Diabetes Mellitus, Type 2/epidemiology/prevention & control ; Enzyme Inhibitors/therapeutic use ; Female ; Gout/*drug therapy/*prevention & control ; Gout Suppressants/*therapeutic use ; Humans ; Hypertension/epidemiology/prevention & control ; Male ; Middle Aged ; Renal Insufficiency, Chronic/epidemiology/prevention & control ; Retrospective Studies ; Thiazoles/therapeutic use ; Uric Acid/*blood/metabolism ; Uricosuric Agents/therapeutic use ; Urolithiasis/epidemiology/prevention & control