Osteonecrosis (ON) is a common comorbidity in gout; however, avascular ON of multiple sites is unusual. Multifocal ON is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 31-year-old woman diagnosed with gout, who had multifocal ON. Initially, she was treated with benzbromarone, colchicine, and meloxicam. Two years later, she developed severe tophi and was diagnosed with chronic renal failure. Magnetic resonance imaging (MRI) of both legs revealed bilateral ON of the femoral head. She underwent bilateral hip replacement surgeries. After two years, she had pain and limited movements in the left shoulder, with tophi identified via dual-energy computed tomography. Despite management with non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, she had persistent shoulder pain. MRI of the left shoulder revealed ON. She therefore underwent left shoulder replacement surgery. Following the case report, we review the literature on multifocal ON with gout.
Adult ; Benzbromarone ; Colchicine ; Comorbidity ; Female ; Gout* ; Head ; Hip ; Humans ; Kidney Failure, Chronic ; Leg ; Magnetic Resonance Imaging ; Osteonecrosis* ; Prednisolone ; Shoulder ; Shoulder Pain

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

OBJECTIVETo study the preventive and therapeutic effects of total saponin of Dioscorea (TSD) on chronic hyperuricemia, and its effect on urate transporter 1 (URAT1) in rats.

METHODNinety male rats were randomly divided into 6 groups: the normal group, the model group, TSD high-, medium- and low-dose (300, 100, 30 mg x kg(-1)) groups and the benzbromarone (10 mg x kg(-1)) group. Potassium oxonate and ethambutol were adopted to establish the chronic hyperuricemia model Since the third week, all the rats were intragastrically administered with drugs for 4 weeks, once a day, in order to determine their uric acid in serum and urine, uric acid excretion and xanthine oxidase (XOD). URAT1 mRNA and URAT1 protein expression in rat renal tubular cells were determined by RT-PCR and immunohistochemistry method respectively.

RESULTSerum uric acid level of the model group increased significantly, while uric acid excretion decreased, with high expressions of renal URAT1 mRNA and URAT1 protein. TSD could dose-dependently reduce the serum uric acid level of chronic hyperuricemia rats, increase the concentration of uric acid and uric acid excretion in urine, and reduce renal URAT1 mRNA and URAT1 protein expression. Its effects were similar with that of benzbromarone, but with no significant effect on XOD and urinary volume of chronic hyperuricemia rats.

CONCLUSIONTSD has an obvious effect of anti-hyperuricemia It may reduce the reabsorption of uric acid by inhibiting the high expression of rat renal URAT1.

Animals ; Anion Transport Proteins ; biosynthesis ; genetics ; metabolism ; Benzbromarone ; pharmacology ; Dioscorea ; chemistry ; Gout Suppressants ; chemistry ; pharmacology ; Hyperuricemia ; blood ; drug therapy ; genetics ; urine ; Kidney Tubules ; drug effects ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Saponins ; chemistry ; pharmacokinetics ; pharmacology ; Uric Acid ; blood ; urine ; Xanthine Oxidase ; metabolism

OBJECTIVETo investigate the quality of life in patients with gout and their influencing factors, and to observe the effects of the intervention program of stage-based treatment of integrative medicine (IM).

METHODSTotally 120 patients with acute attack of gout within 72 h were randomly assigned to the treatment group and the control group, 60 in each group. Patients in the treatment group were treated with Huzhang Tongfeng Granule (HTG), diclofenac sodium extended-release capsule and Jinhuang Ointment (JO) in the acute stage, and Yinlian Tongfeng Granule (YTG) and Benzbromarone Tablet (BT) in the intermission stage. Patients in the control group were treated with diclofenac sodium extended-release capsule in the acute stage, and BT in the intermission stage. All patients were treated for 12 weeks. The quality of life (QOL) before and after treatment was investigated by questionnaire.

RESULTSBefore treatment there were no statistical difference in the physiological function, psychological function, social function, health self-awareness and total score between the two groups (P > 0.05). After treatment the scores of the four aspects and the total score were significantly improved in the two groups (P < 0.01). And the improvement of the treatment group was better than that of the control group (P < 0.01). There was no statistical difference in the gender, age, marital status, educational level, QOL with or without associated disease between the two groups (P > 0.05). The QOL of patients with joint stiffness or deformity was less than that of those without joint stiffness or deformity (P < 0.01). The total QOL scores of the gout patients were obviously correlated with the course of diseases (r = -0.324, P < 0.01).

CONCLUSIONSThe QOL of patients with gout was correlated with the course of disease and joint stiffness or deformity. Stage-based treatment of IM could significantly improve the QOL of f out patients.

Adult ; Aged ; Aged, 80 and over ; Benzbromarone ; therapeutic use ; Diclofenac ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gout ; prevention & control ; therapy ; Humans ; Integrative Medicine ; Male ; Middle Aged ; Quality of Life ; Surveys and Questionnaires ; Universal Precautions

OBJECTIVETo observe the clinical efficacy and safety of Xiezhuo Chubi Recipe (XCR) on hyperuricemic patients.

METHODS99 patients with hyperuricemia were randomly assigned to the XCR group, the Benzbromarone group, and the blank control group. Patients in the XCR group took XCR, one dosage daily, twice per day. Patients in the Benzbromarone group took Benzbromarone Tablet (50 mg each tablet, once per day). Patients in the blank control group were not treated with any drug, but only with clinical observation. Twenty days consisted of one course of treatment. The laboratory data including uric acid, blood routines, urine routines, the liver function, and the renal function were statistically analyzed before and after treatment.

RESULTSThe blood uric acid decreased in the three groups after treatment (P<0.05). The total effective rate was 85.71% in the XCR group, 92.86% in the Benzbromarone group, and 23.33% in the blank control group. There was no statistical difference between the XCR group and the Benzbromarone group (P>0.0167). There was no significant difference in the safety indices such as blood routines, urine routines, liver functions, and renal functions of the XCR group between before and after treatment (P>0.05).

CONCLUSIONXCR could effectively reduce the uric acid level with higher safety.

Adolescent ; Adult ; Aged ; Benzbromarone ; therapeutic use ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Hyperuricemia ; blood ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Treatment Outcome ; Uric Acid ; blood ; Young Adult

OBJECTIVE: Hyperuricemia is known as a risk factor that causes and worsens kidney diseases through a variety of mechanisms. Recent animal studies reported that the correction of hyperuricemia improved the renal function, but there have been few human studies. This study examined whether a hypouricemic treatment affects the renal function in Korean patients with gout. METHODS: Two hundred sixty-seven gout patients who were prescribed uric acid lowering agents for more than 1 year were enrolled at the Division of Rheumatology in the National Health Insurance Corporation Ilsan Hospital and Yonsei University Severance Hospital from January 2005 to January 2010. The following were examined: the levels of serum uric acid and serum creatinine, the amount of 24-hour urine uric acid, glomerular filtration rate (GFR), and abdominal ultrasound findings at baseline and follow-up. RESULTS: Mean age of the study subjects was 54.4+/-13.9 years. Two hundred forty-seven patients were male and 20 patients were female. The mean treatment duration was 35.0+/-19.5 months. Among the 267 patients, 219 and 19 patients received monotherapy with allopurinol and benzbromarone respectively, and 29 patients received combination therapy with allopurinol and benzbromarone. After the treatment with uric acid lowering agents, the serum uric acid and creatinine levels decreased significantly (8.05+/-1.96 mg/dL vs 6.16+/-1.46 mg/dL, p<0.001, 1.25+/-0.46 mg/dL vs 1.18+/-0.42 mg/dL, p=0.001, respectively) and the GFR increased significantly (74.4+/-27.0 mL/min/1.73 m3 vs 80.2+/-31.6 mL/min/1.73 m3, p<0.001). CONCLUSION: Treatment with hypouricemic agents reduced the levels of serum uric acid and improved the renal function. These results suggest that a hypouricemic treatment might improve the kidney function in gout patients.
Allopurinol ; Animals ; Benzbromarone ; Creatinine ; Female ; Glomerular Filtration Rate ; Gout ; Humans ; Hyperuricemia ; Kidney ; Kidney Diseases ; Male ; National Health Programs ; Rheumatology ; Risk Factors ; Uric Acid

Gout is an inflammatory arthritis characterized by recurrent attacks of inflammation caused by precipitation of monosodium urate crystals (MSU) in the joint and is associated with impaired quality of life. The incidence and prevalence of gout is increasing world wide due to the increasing size of the elderly population, kidney disease, diuretic use, dietary changes, and obesity. Furthermore, emerging evidence suggests that gout is strongly associated with metabolic syndrome and may lead to myocardial infarction, type 2 diabetes mellitus, and premature death. Urate nephropathy is also increasing. Thus, the overall disease and the economic burden of gout is substantial and increasing sharply. Although traditional urate lowering agents including allopurinol, probenecid, and benzbromarone have been available for many years, questions still remain about the optimal dosing regimen. Many patients remain undertreated for this potentially curable disorder. Fortunately, more scientific data and evidence for proper management of gout are available. Renewed interest in gout has led to advances in dietary advice and development of new therapeutic options. The importance of risk factors for gout should be emphasized and patients with gout and hyperuricemia should be educated so that they can achieve a good quality of life and longevity. In this review, the comorbidity, mortality, and economic burdens of gout will be presented. In addition, the importance of proper management and patient education will be stressed.
Aged ; Allopurinol ; Arthritis ; Benzbromarone ; Comorbidity ; Diabetes Mellitus, Type 2 ; Gout ; Humans ; Hyperuricemia ; Incidence ; Inflammation ; Joints ; Kidney Diseases ; Longevity ; Mortality, Premature ; Myocardial Infarction ; Obesity ; Patient Education as Topic ; Prevalence ; Probenecid ; Quality of Life ; Risk Factors ; Uric Acid

Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated.
Allopurinol ; Benzbromarone ; Colchicine ; Debridement ; Decompression ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Joints ; Kidney Failure, Chronic ; Tendons ; Uric Acid

Gout is a common chronic inflammatory arthritis that can lead to significant disability. Gout is one of the few rheumatologic diseases that can be diagnosed with certainty and can be cured with appropriate therapy. Alcohol and dietary consumption are related to hyperuricemia and gout attacks. A moderate intake of purine-rich vegetables or protein is not related to an increased risk of gout. A weight-reducing, calorie-restricted diet with moderate carbohydrate restriction was beneficial for gout patients and reduced the serum uric acid and frequency of gout attacks, although these findings need to be confirmed. Clinicians should consider therapeutic options that do not increase the serum uric acid when treating associated conditions in gout patients. The acute gout attack can be treated appropriately with non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids. Hypouricemic treatment reduces the uric acid concentration by inhibiting its production (allopurinol) or enhancing its excretion (benzbromarone). Allopurinol is the agent used most commonly, but the recommended dose often fails to control the serum uric acid. Benzbromarone effectively reduces the serum uric acid, but possible hepatotoxicity should be monitored. Febuxostat, a new xanthine oxidase inhibitor, was recently approved by the Federal Drug Administration (FDA). PEGylated uricase, a potent parenteral hypouricemic agent, is under investigation for the treatment of gout.
Allopurinol ; Arthritis ; Benzbromarone ; Colchicine ; Diet ; Glucocorticoids ; Gout ; Humans ; Hyperuricemia ; Thiazoles ; Urate Oxidase ; Uric Acid ; Vegetables ; Xanthine Oxidase ; Febuxostat

Benzbromarone is a uricosuric agent for hyperuricemia and gout. Some of its well-known side effects include hypersensitivity, renal calculi, and gastrointestinal problems. Although the drug was withdrawn from U.S. market due to severe hepatotoxicity, it is still available in some countries including Korea. We describe a 19-year-old male who was admitted with general weakness and azotemia after use of benzbromarone. A kidney biopsy revealed acute tubular necrosis without an evidence of urate nephropathy. After discontinuation of benzbromarone, the renal function returned to baseline. This is the first case of acute tubular necrosis associated with benzbromarone use.
Azotemia ; Benzbromarone ; Biopsy ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Kidney ; Kidney Calculi ; Korea ; Male ; Necrosis ; Transplants ; Uric Acid ; Young Adult