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Gout Urate Cryst. Depos. Dis., Volume 1, Issue 1 (March 2023) – 6 articles

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13 pages, 1288 KiB  
Review
Metabolomics in Hyperuricemia and Gout
by Rui Li, Ningning Liang, Yongzhen Tao and Huiyong Yin
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 49-61; https://doi.org/10.3390/gucdd1010006 - 21 Mar 2023
Viewed by 2087
Abstract
Urate is one of the key metabolites of purine metabolism, and the overproduction of urate in the liver or decreased excretion in the kidney in humans may lead to elevated levels of urate in the circulation, termed hyperuricemia (HU). The formation of monosodium [...] Read more.
Urate is one of the key metabolites of purine metabolism, and the overproduction of urate in the liver or decreased excretion in the kidney in humans may lead to elevated levels of urate in the circulation, termed hyperuricemia (HU). The formation of monosodium urate (MSU) crystals in the joint or surrounding tissues may trigger inflammatory responses and gout attacks, which is the most common inflammatory arthritis. In addition to gout, HU has also been associated with many other metabolic diseases, such as cardiovascular disease, obesity, diabetes, fatty liver diseases, kidney diseases, hypertension, and various cancers. Overwhelming evidence indicates that HU and gout lead to systematic metabolic alterations underlying these metabolic disorders. As one of the most powerful omics techniques, metabolomics systematically analyzes all small-molecule metabolites in a biological system that directly reflect the physiological and pathological conditions. In recent years, metabolomics has been increasingly employed in clinical and experimental research in HU and gout. Emerging studies have developed predictive models to differentiate HU from gout based on metabolomics and machine-learning algorithms. In this review, we systematically summarize recent advances in metabolomic research in gout and HU in animal and human clinical studies. A comprehensive understanding of systemic metabolic changes caused by HU and gout may provide unprecedented insights into the pathological mechanisms in HU, gout, and related metabolic diseases, which may have a profound impact on the prevention, diagnosis, and treatment of HU and gout. Full article
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12 pages, 926 KiB  
Review
Year in Review: Gout Clinical Research
by Mariana Urquiaga and Angelo L. Gaffo
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 37-48; https://doi.org/10.3390/gucdd1010005 - 20 Mar 2023
Cited by 2 | Viewed by 2463
Abstract
Gout is a prevalent and burdensome condition despite the advances in our knowledge of its underlying mechanisms, prevention, and treatment. There is still work to be done to elucidate relevant questions that could lead to better patient care. This conference report summarizes eight [...] Read more.
Gout is a prevalent and burdensome condition despite the advances in our knowledge of its underlying mechanisms, prevention, and treatment. There is still work to be done to elucidate relevant questions that could lead to better patient care. This conference report summarizes eight impactful publications which inform and improve clinical care in gout from October 2021 to October 2022. The articles we present here address innovative management approaches, the use of serum urate as a surrogate marker, the occurrence of complications such as cardiovascular events and lower extremity amputation, the evaluation of mortality in patients with chronic kidney disease and gout, the effect of intensive serum urate control on radiographic outcomes, and the impact of COVID-19 infection in patients with gout. The conclusions reached by these publications are noteworthy. Some of them are potentially practice-changing, and all provide exciting follow-up questions. Full article
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12 pages, 3380 KiB  
Review
The Gouty Kidney: A Reappraisal
by Thomas Bardin, Emmanuel Letavernier and Jean-Michel Correas
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 25-36; https://doi.org/10.3390/gucdd1010004 - 17 Mar 2023
Cited by 5 | Viewed by 2102
Abstract
This review re-examines the role of crystal deposition in the kidney in view of recent clinical and experimental findings. The involvement of the renal system in gout seems frequent. Indeed, recent studies showed that approximately 25% of patients with gout experience renal failure, [...] Read more.
This review re-examines the role of crystal deposition in the kidney in view of recent clinical and experimental findings. The involvement of the renal system in gout seems frequent. Indeed, recent studies showed that approximately 25% of patients with gout experience renal failure, defined by estimated glomerular filtration rate <60 mL/min/1.73 m2. The pathophysiology is complex and involves several factors, their respective roles being difficult to dissect. The role of crystal deposition in the kidney was the first suspected, and the concept of gouty microcrystalline nephropathy, also called gouty nephropathy, has been popular, supported by early autopsy studies demonstrating uric acid and urate crystal deposition in the renal medulla of patients with gout, together with features of tubulointerstitial nephritis. Crystal deposition was first considered an important source of renal involvement in gout. After the introduction of urate-lowering drugs and the performance of kidney biopsies, which mainly involved the renal cortex and did not reveal much crystal deposition but rather vascular changes, this concept has been criticized and even dismissed. Thereafter, kidney involvement in gout was considered mainly vascular, related to hypertension and associated comorbidities and later to hyperuricemia. The toxic effects of non-steroidal anti-inflammatory drugs is also an important factor. Modern imaging, especially renal ultrasonography, allows for atraumatic exploration of the kidney and has revealed hyperechogenicity of the renal medulla, suggesting crystalline deposits, in approximately one-third of patients with tophaceous gout. Experimental models of gouty nephropathy have recently demonstrated the pathogenic role of microcrystal deposition in the collecting ducts and parenchyma of the renal medulla. Taken together, these recent findings lead to the re-examination of the pathogenic role of crystal deposition in the renal medulla and testing the effect of urate-lowering drugs on renal features of gouty patients with evidence of renal crystal deposition. Full article
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14 pages, 2280 KiB  
Article
Colchicine Use and Major Adverse Cardiovascular Events in Male Patients with Gout and Established Coronary Artery Disease: A Veterans Affairs Nested Retrospective Cohort Study
by Gary H. Ho, Michael Toprover, Daria B. Crittenden, Binita Shah and Michael H. Pillinger
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 11-24; https://doi.org/10.3390/gucdd1010003 - 15 Mar 2023
Cited by 1 | Viewed by 2082
Abstract
Background: Despite colchicine’s proven efficacy in the non-gout population, the effects of colchicine on the risk of major adverse cardiovascular events (MACE) among high-risk patients with gout remain to be determined. The purpose of this study is to evaluate the association between colchicine [...] Read more.
Background: Despite colchicine’s proven efficacy in the non-gout population, the effects of colchicine on the risk of major adverse cardiovascular events (MACE) among high-risk patients with gout remain to be determined. The purpose of this study is to evaluate the association between colchicine use and MACE in gout patients with preexisting coronary artery disease (CAD). Methods: This retrospective cohort study followed patients with gout and established CAD within the VA New York Harbor Healthcare System who did or did not use colchicine regularly (>30 continuous days prescription with at least 1 refill). The primary outcome was first MACE, defined as a composite of non-fatal myocardial infarction, coronary artery bypass graft, non-fatal stroke, and all-cause mortality. Part I of the primary analysis compared MACE between colchicine users and nonusers. Part II of the study compared MACE within the colchicine-use group, divided into quartiles based on consistency of colchicine use (i.e., percentage of time on colchicine). Results: Among 1638 patients with gout, 355 had established CAD (239 colchicine users and 116 nonusers). In this cohort, the odds of MACE were similar between any colchicine use compared to nonuse (OR 1.14; 95% CI (0.59–2.20)); however, colchicine users overall had a higher baseline cardiovascular risk profile than nonusers, suggesting that colchicine may have served to equilibrate risk between the two groups. Moreover, patients in the highest continuous colchicine-use quartile (>70% of observation period on colchicine) demonstrated lower odds of MACE compared to those in the lowest three quartiles (OR 0.35; 95% CI (0.13–0.93)), with no difference in baseline risk. Additionally, colchicine users had a numerically lower rate of MACE during periods of active use compared with periods of lapse. Kaplan–Meier analysis revealed a difference in cumulative MACE over time, favoring the subgroup with the most consistent colchicine use (plog-rank = 0.01). Conclusions: Despite higher CV risk, gout patients with CAD receiving colchicine had no higher rates of MACE than those not receiving colchicine. Among all patients with gout and CAD treated with colchicine, those with the most consistent colchicine use had lower odds of MACE, and event rates were lower during active use. Colchicine protection against cardiovascular events may require maintenance of colchicine bloodstream levels. Full article
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4 pages, 215 KiB  
Editorial
Crystal Clear? The 2022 NICE Guideline for the Diagnosis and Management of Gout
by Chanaka Dahanayake, Kelsey M. Jordan and Edward Roddy
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 7-10; https://doi.org/10.3390/gucdd1010002 - 15 Feb 2023
Cited by 4 | Viewed by 2405
Abstract
Gout is the most common inflammatory arthritis and causes significant pain and disability [...] Full article
6 pages, 998 KiB  
Editorial
Gout, Urate, and Crystal Deposition Disease: Launch of the First Journal Dedicated to a Rapidly Growing Field
by Tristan Pascart, Tony R. Merriman, Hyon K. Choi and Robert Terkeltaub
Gout Urate Cryst. Depos. Dis. 2023, 1(1), 1-6; https://doi.org/10.3390/gucdd1010001 - 25 Nov 2022
Viewed by 2446
Abstract
Gout and crystal deposition-associated disorders are among the leading causes of inflammation and arthritis throughout the world [...] Full article
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