Gout vs Pseudogout :Risk Factors,Causes, and Symptoms

GOUT

Gout is a common form of arthritis. It is also a painful condition that usually involving the joints. It is caused by high levels of uric acid in the blood. Uric acid is formed when the body breaks down purines. The purines can be found in the body and certain foods. When symptoms get worse, it is known as flares. When there are no symptoms, it is known as remissions.

Risk Factors

There are many risk factors for gout.Gout generally develops in men between age 30 to 45 and women age 55 to 70.

Increased Risk for Developing Gout:

  1. Obesity.
  2. High Blood Pressure.
  3. Injury or recent surgery.
  4. Fasting or overeating.
  5. Consuming an excessive amount of alcohol regularly.
  6. Diet high in meat, shellfish, and beverages sweetened with high-fructose corn syrup.
  7. Taking medications that can increase blood levels of uric acid.

Causes

Gout occurs when there is an excess of uric acid in the body. The body makes uric acid when it breaks down purines. Purines are found in the body and the foods we eat. Usually, uric acid crystals can build up in joints, fluids, and tissues within the body when there is an excess of uric acid in the body. Hyperuricemia does not always cause gout. In addition, hyperuricemia without gout symptoms does not need to be treated. The sharp, needle-like crystals cause gout. 

Symptoms

  1. Intense joint pain: can occur at any joint but usually affects the big toe.
  2. Inflammation and redness: joint is usually swollen, warm, and red.
  3. Limited movement: not able to move joint normally.
  4. Lingering discomfort: last from few days to a few weeks.

Symptoms develop quite rapidly. It can last for three to ten days. Usually, the symptoms and signs affect a single joint. Gout attacks are very painful. It can happen quite suddenly, often overnight. The pain is typically severe. So, it shows the severity of inflammation in the joint. The medical term for excessive fluid in a joint is a “joint effusion”.

Treatment

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) – reduce swelling and pain. It is used as first-line treatment.
  2. Colchicine – people who cannot tolerate NSAIDs usually take  colchicine.
  3. Steroids (prednisone) – used in people who cannot take NSAIDs or colchicine. Prednisone is linked with an increased risk of a recurrent gout attack.

PSEUDOGOUT

Pseudogout also is a form of arthritis that causes sudden joint pain and swelling. It is caused by calcium pyrophosphate dihydrate crystals (CPPD). 

The sudden attacks of joint pain, swelling, and warmth can occur when you have pseudogout. It can last for days to weeks. It can affect the ankles, feet, shoulders, elbows, wrists, or hands but it mostly affects the knee.

Risk Factors

Besides older age, several other factors also increase the risk for developing pseudogout :

  • Joint trauma due to injury or surgery.
  • Genetics: some people tend to develop pseudogout and more likely to have symptoms at an earlier age.
  • Excess iron: people with a genetic disorder that causes the body to store excess iron.
  • Other disorders: some disorders that affect metabolism or endocrine glands are likely to develop pseudogout.

Causes

Pseudogout occurs when calcium pyrophosphate crystals form in the synovial fluid in the joints. Crystals can also deposit in the cartilage and can cause damage. The formation of crystal in the joint fluid results in swollen joints and acute pain. Older people have higher possibilities of getting pseudogout compared to younger people. In addition, the genetic condition can cause pseudogout because it always occurs in families.

In addition, other factors may include :

  • Low activity of the thyroid gland.
  • Parathyroid glands create too much parathyroid hormone.
  • Excess iron in the blood.
  • High calcium levels in the blood.
  • Lack of magnesium.

Symptoms

Pseudogout most often affects the knees. In addition, it also affects the ankles, wrists, and elbows.

General symptoms may include:

  1. Bouts of joint pain
  2. Swelling of the affected joint
  3. Fluid build up around the joint
  4. Chronic inflammation

Treatment

Until now, no treatment can completely remove or prevent the formation of calcium pyrophosphate dehydrate crystals. Therefore, treatment is generally focused on reducing pain and swelling.

  • Joint injection: insert a needle into the affected joint and take off the fluid. So, the crystals, pressure, and pain will be relieved. Injection of a steroid into the joint can decrease the amount of inflammation present.
  • Oral medications such as NSAIDs, prednisone, and colchicine can decrease inflammation and pain.
  • Joint immobilization: avoid lifting heavy objects if it involve the legs.

REFERENCES

Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.

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No adverse CV outcomes and excess risks of death from Febuxostat

Cr. Halacious

Source from MIMS.com

According to the results of a meta-analysis, the use of febuxostat does not appear to come with an increased hazard of mortality or adverse cardiovascular (CV) outcomes, for the treatment of patients with gout and hyperuricemia.

Data from 15 randomized controlled trials were collected by researchers and contributed to a total of 16,070 participants. The proportion of patients with hypertension varied between 27.7 percent and 100.0 percent, while those with diabetes ranged from 6.9 percent to 100.0 percent.

A median follow-up of 6.4 months were used across the trials, and the use of febuxostat vs control (allopurinol or placebo) did not result in a significant increase in the risk of CV mortality and all-cause mortality.

The same was true for adverse CV outcomes, as follows: major adverse CV events (risk difference [RD] 1.40 percent), myocardial infarction (RD, -0.06 percent), stroke (RD, 0.10 percent), or new-onset hypertension (RD, 1.58 percent).

Among patients with existing CV disease, the findings were consistent and the test (Egger’s regression test) did not detect significant publication bias.

The evidence were limited by the presence of low to moderate certainty, the researchers said. Recommendations of evaluating CV events and mortality as an outcome were stated by the researchers, as well as defining major adverse CV events, and comparing the outcomes among different doses of febuxostat over a longer follow-up duration in future trials.

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Therapeutic potential in COVID-19 with colchicine

Cr. Fusion Medical Animation

Source from MIMS.com

Based on a study, survival rate in patients with COVID-19 was improved with the use of colchicine, which are usually used for the treatment of gout and other inflammatory disorders as compared with standard of care (SoC).

The well-recognised anti-inflammatory effects and potential antiviral properties made it as one of the drugs that was considered for the treatment of COVID-19.  140 hospitalized patients who contracted COVID-19 had their outcomes evaluated as they were treated with SoC (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir) and in 122 patients treated with colchicine and SoC.

The SoC group, have lower serum concentrations of C-reactive prottein and ferritin, as well as neutrophil count but higher PaO2/FiO2 ratio at baseline.

Survival when being compared over 21 days of follow-up, it was more favourable in the colchicine than the SoC group. A lower risk of death was strongly associated with colchicine, on Cox proprortional hazards regression (hazard ratio, 0.151).

At entry, there were a higher serum levels of ferritin, worse Pa02/Fi02 and poor survival at older age for the risk factors. 

With no treatment discontinuation due to severe adverse events, colchicine had a good safety profile. In nine patients, dosing was reduced from 1 to 0.5 mg/day due to diarrhoea.

With the aim of preventing the patient’s autoinflammatory response, the current study provides proof-of-concept data supporting the possible use of colchicine in the treatment of the early phase of COVID-19.

To determine the efficacy and safety of colchicine, properly designed trials are needed with the best protocol in terms of dosage and timing of administartion in patients with COVID-19, said the researchers.

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