Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Research and Therapy

UAB Center for Education and Research (CERTs) on Therapeutics of Musculoskeletal Disorders, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Arthritis research & therapy (Impact Factor: 3.75). 02/2006; 8 Suppl 1(Suppl 1):S2. DOI: 10.1186/ar1907
Source: PubMed


Gout affects more than 1% of adults in the USA, and it is the most common form of inflammatory arthritis among men. Accumulating data support an increase in the prevalence of gout that is potentially attributable to recent shifts in diet and lifestyle, improved medical care, and increased longevity. There are both nonmodifiable and modifiable risk factors for hyperuricemia and gout. Nonmodifiable risk factors include age and sex. Gout prevalence increases in direct association with age; the increased longevity of populations in industrialized nations may contribute to a higher prevalence of gout through the disorder's association with aging-related diseases such as metabolic syndrome and hypertension, and treatments for these diseases such as thiazide diuretics for hypertension. Although gout is considered to be primarily a male disease, there is a more equal sex distribution among elderly patients. Modifiable risk factors for gout include obesity, the use of certain medications, high purine intake, and consumption of purine-rich alcoholic beverages. The increasing prevalence of gout worldwide indicates that there is an urgent need for improved efforts to identify patients with hyperuricemia early in the disease process, before the clinical manifestations of gout become apparent.

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    • "Current treatments for gout have two targets: to control the inflammation of a gout attack and to lower serum uric acid levels (Tausche et al. 2009). However, given the disadvantages of drug therapy, modifications to lifestyle and diet, which are relatively inexpensive and safe, are attractive alternatives and, moreover, may result in better control of this disorder (Saag and Choi 2006). Thus, we propose the production of low-purine-content food as a novel solution to the problem of elevated serum urate. "
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    ABSTRACT: Construction of a transgenic Arxula adeninivorans strain that produces a high concentration of adenine deaminase and investigation of the application of the enzyme in the production of food with low purine content. The A. adeninivorans AADA gene, encoding adenine deaminase, was expressed in this yeast under the control of the strong inducible nitrite reductase promoter using the Xplor(®) 2 transformation/expression platform. The recombinant enzyme was biochemically characterized and was found to have a pH range of 5.5-7.5 and temperature range of 34-46 °C with medium thermostability. A beef broth was treated with the purified enzyme resulting in the concentration of adenine decreasing from 70.4 mg l(-1) to 0.4 mg l(-1) . It was shown that the production of adenine deaminase by A. adeninivorans can be increased and that the recombinant adenine deaminase can be used to lower the adenine content in the food. Adenine deaminase is one component of an enzymatic system that can reduce the production of uric acid from food constituents. This study gives details on the expression, characterization and application of the enzyme and thus provides evidence that supports the further development of the system. This article is protected by copyright. All rights reserved.
    Journal of Applied Microbiology 08/2013; 115(5):1134-46. DOI:10.1111/jam.12317 · 2.48 Impact Factor
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    • "Gout patients frequently have a number of comorbidities, including obesity, hypertension, high serum lipid and cholesterol levels, kidney disease, diabetes, and cardiovascular disease [2,7,19-21]. Due to the rising incidence and prevalence of gout, greater scrutiny has been directed towards the impact of gout on health-related quality of life (HRQOL) [22,23], healthcare resource utilization, and work productivity, a task complicated by the presence of the other ailments. "
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    ABSTRACT: Background The prevalence of gout is increasing, and most research on the associated burden has focused on serum urate (sUA) levels. The present study quantifies the impact of the presence of tophi and frequency of acute gout attacks on health-related quality of life (HRQOL), productivity, and healthcare resource utilization. Methods Patients with self-reported gout (n = 620; 338 in US and 282 across France, Germany, and UK) were contacted based on inclusion in the 2010 US and EU National Health and Wellness Surveys (Kantar Health) and the Lightspeed Research ailment panel. Respondents were categorized into mutually-exclusive groups based on number of gout flares experienced in the past 12 months (0/don’t recall, 1–2, 3, 4–5, 6+), current presence of tophi (none, 1+, or not sure), and sUA level awareness (yes, no). HRQOL (SF-12v2), healthcare provider visits in the last 6 months, and work productivity and activity impairment (WPAI) were compared across groups. Results Most patients were males, mean age of 61 years, who reported experiencing at least one acute gout flare in the past 12 months, and 12.3% (n = 76) reported presence of tophi. Among the 27.7% (n = 172) of patients who were aware of their sUA levels, higher sUA was associated with more flares and tophi. Decreased HRQOL was associated with more frequent flares and presence of tophi. In multivariable models predicting outcomes based on presence of tophi and number of flares, both flares (≥4) and tophi (≥1) were associated with HRQOL decrements on physical and mental component summary scores and health utilities (all p < 0.05), after adjustment for age, gender, and time since diagnosis. Flares were also associated with greater activity impairment. Conclusions Impairments associated with gout flares and presence of tophi, across patients in the US and EU, underscore the importance of effective management of this potentially curable condition.
    Health and Quality of Life Outcomes 09/2012; 10(1). DOI:10.1186/1477-7525-10-117 · 2.12 Impact Factor
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    • "We also evaluated other suspected risk factors lacking in large-scale epidemiologic data, such as lipid abnormalities, ischemic heart disease, congestive heart failure, psoriasis, and various medications. While all subtypes of hyperlipidemia showed independent associations with the risk of incident gout [25], the association with hypertriglyceridemia was most prominent. Elevated triglyceride level is a cardinal feature of insulin resistance, which is closely associated with elevated serum uric acid levels. "
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    ABSTRACT: The objective of this study was to investigate the contemporary incidence of gout, examine potential risk factors, and evaluate specific gout treatment patterns in the general population. Using the health improvement network (THIN) UK primary care database, we estimated the incidence of gout based on 24,768 newly diagnosed gout patients among a cohort of 1,775,505 individuals aged 20 to 89 years between 2000 and 2007. We evaluated potential risk factors for incident gout in a nested case-control study with 50,000 controls frequency-matched by age, sex and calendar time. We calculated odds ratios (OR) by means of unconditional logistic regression adjusting for demographic variables, lifestyle variables, relevant medical conditions and drug exposures. The incidence of gout per 1,000 person-years was 2.68 (4.42 in men and 1.32 in women) and increased with age. Conventional risk factors were significantly and strongly associated with the risk of gout, with multivariate ORs of 3.00 (95% confidence interval (CI)) for excessive alcohol intake (that is, more than 42 units per week), 2.34 (95% CI 2.22 to 2.47) for obesity (body mass index > = 30 kg/m2), 2.48 (95% CI 2.19 to 2.81) for chronic renal impairment, and 3.00 (95% CI 2.85 to 3.15) for current diuretic use. For other medical conditions the multivariate OR were 1.84 (95% CI 1.70 to 2.00) for heart failure, 1.45 (95% CI 1.18 to 1.79) for hypertriglyceridemia and 1.12 (95% CI 1.04 to 1.22) for psoriasis. Use of cyclosporine was associated with an OR of 3.72 (95% CI, 2.17 to 6.40). Among gout-specific therapies, allopurinol was the most frequently used with a one-year cumulative incidence of 28% in a cohort of incident gout diagnosed from 2000 to 2001. Use of gout-specific treatment has not changed over recent years except for an increase of colchicine. The contemporary incidence of gout in UK remains substantial. In this general population cohort, associations with previously purported risk factors were evident including psoriasis, heart failure, hypertriglyceridemia, and cyclosporine therapy. Use of gout-specific treatment has remained relatively constant in recent years except for an increase of colchicine.
    Arthritis research & therapy 03/2011; 13(2):R39. DOI:10.1186/ar3272 · 3.75 Impact Factor
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