Displaying publications 1 - 20 of 58 in total

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  1. Abdullah H
    MyJurnal
    Introduction: Febuxostat is a non-purine-selective oral xanthine oxidase inhibitor drug, and is an alternative to Allopurinol to lower serum uric acid in gout patients. It is probably more effective than Allopurinol, however, its use is limited because of its cost and availability. Allopurinol has been the mainstay treatment for gout for about 50 years. However, its use has been associated with allergic reactions especially in patients with renal impairment.The objective of this study was to describe HTAA Rheumatology Unit experiences with Febuxostat in the management of gout.
    Materials and method: Case records belonging to 6 patients who had been started on Febuxostat between January 2012 and January 2017 were analysed.
    Results: The majority of patients on Febuxostat were males (83.3%) as well as Malays (83.3%). About 66.7% of patients had already developed mild to moderate chronic kidney disease (GFR between 30-89 mL/min) due to multifactorial causes by the time they were started on Febuxostat. Also 33% of patients had mild liver impairment (ALT & AST < 1.5 ULN) due to fatty liver prior to Febuxostat. All patients had been started on Febuxostat due to allergic reactions to Allopurinol. All patients were on Febuxostat 40 mg once a day. Following Febuxostat, a significant decrease in the uric acid levels much closer to the target level i.e. less than 360 µmol/L were achieved in all patients. Only 1 patient (16.7%) developed a side effect i.e. ALT > 1.5 ULN while the rest tolerated the drug very well.
    Conclusion: Although the number of patients analysed was small, Febuxostat was shown to be very effective and safe for use in patients with gout even with concomitant mild to moderate renal impairment. Serum uric acid levels reduced significantly while on the lowest dose of 40 mg once a day.
    Matched MeSH terms: Gout; Gout Suppressants
  2. Sikkandar MF, Sapuan J, Singh R, Abdullah S
    Med J Malaysia, 2012 Jun;67(3):333-4.
    PMID: 23082430
    A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.
    Matched MeSH terms: Gout*; Arthritis, Gouty/complications*; Arthritis, Gouty/radiography
  3. Sowtali SN, Ariffin SRM, Nazli NS, Shukri NABM, Khattak MMAK, Ab Rashid IM, et al.
    J Public Health Res, 2021 Apr 14;10(2).
    PMID: 33855421 DOI: 10.4081/jphr.2021.2238
    BACKGROUND: To date, no studies have been published at evaluating the level of knowledge, awareness and practice of dietary, particularly regarding to urolithiasis in patients or the general population. This study aims to provide basic information on the level of knowledge, awareness and dietary practice among general population in Kuantan, Pahang.

    DESIGN AND METHODS: The respondents (n=30) were conveniently recruited within 10 kilometres radius of Kuantan city. The data were obtained using semi-guided administered questionnaires, which consists of four parts: socio-demographic data, lifestyle and clinical history (Part A); attitude and awareness on dietary practice regarding urolithiasis (Part B); food frequency questionnaire on urolithiasis (Part C) and level of knowledge on urolithiasis (Part D).

    RESULTS: Majority of the respondents were women (70%), Malay (83.3%), mean age of 33.97 (±9.27), married (63.3%), completed higher education level (60%), working with government sector (33.3%) and have fixed monthly income (53.3%). Some of them had hypertension (n=4), diabetes (n=1), gout (n=1) and intestinal problem (n=1). Majority (80%) claimed having no family history of urolithiasis, consumed alcohol (10%), exercise with average frequency 2-3 times/week (46.7%) and heard about urolithiasis from healthcare worker (46.7%). The respondents' awareness about urolithiasis is considered to be good [81.23 (±9.98)] but having poor knowledge score [2.70 (±1.149)]. Majority preferred wholemeal bread, white rice, chicken meat, mackerel fish, chicken egg, apple, carrot, mustard leave and fresh milk in daily intake. Lesser plain water intake than standard requirement was noticed among respondents. Seasoning powder was commonly used for seasoning.

    CONCLUSIONS: Generally, the general population of Kuantan, Pahang was aware of urolithiasis disease but needed more information on dietary aspect in terms of knowledge and food choice.

    Matched MeSH terms: Gout
  4. Azmi SMN, Jamal P, Amid A
    MyJurnal
    Malaysia has a rich diversity of medicinal plants and some of them inhibit xanthine oxidase (XO), which can be introduced as new natural sources of gout medication and a substitute for synthetic xanthine oxidase inhibitors (XOI). The degree of XO inhibitory activity was determined by measuring the absorbance spectrophotometrically at 295 nm, which is associated with uric acid formation. Our preliminary screening study had employed the use of distilled water, 70% methanol and absolute ethanol to extract XOI from twenty parts of five plant species, namely, Averrhoa carambola, Carica papaya, Dimocarpus longan malesianus, Manilkara zapota and Salacca zalacca. These plants were selected based on their frequent medicinal usages by local folks. The results have shown that an aqueous extract of Carica papaya mature leaves has promising activity to inhibit XO up to 75.68 ± 0.1%. Statistical experimental design were employed to optimize the selected sample (dried Carica papaya leaves: distilled water) on extraction of XOI and the maximum XOI percentage of 86.93 ± 1.9% was obtained, which exhibited only 6.76% less than the activity exhibited by allopurinol (93.69 ± 0.2%), a commercial XOI. The comparison was made between allopurinol and optimized extract on the basis of IC50concentrations. Allopurinol showed IC50 value of 3.74 μg/ml that is considerably lower as compared to the optimized sample (4.33 μg/ml).
    Matched MeSH terms: Gout; Gout Suppressants
  5. Mustafa N, Isa MR, Baharuddin H
    Med J Malaysia, 2024 Jan;79(1):80-84.
    PMID: 38287762
    INTRODUCTION: The treat-to-target serum uric acid approach is recommended in local and international guidelines on gout management. Instruction for initiation and dose escalation for urate lowering therapy may cause confusion to the patient. Our aim was to develop and validate Gout Treat-To- Target booklet to aid in patient education.

    MATERIALS AND METHODS: A content development team which consisted of three consultant rheumatologists developed the booklet. Content validation was performed by a panel of evaluators consisted of eleven physicians (four consultant rheumatologists, two clinical specialists, and five medical officers), who were involved in gout management. Face validation was performed by ten patients with gout.

    RESULTS: Item-Content Validity Index ranged from 0.9 to 1 with regards to relevancy, clarity, ambiguity and simplicity. Side effects of uricosuric agents were added to the draft based on an evaluator's comment. Item-Face Validity Index was 1, which indicated that all patients were in 100% agreement with all items.

    CONCLUSION: We developed and validated our Gout Treat-to- Target booklet. There was high agreement in I-FVI and I-CVI among physicians and patients.

    Matched MeSH terms: Gout Suppressants/therapeutic use
  6. Burns-Cox CJ
    Med J Malaya, 1964 Sep;19:25-9.
    PMID: 14240057
    Matched MeSH terms: Gout*
  7. Cameron JAP
    Malayan Medical Journal, 1934;9(4):206-8.
    Matched MeSH terms: Gout
  8. Veerapen K, Ch'ng SL
    Med J Malaysia, 1987 Sep;42(3):217-8.
    PMID: 3509837
    Matched MeSH terms: Gout; Arthritis, Gouty/diagnosis
  9. Koh WH, Seah A, Chai P
    Ann Acad Med Singap, 1998 Jan;27(1):7-10.
    PMID: 9588267
    The aim of this retrospective study was to characterise the clinical presentation and disease associations of Oriental patients with gout seen in our hospital over a six-month period. One hundred patients comprising of 77 males and 23 females [89% Chinese, 7% Malays, 2% Indians and 2% others; mean age was 50.9 years (range 18 to 82 years), mean age at onset of disease was 43.7 years (range 16 to 78 years)] were studied. The disease was familial in 18% and 44% of patients had a history of alcohol ingestion. Co-morbid conditions included hypertension (36%), hyperlipidaemia (25%), renal failure (17%), ischaemic heart disease (13%), diabetes mellitus (4%), systemic lupus erythematosus (3%), psoriasis (2%) and ankylosing spondylitis (1%). The majority of patients (68%) had at least one associated disease. At the onset of disease, the joints commonly involved were the ankles (39%) and knees (27%) whilst the first metatarsophalangeal (MTP) joint was affected in only 26% of cases. Polyarticular onset was uncommon (n = 6). The precipitating factors reported by the patients included food (n = 23), alcohol (n = 12), drugs (n = 4), trauma (n = 3) and surgery (n = 2). Eleven patients had a history of renal calculi and 15% had tophaceous gout. Majority of patients (71%) had been treated with urate-lowering drugs (allopurinol). We concluded that gout in Singapore predominantly affects middle-aged men who often have an accompanying illness.
    Matched MeSH terms: Gout/diagnosis; Gout/drug therapy; Gout/epidemiology*; Gout Suppressants/therapeutic use
  10. Chong HY, Lim YH, Prawjaeng J, Tassaneeyakul W, Mohamed Z, Chaiyakunapruk N
    Pharmacogenet Genomics, 2018 02;28(2):56-67.
    PMID: 29176400 DOI: 10.1097/FPC.0000000000000319
    OBJECTIVE: Studies found a strong association between allopurinol-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and the HLA-B*58:01 allele. HLA-B*58:01 screening-guided therapy may mitigate the risk of allopurinol-induced SJS/TEN. This study aimed to evaluate the cost-effectiveness of HLA-B*58:01 screening before allopurinol therapy initiation compared with the current practice of no screening for Malaysian patients with chronic gout in whom a hypouricemic agent is indicated.

    METHODS: This cost-effectiveness analysis adopted a societal perspective with a lifetime horizon. A decision tree model coupled with Markov models were developed to estimate the costs and outcomes, represented by quality-adjusted life years (QALYs) gained, of three treatment strategies: (a) current practice (allopurinol initiation without HLA-B*58:01 screening); (b) HLA-B*58:01 screening before allopurinol initiation; and (c) alternative treatment (probenecid) without HLA-B*58:01 screening. The model was populated with data from literature review, meta-analysis, and published government documents. Cost values were adjusted for the year 2016, with costs and health outcomes discounted at 3% per annum. A series of sensitivity analysis including probabilistic sensitivity analysis were carried out to determine the robustness of the findings.

    RESULTS: Both HLA-B*58:01 screening and probenecid prescribing were dominated by current practice. Compared with current practice, HLA-B*58:01 screening resulted in 0.252 QALYs loss per patient at an additional cost of USD 322, whereas probenecid prescribing resulted in 1.928 QALYs loss per patient at an additional cost of USD 2203. One SJS/TEN case would be avoided for every 556 patients screened. At the cost-effectiveness threshold of USD 8695 per QALY, the probability of current practice being the best choice is 99.9%, in contrast with 0.1 and 0% in HLA-B*58:01 screening and probenecid prescribing, respectively. This is because of the low incidence of allopurinol-induced SJS/TEN in Malaysia and the lower efficacy of probenecid compared with allopurinol in gout control.

    CONCLUSION: This analysis showed that HLA-B*58:01 genetic testing before allopurinol initiation is unlikely to be a cost-effective intervention in Malaysia.
    Matched MeSH terms: Gout
  11. Cheng LC, Murugaiyah V, Chan KL
    J Ethnopharmacol, 2015 Dec 24;176:485-93.
    PMID: 26593216 DOI: 10.1016/j.jep.2015.11.025
    ETHNOPHARMACOLOGICAL RELEVANCE: Lippia nodiflora has been traditionally used in the Ayurvedic, Unani, and Sidha systems, as well as Traditional Chinese Medicine (TCM) for the treatment of knee joint pain, lithiasis, diuresis, urinary disorder and swelling.
    AIM OF THE STUDY: The present study aims to investigate the antihyperuricemic effect of the L. nodiflora methanol extract, fractions, and chemical constituents and their mechanism of action in the rat model.
    MATERIALS AND METHODS: The mechanisms were investigated by performing xanthine oxidase inhibitory, uricosuric, and liver xanthine oxidase/xanthine dehydrogenase (XOD/XDH) inhibitory studies in potassium oxonate- and hypoxanthine-induced hyperuricemic rats. The plant safety profile was determined using acute toxicity study. The molecular docking of the active compound to the xanthine oxidase was simulated using computer aided molecular modeling analysis.
    RESULTS: Oral administration of methanol extract showed a dose-dependent reduction effect on the serum uric acid level of hyperuricemic rats. F3 was the most potent fraction in lowering the serum uric acid level of hyperuricemic rats. Bioactivity-guided purification of F3 afforded two phenylethanoid glycosides, arenarioside (1) and verbascoside (2) and three flavonoids, 6-hydroxyluteolin (3), 6-hydroxyluteolin-7-O-glycoside (4), and nodifloretin (5). The highest serum uric acid reduction effect was exhibited by 3 (66.94%) in hyperuricemic rats, followed by 5 (55.97%), 4 (49.16%), 2 (29.03%), and 1 (22.08%) at 0.2 mmol/kg. Dose-response investigation on 3 at doses of 0.05, 0.1, and 0.3 mmol/kg produced a significant dose-dependent reduction on the serum uric acid level of hyperuricemic rats. Repeated administration of F3 or 3 to the hyperuricemic rats for 10 continuous days resulted in a significant and progressive serum uric acid lowering effect in hyperuricemic rats. In contrast, methanol extract and F3 did not reduce serum uric acid level of normoruricemic rats. In addition, F4 significantly increased the uric acid excretion of hyperuricemic rats at 200mg/kg. No toxic effect was observed in rats administered with 5000 mg/kg of methanol extract or F3.
    CONCLUSION: The potential application of L. nodiflora against hyperuricemia in the animal in accordance with its traditional uses has been demonstrated in the present study for the first time. The antihyperuricemic effect possessed by L. nodiflora was contributed mainly by liver XOD/XDH inhibitory activities and partially by uricosuric effect. Flavonoids mainly accountable for the uric acid lowering effect of L. nodiflora through the inhibition of XOD/XDH activities.
    KEYWORDS: Antihyperuricemic; Hypoxanthine-induced hyperuricemic rat; Lippia nodiflora; Liver xanthine oxidase and xanthine dehydrogenase; Serum uric acid; Uric acid excretion
    Matched MeSH terms: Gout Suppressants/pharmacology; Gout Suppressants/therapeutic use*
  12. Murugaiyah V, Chan KL
    J Ethnopharmacol, 2009 Jul 15;124(2):233-9.
    PMID: 19397979 DOI: 10.1016/j.jep.2009.04.026
    ETHNOPHARMACOLOGICAL RELEVANCE: Phyllanthus niruri Linn. (Euphorbiaceae) is used as folk medicine in South America to treat excess uric acid. Our initial study showed that the methanol extract of Phyllanthus niruri and its lignans were able to reverse the plasma uric acid of hyperuricemic animals.
    AIM OF THE STUDY: The study was undertaken to investigate the mechanisms of antihyperuricemic effect of Phyllanthus niruri and its lignan constituents.
    MATERIAL AND METHODS: The mechanisms were investigated using xanthine oxidase assay and uricosuric studies in potassium oxonate- and uric acid-induced hyperuricemic rats.
    RESULTS: Phyllanthus niruri methanol extract exhibited in vitro xanthine oxidase inhibition with an IC50 of 39.39 microg/mL and a moderate in vivo xanthine oxidase inhibitory activity. However, the lignans display poor xanthine oxidase inhibition in vitro and a relatively weak in vivo inhibitory activity at 10mg/kg. On the other hand, intraperitoneal treatment with Phyllanthus niruri methanol extract showed 1.69 folds increase in urinary uric acid excretion when compared to the hyperuricemic control animals. Likewise, the lignans, phyllanthin, hypophyllanthin and phyltetralin exhibited up to 2.51 and 11.0 folds higher in urinary uric acid excretion and clearance, respectively. The co-administration of pyrazinamide with phyllanthin exhibited a significant suppression of phyllanthin's uricosuric activity resembling that of pyrazinamide with benzbromarone.
    CONCLUSIONS: The present study showed that the antihyperuricemic effect of Phyllanthus niruri methanol extract may be mainly due to its uricosuric action and partly through xanthine oxidase inhibition, whereas the antihyperuricemic effect of the lignans was attributed to their uricosuric action.
    Matched MeSH terms: Gout Suppressants/isolation & purification; Gout Suppressants/pharmacology; Gout Suppressants/therapeutic use*
  13. Murugaiyah V, Chan KL
    Planta Med, 2006 Nov;72(14):1262-7.
    PMID: 16953466 DOI: 10.1055/s-2006-947224
    The methanol extract from the leaves of Phyllanthus niruri L. showed oral antihyperuricemic activity in potassium oxonate- and uric acid-induced hyperuricemic rats. Fractionation of the extract by resin chromatography led to the isolation of a less polar fraction which exhibited the highest reduction of plasma uric acid. Further antihyperuricemic-guided purification of the fraction afforded three lignans, phyllanthin (1), hypophyllanthin (2) and phyltetralin (3), of which 1 significantly reversed the plasma uric acid level of hyperuricemic animals to its normal level in a dose-dependent manner, comparable to that of allopurinol, benzbromarone and probenecid which are used clinically for the treatment of hyperuricemia and gout. Thus, the lignans of P. niruri are potential antihyperuricemic agents worthy of further investigation.
    Matched MeSH terms: Gout/drug therapy
  14. Teoh LC, Chan SC
    Family Physician, 2003;12(1):24-28.
    The morbidity patterns of elderly patients presenting to a family physician clinic was studied by the attending physician completing a questionnaire on all elderly patients aged 60 and above attending the clinic between 1st January to 31st March 2000. 612 elderly patients registered during the study period. The most common presentations included upper respiratory tract infections (21.6%), hypertension and diabetes mellitus (18%), gastritis/dyspepsia (5.0%) and injuries (5.0%), Musculoskeletal complaints (backache, gout, osteoarthritis) and anxiety were also among the top 10 most common presenting complaints. Injuries were mainly soft tissue injuries and sprains sustained at home. Some were preventable.
    Matched MeSH terms: Gout
  15. Chai WL, Phang YH, Chong HC
    MyJurnal
    Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.
    Matched MeSH terms: Gout
  16. Chua WT
    Family Practitioner, 1984;7(1):29-33.
    Matched MeSH terms: Gout*
  17. Mohd A, Gun SC, Das Gupta E, De'Souza B
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A89.
    Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
    Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
    Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
    Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
    Matched MeSH terms: Gout
  18. Ong SG, Ding HJ
    Malays Fam Physician, 2021 Mar 25;16(1):50-55.
    PMID: 33948142 DOI: 10.51866/oa0892
    Introduction: The purpose of this study was to describe the local experience in terms of drug efficacy and safety using a new xanthine oxidase inhibitor, febuxostat, as a second-line urate-lowering therapy (ULT) in gout patients with normal renal function and chronic kidney disease.

    Methods: This cross-sectional study included all gout patients who attended the rheumatology clinic from January 2013 to June 2018 and had received febuxostat as a second-line ULT. Analysis focused on the proportion of gout patients who achieved target serum urate (sUA) of <360 μmol/L, duration taken to achieve target sUA, and febuxostat dosage at achievement of target sUA. Safety assessments included comparison of serum creatinine, estimated glomerular filtration rate (eGFR), and serum alanine aminotransferase (ALT) at baseline, at achievement of target sUA, and at 12-monthly intervals.

    Results: Majority (90.9%) of patients achieved target sUA. Median duration required to achieve target sUA was 5.5 months with IQR (interquartile range) of 8.5. Five (22.7%) patients achieved target sUA within one month of therapy with febuxostat 40 mg per day. Eleven (55%) patients achieved target sUA within six months and 16 (80%) by 12 months. Equal proportion of patients achieved target sUA with febuxostat 40 mg per day and 80 mg per day, respectively. There was no significant difference in the changes in serum creatinine level, eGFR and ALT from baseline and at achievement of target sUA, nor at 12-monthly intervals throughout the duration of febuxostat therapy. Apart from three patients who developed hypersensitivity reactions to febuxostat, no other adverse events were reported.

    Conclusion: A significant proportion of gout patients with CKD managed to achieve target sUA with a lower dose of febuxostat at 40 mg per day and it is reasonable to maintain this dose for up to six months before considering dose escalation.

    Matched MeSH terms: Gout; Gout Suppressants
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