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The effect of control and self-medication of chronic gout in a developing country. Outcome after 10 years

Darmawan J, Rasker JJ, Nuralim H

J Rheumatol, 2003 Nov;30(11):2437-43.
PMID: 14677190

OBJECTIVE: We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout.
METHODS: We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 +/- 14.3 SD years. Subjects comprised 228 cases with chronic gout without tophi or urolithiasis (Group 1) and 71 with those complications (Group 2). Attacks of acute gouty arthritis were treated with nonsteroidal antiinflammatory drugs (NSAID) and/or corticosteroids. After acute arthritis had settled, urate-lowering drugs were instituted in both groups combined with low dose colchicine and/or low dose NSAID for at least 0.5-2 years. Urate levels were maintained longterm at a mean of < 5 mg/dl. After 10 years, the dropouts were traced and evaluated for comparison with baseline and those who remained in the study. In Group 2 the urate-lowering drugs were continued.
RESULTS: Control of gout and hyperuricemia was achieved in all patients who remained under control: 91.6% of the 299 patients for at least 2 years (short-term), up to 5 years in 87.5% (medium term), and up to 10 years in 79.6% (longterm). In Group 1 (chronic gout without complication) only 36.8% had no attacks during 8 years, after they had tapered urate-lowering drug after the first 2 years of the study. In the 61 dropouts the intermittent symptomatic treatment and/or self-medication without longterm control of hyperuricemia resulted after 1 decade in chronic gout with more complications and associated conditions leading to increased morbidity, disability, and comorbidity, and 3 early mortalities.
CONCLUSION: By controlling hyperuricemia, improvement of the prognosis of chronic gout, comorbidity, and early death was achieved compared with self-medication alone. Self-medication in a developing country if continued unchecked may become a public health problem in a population with a high prevalence rate of gout.

Matched MeSH terms: Gout/complications*; Gout/drug therapy*; Gout/ethnology; Gout/metabolism
A survey on the management of gout in Malaysia

Yeap SS, Goh EM, Gun SC

Int J Rheum Dis, 2009 Dec;12(4):329-35.
PMID: 20374371 DOI: 10.1111/j.1756-185X.2009.01431.x

AIM: The aim of this study was to ascertain the management of gout by doctors in Malaysia.
METHODS: A cross-sectional questionnaire survey was carried out among doctors attending rheumatology post-graduate courses, where gout was not a lecture topic.
RESULTS: A total of 128 questionnaires were analyzed, of which the majority (67: 52.3%) were general practitioners. In the treatment of acute gout, 68.0% use non-selective non-steroidal anti-inflammatory drugs (NSAIDs), 53.9% use selective COX-2 inhibitors (coxibs), 66.4% use colchicine and 10.2% use allopurinol (ALLO). In the treatment of chronic gout, 36.7% use NSAIDs, 44.5% use coxibs, 19.5% use colchicine and 93% use ALLO. In both acute and chronic gout, corticosteroids (CS) are not used by over 90% of respondents. Fifty percent would stop ALLO during an acute attack. 95.3% do not start ALLO during an acute attack; 87.5% would start ALLO after the attack, with a median of 14 days afterwards. Once ALLO was started, 54.7% would continue indefinitely. Regarding target urate levels while on treatment, 10.9% would be satisfied with a high normal range, 21.9% middle of the range, 18.0% low normal range and 45.3% anywhere within the normal range. Fifteen percent would treat asymptomatic hyperuricemia.
CONCLUSIONS: In Malaysia, anti-inflammatory agents are most commonly used for the treatment of acute and chronic gout, with corticosteroid usage at a low level. However, there are areas of concern regarding the diagnosis of gout and the usage of ALLO which are not consistent with current guidelines

Matched MeSH terms: Gout/diagnosis; Gout/drug therapy*; Gout/physiopathology; Gout Suppressants/therapeutic use*
Clinical presentation and disease associations of gout: a hospital-based study of 100 patients in Singapore

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
Fulltext A rare cause of back pain and radiculopathy - spinal tophi: a case report

Wan SA, Teh CL, Jobli AT, Cheong YK, Chin WV, Tan BB

J Med Case Rep, 2019 Jan 08;13(1):8.
PMID: 30626451 DOI: 10.1186/s13256-018-1940-4

BACKGROUND: Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis.

CASE PRESENTATION: We report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started.

CONCLUSION: Spinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.

Matched MeSH terms: Gout/complications*; Gout/drug therapy; Gout/physiopathology; Gout Suppressants/therapeutic use
Fulltext A single-centre experience of febuxostat as a second-line urate-lowering therapy

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
Fulltext Bioactivity analysis of lemongrass (Cymbopogan citratus) essential oil

Mirghani, M.E.S., Liyana, Y., Parveen, J.

International Food Research Journal, 2012;19(2):569-575.
MyJurnal

Diseases such as diabetes mellitus and gout are among the chronic diseases affecting worldwide population. Investigation is required to find the alternative approaches to treat these chronic diseases, such as plant based medicine. In this study, lemongrass (Cymbopogan citratus) was chosen and examined on the basis of their usage in traditional medicines throughout Southeast Asia. GCMS analysis revealed the major constituents of the lemongrass essential oil which compromise 67.769% and 67.328% of the total oil respectively. Total phenolic content of the essential oil was analyzed by Folin Ciocalteau method and the results indicated that highest amount of phenolic content was obtained from essential oil extracted from lemongrasses stalk, with phenolic concentration of 2100.769 mg/l GAE. Anti oxidant activity was examined by DPPH scavenging test and the highest inhibition was obtained by essential oil extracted from lemongrass stalk (89.5%). β-glucosidase inhibition assay was carried out using an in-vitro model for anti diabetic test and lemongrass stalk essential oil showed highest degree of inhibitory activity (89.63%). Anti gout test was examined by xanthine oxidase inhibition (XOI) assay with the maximum percentage of xanthine oxidase inhibition of 81.34% obtained from lemongrass stalk essential oil.

Matched MeSH terms: Gout; Gout Suppressants
Fulltext Xanthine oxidase inhibitory activity from potential Malaysian medicinal plant as remedies for gout

Azmi SMN, Jamal P, Amid A

International Food Research Journal, 2012;19(1):159-165.
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
Fulltext The use of febuxostat for gout in Hospital Tengku Ampuan Afzan (HTAA) Kuantan. [Abstract]

Abdullah H

International Medical Journal Malaysia, 2017;16(11):50.
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
Fulltext Clinical characteristics of gout: a hospital case series

Mohd A, Das Gupta E, Loh YL, Gandhi C, D'Souza B, Gun SC

Malays Fam Physician, 2011;6(2-3):72-3.
PMID: 25606228 MyJurnal

INTRODUCTION: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity).
METHODS: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja'afar, Seremban.
RESULTS: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, with the age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment.
CONCLUSION: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.
Study site: Rheumatology outpatient clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia.

Matched MeSH terms: Gout
Fulltext Raman spectroscopy applied to the noninvasive detection of monosodium urate crystal deposits

Curran DJ, Rubin L, Towler MR

Clin Med Insights Arthritis Musculoskelet Disord, 2015;8:55-8.
PMID: 26327784 DOI: 10.4137/CMAMD.S29061

An off-the-shelf Raman Spectrometer (RS) was used to noninvasively determine the presence of monosodium urate (MSU) crystals on the metatarsophalangeal joint (MTPJ) of a single gout sufferer. The spectrum sourced from the clinically diagnosed gout sufferer was compared to that sourced from an age-matched healthy subject scanned using the same protocol. Minimal signal processing was conducted on both spectra. Peaks characteristic of MSU crystals were evident on the spectrum sourced from the gout sufferer and not on the spectrum from the healthy control.

Study done in Canada

Matched MeSH terms: Gout
Fulltext High-performance Thin-layer Chromatography Method Development, Validation, and Simultaneous Quantification of Four Compounds Identified in Standardized Extracts of Orthosiphon stamineus

Hashim S, Beh HK, Hamil MS, Ismail Z, Majid AM

Pharmacognosy Res, 2016 Oct-Dec;8(4):238-243.
PMID: 27695261

CONTEXT: Orthosiphon stamineus is a medicinal herb widely grown in Southeast Asia and tropical countries. It has been used traditionally as a diuretic, abdominal pain, kidney and bladder inflammation, gout, and hypertension.
AIMS: This study aims to develop and validate the high-performance thin layer chromatography (HPTLC) method for quantification of rosmarinic acid (RA), 3'-hydroxy-5,6,7,4'-tetramethoxyflavone (TMF), sinensitin (SIN) and eupatorin (EUP) found in ethanol, 50% ethanol and water extract of O. stamineus leaves.
MATERIALS AND METHODS: HPTLC method was conducted using an HPTLC system with a developed mobile phase system of toluene: ethyl acetate: formic acid (3:7:0.1) performed on precoated silica gel 60 F254 TLC plates. The method was validated based on linearity, accuracy, precision, limit of detection, limit of quantification (LOQ), and specificity, respectively. The detection of spots was observed at ultraviolet 254 nm and 366 nm.
RESULTS: The linearity of RA, TMF, SIN, and EUP were obtained between 10 and 100 ng/spot with high correlation coefficient value (R2) of more than 0.986. The limit of detection was found to be 122.47 ± 3.95 (RA), 43.38 ± 0.79 (SIN), 17.26 ± 1.16 (TMF), and 46.80 ± 1.33 ng/spot (EUP), respectively. Whereas the LOQ was found to be 376.44 ± 6.70 (RA), 131.45 ± 2.39 (SIN), 52.30 ± 2.01 (TMF), and 141.82 ± 1.58 ng/spot (EUP), respectively.
CONCLUSION: The proposed method showed good linearity, precision, accuracy, and high sensitivity. Hence, it may be applied in a routine quantification of RA, SIN, TMF, and EUP found in ethanol, 50% of ethanol and water extract of O. stamineus leaves.
SUMMARY: HPTLC method provides rapid estimation of the marker compound for routine quality control analysis.The established HPTLC method is rapid for qualitative and quantitative fingerprinting of Orthosiphon stamineus extract used for commercial product.Four identified markers (RA, SIN, EUP and TMF) found in three a different type of O. stamineus extracts specifically ethanol, 50% ethanol and water extract were successfully quantified using HPTLC method. Abbreviations Used: HPTLC: High-performance thin layer chromatography; RA: Rosmarinic acid; TMF: 3'-hydroxy-5,6,7,4'-tetramethoxyflavone; SIN: Sinensitin; EUP: Eupatorin; E: Ethanol; EW: 50% ethanol; W: Water; BK: Batu Kurau; KB: Kepala Batas; S: Sik; CJ: Changkat Jering; SB: Sungai Buloh.
KEYWORDS: rosmarinic acid; Eupatorin; Orthosiphon stamineus; high-performance thin-layer chromatography; sinensitin; validation

Matched MeSH terms: Gout
Fulltext Suggestive evidence of SIc2a9 polymorphisms association in gouty malay males

Mahfudzah A, Nazihah MY, Wan Syamimee WG, Huay, Lin T, Wan Rohani WT

International Medical Journal Malaysia, 2015;14(2):35-40.
MyJurnal

Introduction: Solute carrier family 2, member 9 (SLC2A9) is thought to be an important urate transporter that influences the excretion and reabsorption of serum uric acid, thus has a strong effect on serum urate and risk of gout. SLC2A9 polymorphisms have been extensively studied in various populations in association with gout development. Our aim was to test for association of SLC2A9 SNPs with gout in Malay males.
Methods: 78 gouty patients and 82 normal subjects were recruited and genotyped for rs3733591, rs5028843 and rs11942223 using PCR-RFLP technique. Single association and haplotype association analyses were conducted using SHEsis online software.
Results: rs3733591 and rs5028843 showed association with gout with p value of 0.020 and 0.036, respectively, whilst rs11942223 yielded no association with p value of 0.08 with trend towards susceptibility projecting by OR=3.547, 3.667 and 2.732, respectively. It is noteworthy that haplotype 1/1/1 conferred protection in gout with p value 0.004 (OR=0.324 [0.147-0.716]).
Conclusion: This study might suggest an evidence of association of SLC2A9 SNPs with gout among Malay males.
KEYWORDS: Gout, SLC2A9, Malay males
Study site: Medical Specialist Clinic at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Gout
Fulltext Gouty wrist arthritis causing carpal tunnel syndrome--a case report

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
Comparison of uric acid levels in some Oriental and Caucasian groups unselected as to gout or hyperuricemia

Duff IF, Mikkelsen WM, Dodge HJ, Himes DS

Arthritis Rheum., 1968 Apr;11(2):184-90.
PMID: 5645731 DOI: 10.1002/art.1780110209
Matched MeSH terms: Gout/blood*
Flavonoids and phenylethanoid glycosides from Lippia nodiflora as promising antihyperuricemic agents and elucidation of their mechanism of action

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*
Mechanisms of antihyperuricemic effect of Phyllanthus niruri and its lignan constituents

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*
Fulltext Compensated polarised microscopy: a simple and cheap modification

Veerapen K, Ch'ng SL

Med J Malaysia, 1987 Sep;42(3):217-8.
PMID: 3509837
Matched MeSH terms: Gout; Arthritis, Gouty/diagnosis
Fulltext Morbidity patterns in elderly patients presenting to a family practice

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
Fulltext Tumoral calcinosis misdiagnosed

Chai WL, Phang YH, Chong HC

International e-Journal of Science, Medicine & Education, 2018;12(1):18-20.
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
Clinical significance of SLC2A9/GLUT9 rs11722228 polymorphisms in gout

Das Gupta E, Sakthiswary R, Lee SL, Wong SF, Hussein H, Gun SC

Int J Rheum Dis, 2018 Mar;21(3):705-709.
PMID: 27456670 DOI: 10.1111/1756-185X.12918

AIM: The main objective of this study is to elucidate the clinical significance of the SLC2A9/GLUT9 rs11722228 polymorphism among male gout patients.
METHOD: We consecutively recruited all newly diagnosed male gout patients who were treatment-naive from the rheumatology outpatient clinics of two Malaysian hospitals. Age-matched healthy male adults were employed as controls. All subjects were tested for the SLC2A9/GLUT9 rs11722228 genotypes, serum uric acid (SUA), urine uric acid and creatinine levels. All gout subjects were examined for the presence of tophi and sonographically screened for renal calculi.
RESULTS: A total of 73 male gout patients and 73 age-matched healthy male adults were recruited in this study. The genotypic frequencies of SLC2A9/GLUT9 rs1172228 did not differ significantly between the gout cases and the healthy controls. The gout subjects with the CC genotype had significantly higher SUA levels (P = 0.002), family history of gout (P < 0.050) and the occurrence of renal calculi (P = 0.026). The SUA-adjusted odds ratios (OR) of the occurrence of renal calculi in the CC genotype (OR = 1 [reference]) was significantly higher than the CT genotype (OR = 0.338, 95%CI: 0.141-0.813) and the TT genotype (OR = 0.271, 95%CI: 0.086-0.854).
CONCLUSIONS: The genotypic distribution of SLC2A9/GLUT9 rs1172228 in male gout patients did not differ significantly from that of healthy male controls. However, the CC genotype in gout had significant associations with higher levels of SUA, renal calculi and a positive family history of gout.
Study site: Rheumatology clinic, Tuanku Jaafar Hospital, Malaysia and Putrajaya Hospital, Malaysia

Matched MeSH terms: Gout/blood; Gout/genetics*; Gout/urine

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