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    [Effect of optimum jogging in a hot environment on uric acid metabolism]. Kimura Naoto,Ito Takashi Nihon eiseigaku zasshi. Japanese journal of hygiene OBJECTIVES:The purpose of this study was to estimate the effect of optimum jogging in a hot environment on uric acid metabolism. METHODS:Six male subjects performed jogging at each optimum speed. The distance of jogging was 8000 m (400 m track x 20 laps). Each jogging was performed twice, once in the summer season (Sept.) and once in the winter season (March). Blood samples were collected before and at 0, 1, 2, 3, 5 and 24 h after each jogging. Urine was also collected before (after 60 min at rest) and from the onset of jogging until 24 h after. RESULTS:The wet bulb globe temperature (W.B.G.T.) during jogging ranged from 24.9 to 27.8 degrees C in the summer and from 5.9 to 11.4 degrees C in the winter. There was no difference in the duration of each jogging between summer and winter. However, the heart rate (H.R.) during jogging in the summer was higher than that in the winter. Serum uric acid at each rest ranged from, on average, 6.2 to 6.4 (mg/dl). After jogging in the summer, serum uric acid rose significantly (p < 0.05) and the increase was maintained until 5 h after. Exercise-induced hyperuricemia (above 7.5 mg/dl of serum uric acid) was shown in 3 out of all the subjects. In contrast, serum uric acid in the winter showed no significant change throughout protocol. There was no difference in the change in clearance of uric acid during each protocol between summer and winter. Urinary uric acid excretion at 24 h after, between summer and winter, showed similar levels. The rate of urinary oxypurine excretion (xanthine + hypoxanthine) in summer was higher than that in winter at 1 h and 2 h. CONCLUSIONS:These results suggest that not only jogging but also a hot environment affects uric acid metabolism, especially the increase of purine nucleotide degradation.
    Accelerated purine nucleotide degradation by anaerobic but not by aerobic ergometer muscle exercise. Yamanaka H,Kawagoe Y,Taniguchi A,Kaneko N,Kimata S,Hosoda S,Kamatani N,Kashiwazaki S Metabolism: clinical and experimental The exact conditions under which exercise causes purine nucleotide degradation are not well understood. We determined plasma hypoxanthine and uric acid levels serially in eight individuals during ergometer muscle exercise. When the load was increased gradually by 15 W/min, plasma hypoxanthine was elevated only after the status exceeded the anaerobic threshold (AT), as determined by analysis of expired gas. Nonstrenuous ergometer exercise, which kept the status continuously below the AT, induced neither blood lactic acid nor plasma hypoxanthine elevation. These results suggest that the AT is also the threshold for the acceleration of purine nucleotide degradation. Muscle exercise to a degree that does not exceed the AT does not cause major purine nucleotide degradation, and, therefore, is expected to be beneficial for patients with gout and/or hyperuricemia.
    Exercise and uric Acid: implication in cardiovascular disease. Francis K,Hamrick M E The Journal of orthopaedic and sports physical therapy The association of elevated serum uric acid (SUA) concentration (hyperuricemia) with gout has been known for many years, but more recently hyperuricemia has been observed to be associated with many of the known major risk factors for coronary heart disease (hypertension, stress, hypercholesterolemia) with much greater frequency than in the general population. Several epidemiological studies have indicated a beneficial relationship between physical activity, risk factor modification, and susceptibility to coronary heart disease. Physical activity has been shown to modify not only the major identified risk factors but SUA levels as well. Whereas acute exercise lasting between one-half and three hours elevates SUA in proportion to intensity of exercise, chronic exercise lowers SUA levels. Mechanisms for these changes are discussed as well as implications in relation to coronary disease.J Orthop Sports Phys Ther 1984;6(1):34-39. 10.2519/jospt.1984.6.1.34
    Persistent production of hypoxanthine in rat skeletal muscle causes prolonged hyperuricemia after an exhaustive exercise. Ogasawara M,Seino T,Hadano S,Ito A,Goto H,Itakura M Advances in experimental medicine and biology 10.1007/978-1-4684-5673-8_60
    [Mechanism of exercise-induced hyperuricemia]. Hadano S,Ogasawara M,Ito A Nihon seirigaku zasshi. Journal of the Physiological Society of Japan This study was designed to make clear why increases and decreases in serum uric acid levels after vigorous exercise were delayed. Eight healthy male subjects who were given allopurinol before exercise participated in this study. We performed exhaustive exercise test on bicycle ergometer, and investigated the changes in purine metabolites levels in blood and urine. Results were summarized as follow; 1) Serum uric acid concentrations did not change significantly. Urinary excretions of uric acid decreased from 30 minutes to 1 hour after exercise, and recovered thereafter. 2) Plasma oxypurines concentrations exhibited the maximum level at 1 hour after exercise, and maintained the higher levels until 7 hours after exercise. Urinary oxypurines excretions exhibited the maximum level at 1 hour after exercise, and maintained the higher levels until 24 hours after exercise. 3) Plasma inosine concentrations increased only in one subject. Plasma hypoxanthine concentrations increased significantly in all subjects. Plasma xanthine concentrations did not change. 4) Blood ammonia concentrations exhibited the maximum level at 5 minutes after exercise, and returned to basal levels at 2 hours after exercise. These observations suggest that the delays of increases and decreases in serum uric acid levels are due to that the prolonged release of hypoxanthine from skeletal muscle lead to the prolonged production of uric acid in liver.
    [Influence of exercise on serum uric acid]. Hashizume Naotaka,Matsumoto Takayuki Nihon rinsho. Japanese journal of clinical medicine
    [The exercise prescription for hyperuricemia]. Ito A Nihon rinsho. Japanese journal of clinical medicine
    Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Nielsen Sabrina M,Bartels Else M,Henriksen Marius,Wæhrens Eva E,Gudbergsen Henrik,Bliddal Henning,Astrup Arne,Knop Filip K,Carmona Loreto,Taylor William J,Singh Jasvinder A,Perez-Ruiz Fernando,Kristensen Lars E,Christensen Robin Annals of the rheumatic diseases OBJECTIVES:Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS:We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS:From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. CONCLUSIONS:The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42016037937. 10.1136/annrheumdis-2017-211472
    [Exercise and hyperuricemia]. Taniguchi A Nihon rinsho. Japanese journal of clinical medicine
    Metabolomics studies on db/db diabetic mice in skeletal muscle reveal effective clearance of overloaded intermediates by exercise. Xiang Li,Zhang Hongsong,Wei Juntong,Tian Xiao Yu,Luan Hemi,Li Shangfu,Zhao Hongzhi,Cao Guodong,Chung Arthur C K,Yang Chunxue,Huang Yu,Cai Zongwei Analytica chimica acta Type 2 diabetes mellitus (T2DM) is characterized by hyperinsulinemia, hyperglycemia and insulin resistance, which correlated with high mortality worldwide. Exercise is one of the effective lifestyle interventions in maintaining blood glucose level in the normal range and lowering risk factors. Metabolomics approaches are powerful tools in systematic study of overall metabolic changes in response to disease or interventions. In this study, mass spectrometry-based metabolomics studies were performed to investigate the regulatory effect of moderate intensity of exercise on db/db diabetic mice in skeletal muscle. Both liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) have been carried out to monitor a wide range of regulated metabolites. Ninety-five metabolites were identified which contributing to the discrimination of db/m  + control and db/db diabetic mice. The regulatory effects of exercise on these metabolites were mainly focusing on attenuating the levels of long-chain fatty acids (C14 to C18) and medium-to long-chain acylcarnitines (C12 to C18), indicated that exercise might play a positive role in inhibiting the accumulation of excessive lipids, which is positively related to insulin resistance. In addition, uric acid, which is a risk factor for inflammation, cardiovascular complications, and fatty liver in diabetic patients, together with its intermediates (such as inosinic acid, hypoxanthine, etc.) in purine metabolism pathway, were also substantially down regulated after exercise, indicating exercise might also be protective against hyperuricemia related risks in T2DM. These findings reveal that moderate intensity of exercise might play a positive role in improving the efficiency of lipid metabolism in skeletal muscle and meanwhile enhancing uric acid clearance to prevent lipid accumulation, which might contribute to improved body fitness and body muscle composition. 10.1016/j.aca.2017.11.082
    An inverted J-shaped association of serum uric acid with muscle strength among Japanese adult men: a cross-sectional study. Huang Cong,Niu Kaijun,Kobayashi Yoritoshi,Guan Lei,Momma Haruki,Cui Yufei,Chujo Masahiro,Otomo Atsushi,Guo Hui,Tadaura Hiroko,Nagatomi Ryoichi BMC musculoskeletal disorders BACKGROUND:Uric acid (UA) may protect muscle function from oxidative damage due to reactive oxygen species through its powerful antioxidant capacity. However, several studies have demonstrated that hyperuricemia is closely related to systemic inflammation and has oxidant properties effects, both of which may increase the risk of muscle strength loss. The purpose of this study was to examine the association of serum UA concentration with grip strength and leg extension power in adult men. METHODS:This study is a cross-sectional survey in which 630 Japanese male employees aged 30 years and older participated. Five hundred and eighty-six subjects participated in the measurement of grip strength, and 355 subjects participated in the measurement of leg extension power. Blood samples were obtained for serum UA analysis. RESULTS:After adjustment for potential confounders, grip strength differed significantly between participants with and those without hyperuricemia (geometric mean and 95% confidence interval [CI]: 40.3 [39.2-41.3] kg vs. 41.9 [41.3-42.5] kg; P = 0.01). In addition, serum UA levels (quartiles) showed an inverted J-shaped curve with grip strength (mean and 95% CI: Q1, 41.6 [40.6-42.6] kg; Q2, 42.2 [41.2-43.2] kg; Q3, 41.8 [40.8-42.8] kg; Q4, 40.4 [39.3-41.4] kg; P for quadratic trend = 0.05). The results in the leg extension power group were similar to those observed in the grip strength group. CONCLUSION:This population-based cross-sectional study shows for the first time that hyperuricemia is associated with poor muscle strength. Moreover, the results indicate an inverted J-shaped association between serum UA quartiles and muscle strength. 10.1186/1471-2474-14-258
    Changes in electrolytes and uric acid excretion during and after a 100 km run. Wołyniec W,Ratkowski W,Kasprowicz K,Małgorzewicz S,Aleksandrowicz E,Witek K,Grzywacz T,Żmijewski P,Renke M Journal of biological regulators and homeostatic agents Physical activity leads to changes in water and electrolyte homeostasis and to enhanced purine metabolism. The typical abnormalities observed after exercise are hyperkaliemia, hyper- or hyponatremia and hyperuricemia. The possible explanations of hyperuricemia are: increased metabolism and decreased elimination of uric acid. Changes in uric acid excretion are commonly observed in disturbances of sodium and water homeostasis. The aim of this study was to evaluate changes in electrolytes and uric acid excretion during a very long period of exercise. Twenty subjects with a mean age of 40.75±7.15 years took part in a 100 km run. The route of the run was based on the university stadium track. All subjects were experienced amateur runners, with a mean time of regular running of 6.11±7.19 years. Blood was collected before the start, after every 25 km and 12 hours after the run. The levels of electrolytes, creatinine, uric acid, cortisol, aldosterone, creatine kinase, C-reactive protein and interleukin-6 were measured. Creatinine clearance, urinary potassium-to-sodium ratio, fractional excretion of electrolytes and uric acid were calculated. Seventeen runners completed the study. Significant increases in sodium (from 141.65±1.90 to 144.29±3.65mmol/l), potassium (from 4.53±0.34 to 5.03±0.42mmol/l), creatinine (from 0.88±0.11 to 1.10±0.20mg/dl) and uric acid (from 5.15±0.87 to 5.94±1.50 mg/dl) were observed after 100 km (p less than 0.05). Other significant changes during the study were noted in fractional excretions of sodium (from 0.86±0.29 to 0.33±0.13%) and potassium (from 6.66±2.79 to 18.90±10.01%), probably reflecting the decrease in renal blood flow (RBF) and increase in renal tubule reabsorption. The fractional excretion of uric acid slightly increased but without statistical significance from 5.34±1.51 to 6.09±2.34%. The results of our study showed that during very long but not very intensive exercise there is no change in uric acid excretion, although at the same time profound changes in electrolyte excretion are found. Both hyperuricemia and hyperuricosuria may be harmful, therefore it seems logical that the best way to avoid those abnormalities is to maintain fractional uric acid excretion.
    Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Kakutani-Hatayama Miki,Kadoya Manabu,Okazaki Hirokazu,Kurajoh Masafumi,Shoji Takuhito,Koyama Hidenori,Tsutsumi Zenta,Moriwaki Yuji,Namba Mitsuyoshi,Yamamoto Tetsuya American journal of lifestyle medicine We reviewed lifestyle factors that influence serum uric acid levels and risk of gout flare, and how to improve their deleterious effects. Since obesity increases uric acid and weight gain increases gout risk, weight reduction by daily exercise and limiting intake of excess calories is recommended. However, strenuous exercise, which causes adenine nucleotide degradation; starvation, which decreases uric acid excretion; and dehydration may raise the level of uric acid in serum and trigger gout. Increased intake of purine-rich foods, such as meat and seafood, raise the level of uric acid in serum and is associated with increased risk of gout, whereas dairy products, especially low-fat types, are associated with a lower risk of gout. Also, heavy alcohol drinking raises the uric acid level and increases the risk of gout through adenine nucleotide degradation and lactate production. Sweet fruits and soft drinks containing fructose should be moderated, since fructose may raise uric acid and increase gout risk through uric acid production and/or decreased excretion. On the other hand, the Mediterranean diet is recommended for gout patients, since it may also help prevent hyperuricemia. Furthermore, coffee and vitamin C supplementation could be considered as preventive measures, as those can lower serum uric acid levels as well as the risk of gout. 10.1177/1559827615601973
    Uridine--an indicator of post-exercise uric acid concentration and blood pressure. Dudzinska W,Lubkowska A,Dolegowska B,Suska M,Janiak M Physiological research Studies have shown that uridine concentration in plasma may be an indicator of uric acid production in patients with gout. It has been also postulated that uridine takes part in blood pressure regulation. Since physical exercise is an effective tool in treatment and prevention of cardio-vascular diseases that are often accompanied by hyperuricemia and hypertension, it seemed advisable to attempt to evaluate the relationship between oxypurine concentrations (Hyp, Xan and UA) and that of Urd and BP after physical exercise in healthy subjects. Sixty healthy men (17.2+/-1.71 years, BMI 23.2+/-2.31 kg m(-2), VO(2max) 54.7+/-6.48 ml kg(-1) min(-1)) took part in the study. The subjects performed a single maximal physical exercise on a bicycle ergometer. Blood for analyses was sampled three times: immediately before exercise, immediately after exercise, and in the 30th min of rest. Concentrations of uridine and hypoxanthine, xanthine and uric acid were determined in whole blood using high-performance liquid chromatography. We have shown in this study that the maximal exercise-induced increase of uridine concentration correlates with the post-exercise increase of uric acid concentration and systolic blood pressure. The results of our study show a relationship between uridine concentration in blood and uric acid concentration and blood pressure. We have been the first to demonstrate that a maximal exercise-induced increase in uridine concentration is correlated with the post-exercise and recovery-continued increase of uric acid concentration in healthy subjects. Thus, it appears that uridine may be an indicator of post-exercise hyperuricemia and blood pressure. 10.33549/physiolres.932766
    [Follow-up study of programmed intervention of hyperuricemia in the prevention and treatment of cardiovascular morbid change]. Zhu Wen-hua,Fang Li-zheng,Chen Li-ying,Chen Zhou-wen,Dai Hong-lei,Chen Jian-hua Zhonghua yi xue za zhi OBJECTIVE:To investigate the beneficial impact of programmed hyperuricemic intervention upon the alterations of metabolic parameters and the prevention of cardiovascular morbid change. METHODS:A total of 531 subjects of hyperuricemia were randomly divided into two groups: intervention group and control group. There was a 36-month follow-up by this prospective study. The intervention group was managed and followed up while the control group received only the baseline and final assessments. The improved way of life, changes of metabolic parameters and sub-clinical cardiovascular lesions were compared between two groups. RESULTS:(1) Except for smoking and drinking habits, such lifestyle aspects as low-purine diet, low-fat diet, high-salt control and regular exercise had improved significantly and their percentages increased 37.1%, 26.2%, 25.7%, 24.8% respectively after management in the intervention group (P < 0.01). Except for low-purine and low-fat diets, the lifestyle aspects had not improved significantly after follow-up in the control group. The incremental percentages of high-salt control and regular exercise were 2.2% and 2.1% respectively and there was no statistical difference (P > 0.05). (2) The pre-intervention and post-intervention levels of uric acid, body mass index, waist circumference, triglycerides and blood pressure were (449 +/- 3) vs (410 +/- 3) mmol/L, (3.62 +/- 0.30) vs (1.98 +/- 0.02) mmol/L, (93.8 +/- 0.6) vs (90.2 +/- 0.5) cm, (27.13 +/- 0.19) vs (25.67 +/- 0.17) kg/m(2), (129.1 +/- 1.0) vs (123.8 +/- 0.6) mm Hg and (80.7 +/- 0.7) vs (78.5 +/- 0.8) mm Hg respectively (P < 0.01). Those for high density lipoprotein and blood glucose were (1.06 +/- 0.02) vs (1.12 +/- 0.18) mmol/L and (5.54 +/- 0.08) vs (5.36 +/- 0.04) mmol/L respectively (P < 0.05). The levels of cholesterol showed no decline (P > 0.05). During follow-up, the level of blood pressure, body mass index, blood glucose and triglyceride in the control group had been reduced (P < 0.05); the level of other metabolic indicators did not (P > 0.05). (3) The pre-intervention and post-intervention levels of hs-CPR and B-type natriuretic peptide were (1.62 +/- 0.12) vs (1.33 +/- 0.11) mg/L and (6.76 +/- 0.10) vs (5.88 +/- 0.17) ng/L respectively. Compared with the control group, there were statistical differences (P < 0.01). The proportions of positive lesions of carotid artery ultrasound type B, ocular fundus disease and cardiac ultrasound in intervention group were 3.81%, 5.71%, 2.85% vs 12.56%, 13.66%, 10.92% in control group (P < 0.01). The proportions of positive incidences of ECG ST-T changes, treadmill exercise test and coronary CT in intervention group was 5.23%, 0.92%, 0 vs 12.02%, 4.91%, 2.73% in control group (P < 0.05). CONCLUSION:Programmed hyperuricemic intervention can improve the lifestyles of patients and optimize their metabolic parameters and cardiovascular lesions. These measures are of great importance in the prevention and treatment of sub-clinical cardiovascular morbid change.
    Excessive consumption of fructose causes cardiometabolic dysfunctions through oxidative stress and inflammation. Bernardes Nathalia,Ayyappan Prathapan,De Angelis Katia,Bagchi Ashim,Akolkar Gauri,da Silva Dias Danielle,Belló-Klein Adriane,Singal Pawan K Canadian journal of physiology and pharmacology A rapid rise in obesity, as well as physical inactivity, in industrialized countries is associated with fructose-consumption-mediated metabolic syndrome having a strong association with cardiovascular disease. Although insulin resistance is thought to be at the core, visceral obesity, hypertension, and hypertriglyceridemia are also considered important components of this metabolic disorder. In addition, various other abnormalities such as inflammation, oxidative stress, and elevated levels of uric acid are also part of this syndrome. Lifestyle changes through improved physical activity, as well as nutrition, are important approaches to minimize metabolic syndrome and its deleterious effects. 10.1139/cjpp-2016-0663
    [Exercise therapy for hyperuricemia]. Taniguchi Atsuo Nihon rinsho. Japanese journal of clinical medicine
    Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes. Wannamethee S G,Shaper A G,Alberti K G Archives of internal medicine OBJECTIVE:To examine the role of nonfasting serum insulin level and components of the insulin resistance syndrome in the relationship between physical activity and the incidence of coronary heart disease and type 2 diabetes. METHODS:Prospective study of 5159 men aged 40 to 59 years with no history of coronary heart disease, type 2 diabetes, or stroke drawn from general practices in 18 British towns. During an average follow-up period of 16.8 years, there were 616 cases of major coronary heart disease events (fatal and nonfatal) and 196 incident cases of type 2 diabetes. RESULTS:After adjustment for potential confounders (lifestyle characteristics and preexisting disease), physical activity was inversely related to coronary heart disease rates, with the lowest rates in the men undertaking moderate physical activity and with no further benefit thereafter. For type 2 diabetes, risk decreased progressively with increasing levels of physical activity. Physical activity was associated with serum insulin level and with factors associated with insulin, ie, heart rate, hyperuricemia, diastolic blood pressure, and high-density lipoprotein cholesterol level, and with gamma-glutamyltransferase level, a possible marker of hepatic insulin resistance. Adjustment for insulin and associated factors made little difference to the relationship between physical activity and risk of coronary heart disease. By contrast, these factors together with gamma-glutamyltransferase level appear to explain a large proportion of the reduction in risk of type 2 diabetes associated with physical activity. CONCLUSIONS:The relationship between physical activity and type 2 diabetes appears to be mediated by serum true insulin level and components of the insulin resistance syndrome. However, these factors do not appear to explain the inverse relationship between physical activity and coronary heart disease.
    [Epidemiology of hyperuricemia and gout in Japan]. Hakoda Masayuki Nihon rinsho. Japanese journal of clinical medicine It has been reported that the prevalence of hyperuricemia in Japan is 20-25% in adult male population and has been increasing at least until a few years ago. Although epidemiological data for the prevalence of gout in Japan is limited, a recent study conducted in a local area of Wakayama prefecture reported a prevalence of 1.1% in men. Japanese national census data revealed that the number of individuals visiting hospitals with a self-diagnosis of gout has been increasing. The census data also showed that the proportion of individuals with obesity(BMI > or = 25) has been increasing in male population, probably due to decreasing physical exercise. This epidemic of obesity may be one cause for a recent increase in hyperuricemic individuals in Japan.
    Physical exercises and weight loss in obese patients help to improve uric acid. Zhou Jun,Wang Yu,Lian Fan,Chen Dongying,Qiu Qian,Xu Hanshi,Liang Liuqin,Yang Xiuyan Oncotarget Objective:to assess the impact of longitudinal change of the overweight and physical activity on hyperuricemia. Methods:We performed a retrospective cohort study. Demographic information, clinical features, laboratory findings, body weight and physical exercises pattern were documented. Results:Altogether 4678 cases of hyperuricemia were enrolled. The median aged males were most affected. Individuals in the middle age had the highest prevalence of being overweight (2501/3382, 74.0%). Middle aged with BMI≥25 kg/m were more likely to lose weight (963/2807, 34.3%). BMI and waist circumference control helped to reduce serum uric acid. Overweight population was more likely to use urate-lowering or uricosuric medication (3025/3382, 89.4%). Intermediate and heavy activity were associated with bigger SUA improvement. Patients in the age of 35-60 were more likely to do physical exercises than the others. Conclusion:Being overweight is strongly associated with hyperuricemia. Successful weight control was correlated with significant uric acid reduction. Intermediate to heavy physical activity helps to reduce waist circumference and SUA. In the hyperuricemia population, obese, middle aged men were the most affected, and also the most likely to do more exercises and get their bodyweight back to normal. 10.18632/oncotarget.22046
    Non-pharmacologic measures for gout management in the prospective GOSPEL cohort: Physicians' practice and patients' compliance profiles. Chapron Anthony,Chopin Typhaine,Esvan Maxime,Ea Hang-Korng,Lioté Frédéric,Guggenbuhl Pascal Joint bone spine OBJECTIVES:Gout management includes non-pharmacological measures (NPM). The main objective of this study was to describe the NPM proposed by physicians and their implementation by patients after 3-6 months. The secondary objective was to identify NPM compliance profiles among these patients. METHODS:Ancillary observational study using the GOSPEL French cohort of 1003 patients with gout, based on questionnaires for physicians and patients at inclusion and then after 3-6 months. Patients were included by a representative sample of 398 general practitioners (GP) and 109 private-practice rheumatologists. Modifiable risk factors of hyperuricemia and proposed NPM were compared. Patient compliance profiles were identified by multiple correspondence and hierarchical clustering analysis. RESULTS:The study included 630 patients: 80.7% were obese or overweight, 51% reported excessive alcohol consumption. Physicians identified fewer modifiable risk factors than their real prevalence in the cohort. Physicians proposed NPM to 57% of patients, particularly diet modifications (46.4%). Increasing physical activity (P < 0.0001) was the best followed NPM. The physician's influence in the decision of starting NPM was more frequent among GPs' patients (P = 0.01). Three patients' compliance profiles were identified. "Very good responders" (55.8%) implemented all the proposed NPM. "Good responders" (12.7%) had a more severe disease and followed the proposed NPM, but for alcohol consumption. "Bad responders" (31.5%) did not modify their life style: these were older patients with a very recent gout diagnosis. CONCLUSION:More personalized care about NPM requires adapting the practitioner's approach to patients' compliance profiles, especially elderly patients with recent gout. 10.1016/j.jbspin.2018.06.013
    Serum uric acid is associated with dietary and lifestyle factors in elderly women in suburban Guangzhou in Guangdong province of south China. Xiong Z,Zhu C,Qian X,Zhu J,Wu Z,Chen L The journal of nutrition, health & aging OBJECTIVES:To estimate the prevalence of hyperuricemia and lifestyle risk factors for hyperuricemia in elderly women. DESIGN:Cross-sectional study. SETTING:The suburban area of Guangzhou, Guangdong province, China. PARTICIPANTS:The study included 856 Chinese women aged 60 to 102 years who received their annual health examinations in the suburban area of Guangzhou, south China in 2002. MEASUREMENTS:Information on anthropometric measurements and lifestyle factors were obtained via a questionnaire processed by the attending physicians or nurses. Blood biochemistry was performed after subjects fasted for 8-14 h. Unconditional logistic regression analysis was used to investigate associations between hyperuricemia, meat intake quintiles, physical activity quintiles, and alcohol intake quintiles. RESULTS:The prevalence of hyperuricemia in the studied population was 12.01%. Alcohol, meat and seafood consumption; being overweight or obese; hypertension; and abnormal triglyceride levels were strongly associated with a higher prevalence of hyperuricemia. Physical activity was inversely related to the prevalence of hyperuricemia. The odds ratios for hyperuricemia for quintiles of physical activity were 1.00, 0.74, 0.72, 0.63, and 0.55 (P<0.01). CONCLUSIONS:Our data suggest that the prevalence of hyperuricemia is high in elderly women in suburban Guangzhou in Guangdong province of South China. Obesity, meat and seafood intake and alcohol consumption are associated with a higher prevalence of hyperuricemia, whereas daily physical activity is inversely related to the prevalence of hyperuricemia. 10.1007/s12603-012-0076-2
    [112th Scientific Meeting of the Japanese Society of Internal Medicine: Educational Lecture: Diagnosis and Management of Hyperuricemia and Gout]. Yamanaka Hisashi Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine
    The visceral fat area to leg muscle mass ratio is significantly associated with the risk of hyperuricemia among women: a cross-sectional study. Wang Xiao-He,Jiang Wei-Ran,Zhang Min-Ying,Shi Ying-Xin,Ji Yun-Ping,Li Chun-Jun,Lin Jing-Na Biology of sex differences BACKGROUND:A significant positive association was found in previous studies among obesity, visceral fat accumulation, and hyperuricemia. The purpose of this study was to explore the association between the ratio of visceral fat area to leg muscle mass (VFA-to-LMM) and hyperuricemia, and verify the role of gender differences in the association. METHODS:A total of 3393 (43.3% are men) participants from Tianjin Union Medical Center-Health Management Center were recruited for this cross-sectional study. The VFA-to-LMM ratio was used as the independent variable. Hyperuricemia, a serum uric acid level ≥ 416 μmol/L in men and in menopausal women and ≥ 357 μmol/L in premenopausal women, was used as the dependent variable. Multiple logistic regression analysis was used to estimate the odds ratio and the 95% confidence interval between the VFA-to-LMM ratio and hyperuricemia. RESULTS:The overall prevalence of hyperuricemia was 14.8% (8.9% in women, and 22.5% in men). After adjustment by age, smoking status (for males), menopause status (for females), drinking status, exercise frequency, blood pressure, alanine aminotransferase, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, creatinine, and history of diseases, a strong positive association was found between the VFA-to-LMM ratio and hyperuricemia in both men (4th vs. 1st quartile 1.60, 95%CI: 1.03-2.49) and women (4th vs. 1st quartile 5.22, 95%CI: 2.44-12.56). After additional adjustment by BMI, there was still a significant positive association in women (4th vs. 1st quartile 2.57, 95%CI: 1.06-6.77). The results of subgroup analysis showed that pre-menopausal women (4th vs. 1st quartile OR: 3.61) have a higher risk of hyperuricemia than postmenopausal women (4th vs. 1st quartile OR: 1.94) with the increase of the VFA-to-LMM ratio. Besides, the interaction analysis results showed the highest risk of hyperuricemia when VFA and LMM were both in the highest quantile (OR: 11.50; 95% CI: 4.86-31.98). CONCLUSION:The VFA-to-LMM ratio was positively associated with the risk of hyperuricemia in women after adjustment by confounders. Pre-menopausal women have a higher risk of hyperuricemia than postmenopausal women with the increase of the VFA-to-LMM ratio. In addition, the highest risk of hyperuricemia was demonstrated when both VFA and LMM were at the highest quartile. 10.1186/s13293-021-00360-9
    Non-pharmacological treatment of gout. Líška Dávid Vnitrni lekarstvi Gout is a metabolically-related joint disease, characterized by recurrent episodic arthritis. The recent epidemiological study suggests that the incidence of hyperuricemia and gout in many countries has risen especially in recent decades. A possible explanation may be a decreased physical activity level and changes in eating habits. The patients lifestyle is one of the key factors contributing to the development of hyperuricemia. For patients, an important part of therapy is non-pharmacological treatment through changes in lifestyle factors such as dietary measures, weight control, and adequate hydration and exercise. Lifestyle changes can lead to beneficial health changes in patients. The relationships between serum uric acid levels, hyperuricemia, obesity, and metabolic syndrome are well established. Higher serum uric acid concentration positively correlates with body mass index (BMI) and metabolic syndrome. The reduction of BMI may lead to improved hyperuricemia in patients. Other important changes include stopping alcohol consumption, reducing the intake of sweetened beverages, increasing the intake of dairy products, no eating organ meats, sea fish, sausages. Proper hydration is also an important part of the treatment.
    Hyperuricemia and high blood pressure at rest and during exercise: Guilty or innocent? The jury is still out. Mulè Giuseppe,Nardi Emilio,Lattuca Luigi,Cottone Santina Journal of clinical hypertension (Greenwich, Conn.) 10.1111/jch.13227
    Influence of physical activity intensity and aerobic fitness on the anthropometric index and serum uric acid concentration in people with obesity. Nishida Yuichiro,Iyadomi Minako,Higaki Yasuki,Tanaka Hiroaki,Hara Megumi,Tanaka Keitaro Internal medicine (Tokyo, Japan) BACKGROUND AND OBJECTIVE:Physical activity (PA) is considered an important approach to prevent and treat obesity and hyperuricemia. The purpose of the present study was to examine the influence of PA intensity and aerobic fitness on anthropometric indices and serum uric acid in obese individuals. METHODS:PA was examined using a single-axial accelerometer and aerobic fitness was assessed by electric cycle ergometry in obese middle-aged men (n=71, 47.2 ± 4.4 years). PA was defined as light (<3 metabolic equivalents [METs]), moderate (3.0-6.0 METs) or vigorous (>6.0 METs) intensity from the corresponding METs multiplied by time spent at the corresponding intensity levels. Serum uric acid was measured by the uricase peroxidase method. RESULTS:The association between aerobic fitness index (lactate threshold) and serum uric acid did not reach statistical significance after adjustment for potential confounding factors (age, body mass index [BMI], and alcohol consumption) (β=-0.110, p=0.138). Light intensity PA was inversely associated with BMI and waist circumference, even after adjustment for age and alcohol consumption (BMI: β=-0.543, p=0.023; waist circumference: β=-1.333, p=0.016). Moderate intensity PA, but not light or vigorous intensity PA, was inversely correlated with the uric acid level and this remained significant after adjustment for age, BMI, and alcohol consumption (β=-0.222, p=0.036). CONCLUSION:Our results suggest that light intensity PA may have an important role in weight control while moderate intensity PA may be associated with the lower uric acid concentrations in obese individuals. 10.2169/internalmedicine.50.5506
    Physical Function, Hyperuricemia, and Gout in Older Adults. Burke Bridget Teevan,Köttgen Anna,Law Andrew,Windham Beverly Gwen,Segev Dorry,Baer Alan N,Coresh Josef,McAdams-DeMarco Mara A Arthritis care & research OBJECTIVE:Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. METHODS:We studied gout, hyperuricemia, and physical function in 5,819 older adults (age ≥65 years) attending the 2011-2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity function (Short Physical Performance Battery [SPPB] and 4-meter walking speed) and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalence of poor physical performance (first quartile) by gout and hyperuricemia was estimated using adjusted modified Poisson regression. RESULTS:Ten percent of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P = 0.77). Participants with gout performed worse on the SPPB test; they had 0.77 times (95% confidence interval [95% CI] 0.65, 0.90, P = 0.001) the prevalence odds of a 1-unit increase in SPPB score and were 1.18 times (95% CI 1.07, 1.32, P = 0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference -0.03; 95% CI -0.05, -0.01, P < 0.001) and were 1.19 times (95% CI 1.06, 1.34, P = 0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. CONCLUSION:Older adults with gout and hyperuricemia are more likely to have worse lower extremity, but not upper extremity, function. 10.1002/acr.22648
    Relationship between lifestyle choices and hyperuricemia in Chinese men and women. Liu Li,Lou Shanshan,Xu Ke,Meng Zhaowei,Zhang Qing,Song Kun Clinical rheumatology We aimed to explore correlations between lifestyle choices and hyperuricemia in a large Chinese population, emphasizing the differences from opposite sex. Ten thousand four hundred fifty subjects were randomly recruited from Tianjin municipality in China. Hyperuricemia was defined as serum uric acid >420 μmol/L for men and >360 μmol/L for women. Demographic data, highest education degree, work type, commuting means, smoking and drinking status, exercise frequency, and quantitative assessments of dietary factors were collected. Anthropometric measurements and fasting blood tests were performed. Statistical analyses were conducted. Total hyperuricemic prevalence was 12.89 %, with male significantly higher than female. Body mass index, waist circumference, serum indices, and age displayed high correlation coefficients, and most lifestyle factors also showed significant correlations as well. Binary logistic regression models showed odds ratio of developing hyperuricemia were much greater in males than in females by eating habits. However, physical activity-related lifestyle choices tended to cast much greater influences on the likelihood of hyperuricemia in females. Lifestyle choices and hyperuricemia are closely related. For males, eating habits have greater influences on the likelihood of developing hyperuricemia. For females, lifestyle factors like work type, commuting method, and exercise have such effects. 10.1007/s10067-012-2108-z
    PREVALENCE OF HYPERURICEMIA IN PATIENTS WITH CHRONIC HEART FAILURE. Sanikidze Q,Mamacashvili I,Petriashvili Sh Georgian medical news The aim of our study was to study prevalence and clinical importance of Hyperuricemia (HU) in patients with heart failure (HF). 126 patients with HF were involved in a study. Main group included 75 patients with HF and HU. 51 patients with HF without HU were included in the control group. All patients underwent to a standardized clinical evaluation, including physical examination, determination of NYHA class and laboratory studies; namely, full blood count, serum uric acid, creatinine and ferritin. Assessment of exercise capacity was performed using a 6-min walk test. Echocardiographic assessment included interventricular septum thickness, left ventricular systolic and diastolic dimensions, left ventricular diastolic function, posterior wall thickness, left ventricular mass index and LVEF. Patients with HU had higher prevalence of diabetes mellitus than patients without HU. Patients with HU had significantly lower LVEF (38.2±7.0 and 44.5±5.1; respectively. P<0.05). No differences were recorded for body weight, diastolic blood pressure, platelets, serum creatinine, or presence of chronic obstructive pulmonary disease. Patients with HU had significantly thicker IVS, than those without it (10.49±2.9 vs 10.93 ±1.64mm; respectively. P<0.006). LV mass index was larger in patients with HU (P<0.001); There were no significant differences in LV end-systolic (LVESd) and end-diastolic (LVEDd) dimensions. Additionally, there were no differences in LV diastolic functional parameters. In both groups was decreased average distance walked and percentage of expected distance for healthy persons. Study results point out that female gender, higher NYHA class, low level of LVEF, the presence of hyperuricemia, lower than normal eGFR predict lower exercise capacity. Presented study demonstrates high prevalence of HU in patients with chronic heart failure. Despite high prevalence, historically the meaning of HU was underestimated in patients with HF. Taken into account the clinical relevance, treatability, and independent association with reduced exercise capacity, it is highly recommended to define HU level in all the patients with chronic heart failure to avoid future complications.
    Effect of a Health Belief Model-based education program on patients' belief, physical activity, and serum uric acid: a randomized controlled trial. Shao Chunhai,Wang Jiwei,Liu Jingfang,Tian Fang,Li Hua Patient preference and adherence Objective:We aimed to investigate the effect of a Health Belief Model (HBM)-based education program on the perception scores of 5 HBM domains, physical activity, and serum uric acid (SUA) among asymptomatic hyperuricemia (AHU) patients in a randomized controlled trial. Methods:One hundred and ninety-three AHU patients were involved in this prospective experimental interventional study in Shanghai, China. Subjects were randomly divided into interventional or control group. The educational program was designed based on HBM component for the improvement of knowledge and promotion of lifestyle adherence in terms of low-purine diet and physical activity among AHU patients. This program included educational booklets and educational classes. Data were collected from interventional and control group members both before and after the intervention, using a questionnaire covering sociodemographic characteristics, HBM variables, physical activity from the Health-Promoting Lifestyle Profile II, and a check list for recording the subject's SUA values, as well as the body mass index, waist-hip ratio, systolic blood pressure, and diastolic blood pressure. Results:In the interventional group, the mean scores of the HBM variables (perceived susceptibility, perceived severity, perceived benefit, perceived barriers, and self-efficacy), SUA values, physical activity, body mass index, and waist-hip ratio were improved significantly after the intervention (<0.05), whereas no significant differences were detected in the control group between baseline and follow-up measures. Conclusion:This study showed the importance of the educational program based on the HBM in improving the model constructs and physical activity, as well as in decreasing the SUA values in AHU patients. 10.2147/PPA.S166523
    Prevalence and determinants of hyperuricemia in middle-aged, urban Chinese men. Villegas Raquel,Xiang Yong-Bing,Cai Qiuyin,Fazio Sergio,Linton MacRae,Li Honglan,Elasy Tom,Zheng Wei,Shu Xiao Ou Metabolic syndrome and related disorders BACKGROUND:Hyperuricemia is associated with metabolic syndrome and has emerged as a marker for both type 2 diabetes and cardiovascular disease. We estimated the prevalence and lifestyle risk factors of hyperuricemia in middle-aged, urban Chinese men. METHODS:The study included 3,978 urban Chinese men 40-74 years of age from a population-based cohort study, the Shanghai Men's Health Study, who were free of type 2 diabetes at baseline and had provided fasting blood samples. Uric acid concentrations were measured by the uricase method. Hyperuricemia was defined as >7.0 mg/dL. Anthropometric measurements and information on lifestyle factors and disease history were collected by in-person interviews. RESULTS:One quarter of the study subjects had hyperuricemia. Participants with metabolic syndrome had a higher prevalence of hyperuricemia. Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and weight gain (since age 20) were positively associated with the prevalence of hyperuricemia. Physical activity was inversely related to the prevalence of hyperuricemia. The odds ratios for hyperuricemia for quintiles of nonoccupational physical activity were 1.00, 0.80, 0.73, 0.75, and 0.57 (P trend <0.001). Participants with hyperuricemia were less likely to be current smokers, but were more likely to drink alcohol regularly. Beer consumption was associated with higher risk of hyperuricemia compared with consumption of wine or liquor. CONCLUSIONS:In this representative sample of middle-aged, urban Chinese men, hyperuricemia is highly prevalent. Obesity, weight gain in adulthood, and alcohol intake were associated with a higher prevalence of hyperuricemia, whereas daily physical activity and smoking were inversely related to the prevalence of hyperuricemia. 10.1089/met.2009.0084
    [Practical strategies for lifestyle modification in people with hyperuricemia and gout treatment through diet, physical activity, and reduced alcohol consumption]. Mineo Ikuo,Kamiya Hiroki,Tsukuda Akiko Nihon rinsho. Japanese journal of clinical medicine There has been an explosive increase in the prevalence of hyperuricemia and gout in Japan, suggesting the recent lifestyle change may be a key factor leading to this pathophysiological condition. In addition, people with hyperuricemia are often associated with various morbid conditions constituting the metabolic syndrome, such as abdominal obesity, hypertension, dyslipidemia and impaired glucose tolerance. Therefore, healthy lifestyle interventions would be a basic therapeutic approach not only to hyperuricemia but to metabolic syndrome, though it is not easy to promote behaviour changes. This review focuses on strategies for lifestyle intervention for clinical practice, including how we advise patients on appropriate diets, physical activity and alcoholic beverage consumption.
    Prevalence of hyperuricemia and its correlates in rural Northeast Chinese population: from lifestyle risk factors to metabolic comorbidities. Yu Shasha,Yang Hongmei,Guo Xiaofan,Zhang Xingang,Zhou Ying,Ou Qiaoyun,Zheng Liqiang,Sun Yingxian Clinical rheumatology The increasing trend of hyperuricemia in urban areas of China has been noted in the past decade. However, the prevalence of hyperuricemia in rural China has not been extensively investigated. We aimed to estimate the prevalence and risk factors of hyperuricemia and the associated comorbidities in rural Northeast China. This survey was conducted from July 2012 to August 2013. In this study, a total of 11,576 residents from the rural Northeast China were randomly selected and examined. Hyperuricemia was defined as serum uric acid ≥416 μmol/l in men and ≥357 μmol/l in women. Data regarding the demographic and lifestyle characteristics and the blood biochemical indexes of these participants were collected by well-trained personnel. The prevalence of hyperuricemia was 10.9 % and was more prevalent in men than in women (15.0 vs. 7.3 %, P < 0.001). Multivariate logistic regression models revealed that besides age, hyperuricemia in men was associated with ethnic minority [OR (95 %): 0.683 (0.472,0.989)], physical activity [moderate, OR (95 %): 0.716 (0.596,0.859); high, OR (95 %): 0.527 (0.354,0.786)], current smoking [OR(95 %):1.380 (1.179,1.616)], and current drinking [OR(95 %):0.705 (0.603,0.825)], while in women was only associated with ethnic minority [OR(95 %):0.485 (0.262,0.896)]. After adjusting for possible confounders, hyperuricemia was related to different subtypes of cardiometabolic comorbidities in both gender like abdominal obesity, general obesity, hypertriglyceridemia, hypertension, hypercholesterolemia, and low HDL-C. Besides, in women only, hyperuricemia was related to diabetes and high LDL-C. Hyperuricemia was common among residents living in rural Northeast China especially among men. Ethnic minority, physical activity, current smoking, and drinking contributed to hyperuricemia in this population. 10.1007/s10067-015-3051-6
    Results of an Observational Cohort Study of Hyperuricemia as a Predictor of Poor Physical Performance in the Elderly. Veronese Nicola,Stubbs Brendon,Trevisan Caterina,Bolzetta Francesco,De Rui Marina,Maggi Stefania,Sartori Leonardo,Musacchio Estella,Zambon Sabina,Perissinotto Egle,Noale Marianna,Crepaldi Gaetano,Manzato Enzo,Sergi Giuseppe Arthritis care & research OBJECTIVE:Hyperuricemia is frequent in older people and associated with several medical conditions. The relationship between hyperuricemia and physical performance is limited. We aimed to investigate the association between hyperuricemia and physical performance over a 4.4-year followup in the elderly. METHODS:A total of 1,904 community-dwelling older participants were followed for a mean of 4.4 years. Hyperuricemia at baseline was defined using serum uric acid concentrations ≥6 and ≥7 mg/dl for women and men, respectively. Objective physical performance tests measured included the Short Physical Performance Battery (SPPB), 4-meter gait speed, chair-stands time, leg extension and flexion, handgrip strength, and the 6-minute walking test. RESULTS:At baseline, participants with hyperuricemia (n = 98 men, 232 women) scored significantly worse in all the tests investigated. After adjusting for 19 covariates, men with hyperuricemia at baseline had an increased risk of having poor SPPB scores at followup (odds ratio [OR] 1.44 [95% confidence interval (95% CI) 1.21-1.72]; P < 0.0001), poor chair-stands time (OR 1.40 [95% CI 1.18-1.6]; P < 0.0001), poor leg extension (OR 1.47 [95% CI 1.21-1.7]; P < 0.0001), and poor handgrip strength (OR 1.54 [95% CI 1.24-1.90]; P < 0.0001). Among women, hyperuricemia was associated with an increased risk of having poor scores in all the SPPB items and in leg flexion (OR 1.26 [95% CI 1.08-1.49]; P = 0.03). CONCLUSION:Hyperuricemia seems to be significantly associated with poor physical performance in older people, over a followup of 4.4 years. The relationship appears to be more consistent in men than in women. Further longitudinal research is required to better understand the relationships and potential biologic pathways. 10.1002/acr.23118
    Ideal Cardiovascular Health Metrics and Incident Hyperuricemia. Li Zheng,Meng Lingmin,Huang Zhe,Cui Liufu,Li Weijuan,Gao Jingsheng,Wang Zhanqi,Zhang Rui,Zhou Jing,Zhang Ge,Chen Shuohua,Zheng Xiaoming,Cong Hongliang,Gao Xiang,Wu Shouling Arthritis care & research OBJECTIVE:Hyperuricemia has been shown to be associated with increased risks of gout and cardiovascular diseases. We prospectively investigated the association between the American Heart Association (AHA) ideal cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose, and the risk of developing hyperuricemia. METHODS:We included 77,787 Chinese adults, ages ≥18 years (60,951 men and 16,836 women), without hyperuricemia at the baseline (2006) in this study. Information on the cardiovascular health metrics at baseline was collected. Incident hyperuricemia cases were identified by elevated serum uric acid concentrations, which were repeatedly assessed in 2006, 2008, 2010, and 2012, respectively. Cox regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident hyperuricemia according to the baseline ideal cardiovascular health metrics. RESULTS:We observed an inverse relation between the greater numbers of ideal cardiovascular health metrics at baseline and lower risks of developing hyperuricemia during 6 years of followup. After adjusting for age, sex, alcohol consumption, and other potential confounders, the HRs for incident hyperuricemia were 0.95, 0.84, 0.72, and 0.64 (95% CIs 0.58-0.70, P for trend < 0.0001) for participants who met 2, 3, 4, and 5-7 metrics, respectively, compared with those who met 0-1 cardiovascular health metrics. CONCLUSION:Greater cardiovascular health metrics were associated with lower risk of hyperuricemia in this Chinese population, suggesting that the modifiable construct defined by the AHA could be of significance in reducing the risk of developing hyperuricemia-related diseases, such as gout. 10.1002/acr.22830
    Association between urbanisation and the risk of hyperuricaemia among Chinese adults: a cross-sectional study from the China Health and Nutrition Survey (CHNS). Yu Xixi,Zhu Cheng,Zhang Han,Shen Ziyan,Chen Jing,Gu Yulu,Lv Shiqi,Zhang Di,Wang Yulin,Ding Xiaoqiang,Zhang Xiaoyan BMJ open OBJECTIVE:To explore the association between urbanicity and hyperuricaemia (HUA) and whether urbanicity is an independent risk factor for HUA in Chinese adults. DESIGN:Data analysis from a cross-sectional survey. SETTING AND PARTICIPANTS:8579 subjects aged 18 years or older were enrolled in the study from the 2009 wave of the China Health and Nutrition Survey to analyse the association between urbanicity and HUA. We divided them into three categories according to urbanisation index (low, medium and highly urbanised groups). MAIN OUTCOME MEASURES:HUA was defined as serum uric acid ≥7 mg/dL in men and ≥6 mg/dL in women. RESULTS:The prevalence of HUA in low, medium and highly urbanised groups was 12.2%, 14.6% and 19.8%, respectively. The independent factors influencing serum uric acid included age, gender, hypertension, diabetes, chronic kidney disease, drinking, obesity and community-level urbanisation index (β=0.016, p<0.001). The risk of HUA in the highly urbanised group was significantly higher than that of the low urbanised group (OR 1.771, 95% CI 1.545 to 2.029, p<0.001), even after adjusting for other covariates (OR 1.661, 95% CI 1.246 to 2.212, p=0.001). In a subgroup analysis, we found that age, gender, comorbidity (such as hypertension, diabetes, obesity and chronic kidney disease) and physical activity affected the association between urbanisation and the risk of HUA. CONCLUSIONS:Our findings suggest that living in highly urbanised areas is linked with higher risk of HUA independent of cardiometabolic and health-related behavioural risk factors, which have been shown to increase along with urbanisation. 10.1136/bmjopen-2020-044905
    Epidemiology and prevalence of hyperuricemia among men and women in Chinese rural population: The Henan Rural Cohort Study. Dong Xiaokang,Zhang Honglei,Wang Fang,Liu Xiaotian,Yang Kaili,Tu Runqi,Wei Min,Wang Ling,Mao Zhenxing,Zhang Gongyuan,Wang Chongjian Modern rheumatology The aim of this study was to explore the latest prevalence of hyperuricemia and influencing factors in Chinese rural population. A survey was conducted from July 2015 to September 2017. A total of 38,855 (15,371 men and 23,484 women) subjects were recruited from the Henan Rural Cohort Study. Hyperuricemia was defined as a serum urate level of >7.0 mg/dL for men and >6.0 mg/dL for women. A meta-analysis of 19 studies that focused on hyperuricemia prevalence was performed to validate the result of the cross-sectional survey. The crude and age-standardized prevalence of hyperuricemia was 10.24% and 12.60%, respectively. The prevalence of hyperuricemia decreased in men with increasing age, but the opposite trend was observed in women. The results of meta-analysis demonstrated that hyperuricemia prevalence in Chinese rural areas was 11.7%, consistent with the result of current survey. Multivariate logistic regression revealed that overweight or obesity, hypercholesterolemia, hypertriglyceridemia, hypoalphalipoproteinemia and high serum creatinine level could increase the risk of hyperuricemia, while high physical activity and fasting plasma glucose were associated with a lower risk of hyperuricemia in all participants. The latest prevalence of hyperuricemia is high in rural China and is associated with multiple factors, indicating that prevention and control strategies for hyperuricemia are needed urgently. 10.1080/14397595.2019.1660048
    Sex-specific differences in the prevalence of and risk factors for hyperuricemia among a low-income population in China: a cross-sectional study. Qi Dongwang,Liu Jie,Wang Conglin,Wang Lixia,Zhang Xinxin,Lin Qiuxing,Tu Jun,Wang Jinghua,Ning Xianjia,Cui Jingqiu Postgraduate medicine : China has already entered the aging society, and its aging population is the largest worldwide. Accordingly, several aging-related conditions including hyperuricemia are becoming a public health concern owing to their increasing prevalence in rural areas. However, the sex-specific differences in the risk factors for hyperuricemia among the middle-aged and elderly in rural North China are unclear. Thus, this study aimed to evaluate sex-specific differences in the prevalence of and risk factors for hyperuricemia in low-income adults in rural North China. : This population-based cross-sectional study recruited participants aged ≥50 years from the Tianjin Brain Study between April and August 2019. After excluding those who had cancer, severe psychiatric disturbances, hepatic failure, and serious renal disease (i.e., an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m), 3119 (1392 men and 1727 women) eligible participants were included. Basic information and blood samples were collected, and data were analyzed using logistic regression models. : Hyperuricemia was prevalent in 14.4% (men, 14.2%; women, 14.5%)of the participants, and the prevalence significantly increased with increasing age in both sexes (male, = 0.034; female, < 0.001). In multivariate analysis, obesity, metabolic syndrome, and high levels of total cholesterol, 2 h plasma glucose, and blood urea nitrogen were risk factors for hyperuricemia in both men and women. Physical activity was a risk factor in men, while a high white blood cell count was a risk factor in women. A high eGFR was a protective factor in both sexes. : Hyperuricemia was highly prevalent in low-income adults in Tianjin, with men and women showing differences in risk profiles and comorbidities. Early management of hyperuricemia according to sex-specific risk factors should be considered in primary care to reduce the prevalence and burden of hyperuricemia in rural China. 10.1080/00325481.2020.1761133
    Attenuating the mortality risk of high serum uric acid: the role of physical activity underused. Chen Jiunn-Horng,Wen Chi Pang,Wu Shiuan Bei,Lan Joung-Liang,Tsai Min Kuang,Tai Ya-Ping,Lee June Han,Hsu Chih Cheng,Tsao Chwen Keng,Wai Jackson Pui Man,Chiang Po Huang,Pan Wen Han,Hsiung Chao Agnes Annals of the rheumatic diseases BACKGROUND:High serum uric acid (sUA) has been associated with increased mortality risks, but its clinical treatment varied with potential side effects. The role of physical activity has received limited attention. METHODS:A cohort, consisting of 467 976 adults, who went through a standard health screening programme, with questionnaire and fasting blood samples, was successively recruited between 1996 and 2008. High sUA is defined as uric acid above 7.0 mg/dL. Leisure time physical activity level was self-reported, with fully active defined as those with 30 min per day for at least 5 days a week. National death file identified 12 228 deaths with a median follow-up of 8.5 years. Cox proportional model was used to analyse HRs, and 12 variables were controlled, including medical history, life style and risk factors. FINDINGS:High sUA constituted one quarter of the cohort (25.6%). Their all-cause mortality was significantly increased [HR: 1.22 (1.15-1.29)], with much of the increase contributed to by the inactive (HR: 1.27 (1.17-1.37)), relative to the reference group with sUA level of 5-6 mg/dL. When they were fully active, mortality risks did not increase, but decreased by 11% (HR: 0.89 (0.82-0.97)), reflecting the benefits of being active was able to overcome the adverse effects of high sUA. Given the same high sUA, a 4-6 years difference in life expectancy was found between the active and the inactive. CONCLUSIONS:Physical activity is a valuable alternative to pharmacotherapy in its ability to reduce the increases in mortality risks from high sUA. By being fully active, exercise can extend life span by 4-6 years, a level greater than the 1-4 years of life-shortening effect from high sUA. 10.1136/annrheumdis-2014-205312
    Residential greenness associated with lower serum uric acid levels and hyperuricemia prevalence in a large Chinese rural population. Dong Xiaokang,Liu Xiaotian,Zhang Lulu,Li Ruiying,Tu Runqi,Hou Jian,Mao Zhenxing,Huo Wenqian,Guo Yuming,Li Shanshan,Chen Gongbo,Wang Chongjian The Science of the total environment BACKGROUND:The association between residential greenness and hyperuricemia remains unclear, especially in developing countries. The current study aimed to explore the associations between residential greenness and both serum uric acid (SUA) levels and hyperuricemia in a Chinese rural population and to examine potential pathways of these associations. METHODS:In this cross-sectional study, 38,721 rural residents were recruited from the baseline survey of the Henan Rural Cohort study in 2015-2017. Two satellite-derived vegetation indices, i.e., the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. Air pollution was determined by two proxies: particulate matter with aerodynamic diameter ≤ 2.5 μm (PM) and nitrogen dioxide (NO). Hyperuricemia was defined as SUA levels of >417 μmol/L and > 357 μmol/L for men and women, respectively. Multivariable-adjusted linear regression and logistic regression models were applied to investigate the associations of greenness with SUA and hyperuricemia, and mediation analyses were used to explore possible mechanisms underlying the associations. RESULTS:An interquartile range (IQR) increase in both EVI and NDVI in the 500 m buffer was significantly associated with reductions in SUA levels of -7.23 μmol/L (95% confidence interval (CI): -8.96, -5.50) and -4.38 μmol/L (95% CI: -5.93, -2.83), respectively. The same increases in EVI and NDVI were associated with 13.8% (95% CI: 5.8%, 21.2%) and 13.0% (95% CI: 5.6%, 19.8%) lower hyperuricemia prevalence, respectively. These associations were stronger in older people (age ≥ 65), men or participants with higher averaged monthly income. The associations were partly mediated by physical activity and BMI, while no mediation effect was observed for air pollution. CONCLUSIONS:Higher levels of residential greenness were significantly associated with lower SUA levels and hyperuricemia prevalence in the Chinese rural population. BMI and physical activity may play important mediating roles in the associations. 10.1016/j.scitotenv.2021.145300
    [Hyperuricemia in shift workers: a cross-sectional study in a spanish chemical factory]. de Pedro Jiménez Domingo,de Diego Cordero Rocío,Romero-Saldaña Manuel,Verástegui Cristina Revista espanola de salud publica OBJECTIVE:There is no clear consensus over the findings of research into shift work and cardiovascular risk factors, such as those present in the metabolic syndrome (MetS). This is further confounded by the varying definitions of MetS and shift work. Our objective was to learn about the link between shift work, lifestyles and cardiovascular health in chemical factory workers. METHODS:Cross-sectional analytical study, carried out 2018-2019; data obtained from annual occupational health check-ups. 515 workers chosen, with a 1:3 ratio (shifts/no shifts). Variables collected: MetS, arterial hypertension, obesity, abdominal adiposity and biochemical alterations (glucose, total cholesterol, HDL cholesterol, triglycerides and uric acid). Explanatory variables: age, gender, tobacco consumption, physical activity and shift work. Besides the usual descriptions, both non-adjusted and adjusted bivariate logistic regression were performed, producing Odds Ratio (OR) values with 95% CI. RESULTS:The non-adjusted logistic regression showed that shift workers performed less physical activity (OR=0.22; 95% CI=0.14-0.35; p<0.001) and had lower HDL cholesterol levels (OR=2.1; 95% CI=1.2-3.8; p<0.05), plus a higher rate of hypertriglyceridemia (OR=2.05; 95% CI=1.3-3.2; p<0.01) and hyperuricemia (OR=2.7; 95% CI=0.9-2.7; p<0.001). In the logistic regression adjusted for age, gender, tobacco consumption, physical activity and shift work only the prevalence of hyperuricemia was higher in shift workers (OR=2.25; 95% CI=1.1-4.6; p<0.05), as well as with less moderate/high physical activity (OR=0.19; 95% CI=0.12-0.31; p<0.001). CONCLUSIONS:While no link was found between shift work and increased smoking or a higher cardiovascular risk, there was evidence of an association with high uric acid levels and less moderate/high physical activity.
    Regular physical activity prevents development of hypertension in young people with hyperuricemia. Saladini Francesca,Mos Lucio,Fania Claudio,Garavelli Guido,Casiglia Edoardo,Palatini Paolo Journal of hypertension OBJECTIVE:The association of serum uric acid (SUA) with risk of hypertension is controversial and may be modulated by lifestyle factors. We did a prospective study to investigate whether SUA was an independent predictor of hypertension in the young and whether physical activity influences this association. METHODS:The study was conducted in a cohort of 1156 young to middle-age participants screened for stage 1 hypertension and followed for a median of 11.4 years. In multivariable Cox analyses, participants were stratified by tertiles of uric acid and physical activity habits. RESULTS:At follow-up end, 63.3% of the study participants developed hypertension needing treatment. In the whole group, SUA was an independent predictor of future hypertension (P = 0.005). Participants with SUA more than 5.60 mg/dl (top tertile) had a 31% increase in risk compared with those of the bottom tertile. However, the risk of hypertension related to SUA was increased only among the sedentary participants with a hazard ratio of 1.44 (95% confidence interval, 1.11-1.88) for the participants of the top SUA tertile. In contrast, among the active participants no association was found between SUA and risk of hypertension. Alcohol intake was another modulator of the SUA-hypertension relationship (hazard ratio, 95% confidence interval: 1.38, 1.02-1.87). Plasma renin activity, office and ambulatory heart rates, and metabolic variables were proportional to SUA level and were lower in active than sedentary participants. CONCLUSION:These data confirm that SUA is a predictor of hypertension and suggest that exercise may counteract the pathophysiological mechanisms involved in the association between hyperuricemia and future hypertension. 10.1097/HJH.0000000000001271
    Antacids' side effect hyperuricaemia could be alleviated by long-term aerobic exercise via accelerating ATP turnover rate. Yuan Shu,Zhang Zhong-Wei,Li Zi-Lin Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie Hyperuricemia is the term for an abnormally high serum uric acid level. Many factors contribute to hyperuricemia, however no definite correlation between proton pump inhibitors (PPIs) and hyperuricemia has been reported before. Physical exercise also decreases serum uric acid levels. However, the detailed biochemical-regulatory mechanisms remain unknown. Here we found that adenylate deaminase activities are much higher in hyperuricemia patients than in the healthy people. Therefore, the patients have higher levels of adenosine metabolites hypoxanthine and uric acid. Acid-inhibitory drugs (antacids) significantly increased serum uric acid level and may lead to gout in the hyperuricemia patient. Long-term aerobic exercise significantly increased serum phosphorus and decreased serum ATP and its metabolites, and therefore decreased serum uric acid. Antacids slow down the ATP turnover rate and result in serum uric acid elevation subsequently. While the long-term aerobic exercise decreases serum uric acid levels by accelerating ATP turnover rate. The results imply that long-term aerobic exercise may be a useful strategy to prevent and treat hyperuricaemia. 10.1016/j.biopha.2018.01.052
    Independent and interactive effect of sitting time and physical activity on prevalence of hyperuricemia: the Henan Rural Cohort Study. Dong Xiaokang,Li Yuqian,Zhang Lulu,Liu Xiaotian,Tu Runqi,Wang Yikang,Li Ruiying,Li Linlin,Hou Jian,Mao Zhenxing,Huo Wenqian,Wang Chongjian Arthritis research & therapy BACKGROUND:There are few studies on the hyperuricemia (HUA) and moderate to vigorous intensity physical activity (PA) and also hardly regarding sitting time (ST). The purpose of this study was to examine the independent and interactive association of PA and ST with HUA. METHODS:A cross-sectional analysis was performed on 38,855 participants (aged 18-79) enrolled from the Henan Rural Cohort Study at baseline (2015 to 2017). PA and ST levels were assessed by using the International Physical Activity Questionnaire (IPAQ). HUA was defined as a serum uric acid level of > 7.0 mg/dL for males and > 6.0 mg/dL for females. Multivariable logistic regression and linear regression models were applied to examine the independent association between PA or ST and HUA and serum uric acid level. Interaction plots were used to visualize the interaction effects of PA and ST on HUA. RESULTS:PA level was inversely related with serum uric acid level (β - 0.15, 95% confidence interval (CI) - 0.22, - 0.07), but ST was positively related with uric acid level (β 2.12, 95% CI 1.90, 2.34). Metabolic equivalent (MET-hour/day) was associated with decreased prevalence of HUA (odds ratio (OR) 0.97, 95% CI 0.96, 0.99), while per hour increased for ST was associated with increased HUA (OR 1.05, 95% CI 1.04, 1.06). The interaction of PA and ST was significant (P < 0.001). CONCLUSION:Exposure to higher ST was independently related to increased prevalence of HUA, while vigorous PA with a decreased HUA prevalence. Meanwhile, higher daily ST might attenuate the protective effect of PA on HUA. TRIAL REGISTRATION:The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699 ). 10.1186/s13075-020-02385-8
    The association between sedentary behavior, physical activity and hyperuricemia. Park Doo Yong,Kim Yeon Soo,Ryu Seung Ho,Jin Yu Sun Vascular health and risk management Background:A significant discovery was recently made in which participation in physical activity and sedentary behavior, two contrasting lifestyles, was found to be related to the frequency of hyperuricemia diagnosis. The purpose of this study was to identify the association between sedentary behavior and physical activity levels in South Korean men and women diagnosed with hyperuricemia. Methods:This study included 161,064 healthy men and women participants who had obtained a complete health examination. Physical activity levels and sitting time were assessed by the validated International Physical Activity Questionnaire Short Form Korean version. The presence of hyperuricemia in the subjects was determined by measuring serum uric acid (SUA) concentration (SUA ≥6 mg/dL [male], SUA ≥7 mg/dL [female]). Logistic regression analysis, adjusting other confounding factors, was conducted to identify the association of sedentary behavior and physical activity levels with hyperuricemia (<0.05). Results:Subjects who spent ≥10 hr/day in sedentary behavior were more likely to have hyperuricemia than those who spent <5 hour/day in sedentary behavior (OR=1.08, 95% CI=1.03-1.12). The subject group that more frequently participated in health enhanced physical activity (HEPA) had a lower hyperuricemia odds ratio than the subject group with lower physical activity participation rate (OR=0.90, 95% Ci=0.86-0.93). From the analysis of sex (male, female), age (young, middle, older), methods of measuring obesity (body mass index, waist circumference, body fat percentage), the association of sedentary behavior and physical activity levels with hyperuricemia was shown differently in different multivariable models. Conclusion:Participation in regular physical activity and reduced sedentary time is highly recommended in order to reduce the prevalence of hyperuricemia. 10.2147/VHRM.S200278
    Quality of life and quality of care for patients with gout. Singh Jasvinder A Current rheumatology reports Significant pain, activity limitation, and disability in patients with acute and chronic gouty arthritis lower health-related quality of life. Although many effective therapies are available for gouty arthritis, medication errors are common. One goal of therapy is to reduce the frequency of gout flares by lowering serum uric acid. Further, evidence suggests that the quality of care provided to patients with gout may also impact health-related quality of life. This article reviews evidence concerning quality of care and quality of life for patients with gout. 10.1007/s11926-009-0022-4
    The role of physical activity in individuals with cardiovascular risk factors: an opinion paper from Italian Society of Cardiology-Emilia Romagna-Marche and SIC-Sport. Nasi Milena,Patrizi Giampiero,Pizzi Carmine,Landolfo Matteo,Boriani Giuseppe,Dei Cas Alessandra,Cicero Arrigo F G,Fogacci Federica,Rapezzi Claudio,Sisca Giovanbattista,Capucci Alessandro,Vitolo Marco,Galiè Nazzareno,Borghi Claudio,Berrettini Umberto,Piepoli Massimo,Mattioli Anna V Journal of cardiovascular medicine (Hagerstown, Md.) : Regular physical activity is a cornerstone in the prevention and treatment of atherosclerotic cardiovascular disease (CVD) due to its positive effects in reducing several cardiovascular risk factors. Current guidelines on CVD suggest for healthy adults to perform at least 150 min/week of moderate intensity or 75 min/week of vigorous intensity aerobic physical activity. The current review explores the effects of physical activity on some risk factors, specifically: diabetes, dyslipidemia, hypertension and hyperuricemia. Physical activity induces an improvement in insulin sensitivity and in glucose control independently of weight loss, which may further contribute to ameliorate both diabetes-associated defects. The benefits of adherence to physical activity have recently proven to extend beyond surrogate markers of metabolic syndrome and diabetes by reducing hard endpoints such as mortality. In recent years, obesity has greatly increased in all countries. Weight losses in these patients have been associated with improvements in many cardiometabolic risk factors. Strategies against obesity included caloric restriction, however greater results have been obtained with association of diet and physical activity. Similarly, the beneficial effect of training on blood pressure via its action on sympathetic activity and on other factors such as improvement of endothelial function and reduction of oxidative stress can have played a role in preventing hypertension development in active subjects. The main international guidelines on prevention of CVD suggest to encourage and to increase physical activity to improve lipid pattern, hypertension and others cardiovascular risk factor. An active action is required to the National Society of Cardiology together with the Italian Society of Sports Cardiology to improve the prescription of organized physical activity in patients with CVD and/or cardiovascular risk factors. 10.2459/JCM.0000000000000855
    How should we manage asymptomatic hyperuricemia? Chalès Gérard Joint bone spine The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available. 10.1016/j.jbspin.2018.10.004
    [Gout management: an update]. Ankli Barbara,Krähenbühl Stephan Therapeutische Umschau. Revue therapeutique Gout is the most frequent arthritis worldwide. Despite progress in therapeutic options the majority of gout patients are still insufficiently treated. International guidelines (ACR, EULAR, 3e initiative) clearly specify treatment targets: keep the patient flare-free and maintain a low urate serum level (< 360 µmol/l). The treat to target strategy includes therapy of flares, urate lowering treatment (ULT) and prophylaxis of flares. Evolution of gout guidelines over several years shows a broader indication for ULT, mandatory prophylaxis of flares during the initiation of ULT over several months and an earlier start of ULT in patients with flares as soon as symptoms have diminished. Colchicine is the preferred specific flare treatment, Caution has to be taken especially in patients with kidney disease, patients with hepatic dysfunction or in patients with interacting comedication. Low dose oral colchicine is nowadays the standard flare treatment. NSAIDs and prednisone are valuable alternatives. Interleukin-1 blockers offer a quick resolution of flares and may be an option in patients with chronic gout and severe kidney disease. Xanthinoxidase inhibitors (XOI) are the mainstay of ULT, with allopurinol still being the preferred XOI. The recently approved XOI febuxostat is eliminated mostly by the liver and can induce a faster lowering of urate. Uricosuric drugs such as probenecid are recommended in patients with sufficient renal function in whom the treatment goals cannot be reached with XOI. In Switzerland, only the two gout-lowering drugs allopurinol and probenecid are available, which reduces the therapeutic possibilities. Treatment success is often hampered by malcompliance. Recent guidelines stress the importance of patient education to ameliorate compliance. Comorbidities such as metabolic syndrome, cardiovascular and kidney disease are often found in gout patients. Patients with severe kidney disease are the most difficult to treat: the choice of antiinflammatory treatment is narrowed, ULT has to be uptitrated very carefully and patients often suffer from repeated flares. Another factor associated with treatment failure is the low physician’s adherence towards the guidelines. Therapeutic failure can lead to chronic and refractory gout (polyarticular gout, uncontrolled flare activity, chronic synovitis, destructive tophi) which makes the further management very difficult. Most gout patients are treated in primary care settings. Patients with chronic gout or at high risk for development of chronic gout (in particular patients with severe kidney disease or patients transplanted) should be additionally treated by a rheumatologist. 10.1024/0040-5930/a000766
    Japanese guideline for the management of hyperuricemia and gout: second edition. Yamanaka Hisashi, Nucleosides, nucleotides & nucleic acids Gout is a urate deposition disease caused by persistent hyperuricemia. Because gout patients present with a variety of clinical symptoms, it is necessary to have a guideline for the standard management and care of gout and hyperuricemia. The Japanese Society of Gout and Nucleic Acid Metabolism, a scientific society committed to study nucleic acid metabolism and related diseases, established the first edition of the "Guideline for the Management of Hyperuricemia and Gout" in 2002, and published the revised version in January 2010. This second edition is not only evidence based on a search of systemic literature, but also includes consensus levels by a Delphi exercise to determine the strength of the recommendations. A draft version of this guideline was reviewed by internal and external reviewers as well as a patient. In this guideline, key messages from each chapter are listed as statements together with the evidence level, consensus level, and strength of the recommendation. In this proceeding, several selected chapters on the clinical management of gout and hyperuricemia are described. We hope this guideline is appropriately used for the standard management and care of patients with hyperuricemia and gout in daily practice. 10.1080/15257770.2011.596496
    A prescription for lifestyle change in patients with hyperuricemia and gout. Choi Hyon K Current opinion in rheumatology PURPOSE OF REVIEW:This review summarizes the recent data on lifestyle factors that influence serum uric acid levels and the risk of gout and attempts to provide holistic recommendations, considering both their impact on gout as well as on other health implications. RECENT FINDINGS:Large-scale studies have clarified a number of long-suspected relations between lifestyle factors, hyperuricemia, and gout, including purine-rich foods, dairy foods, various beverages, fructose, and vitamin C supplementation. Furthermore, recent studies have identified the substantial burden of comorbidities among patients with hyperuricemia and gout. SUMMARY:Lifestyle and dietary recommendations for gout patients should consider overall health benefits and risk, since gout is often associated with the metabolic syndrome and an increased future risk of cardiovascular disease (CVD) and mortality. Weight reduction with daily exercise and limiting intake of red meat and sugary beverages would help reduce uric acid levels, the risk of gout, insulin resistance, and comorbidities. Heavy drinking should be avoided, whereas moderate drinking, sweet fruits, and seafood intake, particularly oily fish, should be tailored to the individual, considering their anticipated health benefits against CVD. Dairy products, vegetables, nuts, legumes, fruits (less sugary ones), and whole grains are healthy choices for the comorbidities of gout and may also help prevent gout by reducing insulin resistance. Coffee and vitamin C supplementation could be considered as preventive measures as these can lower urate levels, as well as the risk of gout and some of its comorbidities. 10.1097/BOR.0b013e328335ef38
    Outcome measures in acute gout: a systematic literature review. Dalbeth Nicola,Zhong Cathy S,Grainger Rebecca,Khanna Dinesh,Khanna Puja P,Singh Jasvinder A,McQueen Fiona M,Taylor William J The Journal of rheumatology OBJECTIVE:Five core domains have been endorsed by Outcome Measures in Rheumatology (OMERACT) for acute gout: pain, joint swelling, joint tenderness, patient global assessment, and activity limitation. We evaluated instruments for these domains according to the OMERACT filter: truth, feasibility, and discrimination. METHODS:A systematic search strategy for instruments used to measure the acute gout core domains was formulated. For each method, articles were assessed by 2 reviewers to summarize information according to the specific components of the OMERACT filter. RESULTS:Seventy-seven articles and abstracts met the inclusion criteria. Pain was most frequently reported (76 studies, 20 instruments). The pain instruments used most often were 100 mm visual analog scale (VAS) and 5-point Likert scale. Both methods have high feasibility, face and content validity, and within- and between-group discrimination. Four-point Likert scales assessing index joint swelling and tenderness have been used in numerous acute gout studies; these instruments are feasible, with high face and content validity, and show within- and between-group discrimination. Five-point Patient Global Assessment of Response to Treatment (PGART) scales are feasible and valid, and show within- and between-group discrimination. Measures of activity limitations were infrequently reported, and insufficient data were available to make definite assessments of the instruments for this domain. CONCLUSION:Many different instruments have been used to assess the acute gout core domains. Pain VAS and 5-point Likert scales, 4-point Likert scales of index joint swelling and tenderness and 5-point PGART instruments meet the criteria for the OMERACT filter. 10.3899/jrheum.131244
    Asymptomatic hyperuricemia: is it time to intervene? Paul Binoy J,Anoopkumar K,Krishnan Vinod Clinical rheumatology Whether to treat hyperuricemia uncomplicated by articular gout, urolithiasis, or uric acid nephropathy is an exercise in clinical judgment and universal agreement is lacking. Patients with coronary artery disease, chronic kidney disease, and early onset hypertension with persistent hyperuricemia are likely to be benefited with urate-lowering therapy. The paradigm of the causative association of hyperuricemia with cardiovascular and chronic kidney diseases seems to have progressed from skepticism to increasing evidence of a true relationship. Although such evidences are mounting, they are not enough to support pharmacotherapy for all patients with asymptomatic hyperuricemia. Further studies are needed to determine which patients are likely to get beneficial effects from pharmacotherapy and the minimum threshold of uric acid level required to experience clinical benefits. 10.1007/s10067-017-3851-y
    The treatment of hyperuricemia. Gliozzi Micaela,Malara Natalia,Muscoli Saverio,Mollace Vincenzo International journal of cardiology Hyperuricemia has long been established as the major etiologic factor in gout. Alongside with an inflammatory state triggered by urate crystal deposition in the joints, hyperuricemia displayed additional pathophysiological consequences leading to tissue inflammation mainly in the vascular wall. Thus, therapeutic strategies used to treat hyperuricemia in the past decades have often been focused on limiting acute episodes. Recently, evidence has been accumulated suggesting that chronic urate deposition requires a correct treatment not limited to acute episodes based on the modulation of the activity of key enzymes involved in metabolism and excretion of urate including xanthine oxidoreductase (XO) and URAT1. The present review article will try to summarize the most recent evidences on the efficacy of XO inhibitors and uricosuric compounds in lowering uric acid levels in both the bloodstream and peripheral tissues. In particular, we will focus on the effect of novel XO inhibitors in counteracting uric acid overproduction. On the other hand, the effect of lowering uric acid levels via XO inhibition will be correlated with attenuation oxidative stress which leads to endothelial dysfunction thereby contributing to the pathophysiology of diabetes, hypertension, arteriosclerosis, and chronic heart failure. Hence, scavenging and prevention of the XO generated oxygen radical accumulation emerge as an intriguing novel treatment option to counteract uric acid-induced tissue damages. 10.1016/j.ijcard.2015.08.087