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Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout
Dalbeth Nicola,House Meaghan E,Horne Anne,Petrie Keith J
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-174
Abstract: Background Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout. Methods Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed. Results Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Urate-lowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03). Conclusions ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout.
The Action of Puricase in Depleting Stores of Serum Urate Crystals  [cached]
B. E. A. Eno,E. O. Effanga,I. O. Isaac,Z. Lipscey
Journal of Mathematics Research , 2012, DOI: 10.5539/jmr.v4n4p60
Abstract: From the study of purine synthesis, urate crystal deposition in joints and puricase interaction with plasma protein, a system of first order differential equations is obtained. The existence and uniqueness of the solutions of the system of equations is established. Some controllability and stabilizability results are obtained via the Pontryagins Maximum Principles.
Comparison of serum apolipoprotein A-I between Chinese multiple sclerosis and other related autoimmune disease
Bin Zhang, ShuXiang Pu, BinMei Li, JianRui Ying, Xing Song, Cong Gao
Lipids in Health and Disease , 2010, DOI: 10.1186/1476-511x-9-34
Abstract: In the presentation we performed a study on serum apoA-I levels in the patients with MS. We enrolled some age and gender matched patients with MS, autoimmune demyelinating diseases (Guillain-Barre Syndrome and Clinically Isolated Syndrome), neuroinflammatory diseases (viral encephalitis), autoimmune connective diseases (rheumatoid arthritis and systemic lupus erythematosus) and healthy control groups, and tested their serum lipids levels: total cholesterol (TC), triglyceride (TG), high-density lipoproteins (HDL), apolipoproteinB100 (apoB100), apolipoproteinA-I (apoA-I).For all patients, age had no effect on serum apoA-I levels (P > 0.05). Meanwhile, we proved the highest serum apoA-I levels in MS patients and the lowest serum apoA-I levels in SLE patients. Serum apoA-I levels was significantly elevated in female MS patients (P = 0.033; P < 0.05).In short we believed that patients with MS and other autoimmune demyelination had significantly decreased serum levels of apo A-I.Some previous study suggested that apoA-I was the major structural protein to promote lipid transfer in human plasma, which modulated several cellular functions and involved in the pathogenesis of some autoimmune diseases [1-9]. Hyka et al. approved that apolipoprotein A-I (apo A-I) interfered interreaction between monocytes and activeted T lymphocyte, repressed activation and production of some important pro-inflammatory cytokines in the pathogenesis of some inflammatory and autoimmune diseases (including multiple sclerosis) [6,7].Multiple sclerosis (MS) is an autoimmune demyelinating disease in central nervous system (CNS) [10,11], and some cytokines secreted by T-help cell (TH1/TH2) play the critical role in initiation and progression of MS [12-14]. Nowadays, more and more study focused on the relationship between apoA-I and autoimmune diseases including rheumatoid arthritis (RA), experimental colitis, thyroiditis and systemic lupus erythematosus (SLE) [15-18]. Although previous studies confirm
Serum Iron and Ferritin in Patients with Multiple Sclerosis  [cached]
Farhad Iranmanesh,Hamid Bakhsgi,Abbas Akbaripoor
Zahedan Journal of Research in Medical Sciences , 2013,
Abstract: Background: Multiple sclerosis (MS) is one of the most frequent and debilitating disease of the nervous system. Some recent studies show the possible role for iron and ferritin in the course of MS. The aim of this study was to evaluate the level of serum iron and ferritin in patients with MS and comparision of them with control group. Materials and Methods: In this descriptive study, serum iron and ferritin were determined in 30 patients with MS and compared with 30 healthy persons, which were matched in terms of age and gender. Data were analyzed with statistical descriptive methods and and t-test.Results: In this study, 30 patients were evaluated. The mean age of both groups was 35.2. Mean serum iron in patients group was 85.16±38.38, and in control group was 91.73±27.89. Mean serum ferritin in patients group was 132.20±80.71 and in control group was 147.40±75.02. There was no significant relationship between serum iron and ferritin in both groups, and also there was no relationship between serum iron and ferritin with age and sex and the type of disease.Conclusion: This study did not show any difference between serum iron and ferritin in patients with multiple sclerosis and control group.
What lies behind serum urate concentration? Insights from genetic and genomic studies
Kimiyoshi Ichida
Genome Medicine , 2009, DOI: 10.1186/gm118
Abstract: Hyperuricemia induces or facilitates gout, kidney stones, metabolic syndrome, hypertension and renal and cardiovascular disease, while exercise-induced acute renal failure is a significant complication of renal hypouricemia [1-3]. Although hyperuricemia has been more closely associated with gout and kidney stones, it has been recently recognized to be independently associated with components of metabolic syndrome, insulin resistance, hypertension, dyslipidemia and obesity. Metabolic syndrome is a clustering of cardiovascular disease risk factors and its prevalence is increasing. Several mechanisms for the association between hyperuricemia and metabolic syndrome have been proposed; insulin resistance leads to renal underexcretion of uric acid (urate); increased lactate in obesity accelerates renal urate reabsorption via urate transporter 1 (URAT1); fatty acid synthesis accelerates de novo purine synthesis via the pentose phosphate pathway, and so on [4]. Recent studies have shown that hyperuricemia independently causes atherosclerosis through urate-mediated inflammation and endothelial dysfunction, in addition to metabolic syndrome [5,6]. Thus, monitoring of serum urate concentrations in patients with hyperuricemia, kidney stones, metabolic syndrome, or renal or cardiovascular disease has been recommended, at least after a certain age.Urate is the end product of human purine metabolism and is mainly excreted in urine. Serum urate concentrations are determined by the volume of urate produced via purine metabolism and by renal urate excretion. Many factors, including genetic components and acquired factors such as obesity and alcohol consumption, influence serum urate concentrations. Genetic links to serum urate concentrations have been identified, mainly from earlier studies of monogenic disorders, but have also been recently analyzed using genome-wide association approaches. Monogenic disorders such as hypoxanthine-guanine phosphoribosyl transferase deficiency (Lesch
Serum urate, menopause, and postmenopausal hormone use: from eminence to evidence-based medicine
Angelo L Gaffo, Kenneth G Saag
Arthritis Research & Therapy , 2008, DOI: 10.1186/ar2524
Abstract: In the past era of predominately opinion-based or eminence-based medicine, the relationship between serum urate, sex, and aging has always been perceived by astute clinicians to be a rather simple one; namely, women have lower levels of serum urate than men, and have a lower prevalence of gout. In women, serum urate levels increase with aging and the onset of menopause until the levels roughly equal those of men in later years – this is the traditional view being revised in the present issue of Arthritis Research and Therapy by Hak and Choi's study [1].Menopause and hormone replacement therapies, possibly mediated by steroid hormones inducing a more efficient renal uric acid excretion, are thought to influence the age-related phenomenon of changes in women's serum urate [2-5]. The impression of a simple relationship between sex, menopausal status, and serum urate has not been particularly evidence-based, however, given the lack of large studies in which there was adequate control for confounding factors known to affect the serum urate and menopausal status. Uncovering the true effect of these relationships has significant relevance not only for rheumatologists who treat gout but also for all physicians, given increasing data on the association of serum urate with adverse cardiovascular outcomes among postmenopausal women [6].In this context, Hak and Choi present data from a large and representative sample of 7,662 women in the United States – the Third National Health and Nutritional Examination Survey [1]. Using a cross-sectional design, the study evaluates the relation between menopause (natural and surgically induced), postmenopausal hormone use, and serum urate levels.The main strength of the study is its careful methodology, including a thorough assessment of potential confounders such as age, body mass index, medication use, comorbidities, and dietary factors. After multivariate adjustment, menopause was found to significantly increase serum urate levels (by 0
Serum prolactin level in multiple sclerosis patients  [cached]
Mohammad Ali Shafa,Alireza Vakilian,Alireza Poorebrahimi,Jafar Ahmady Kahnali
Journal of Research in Medical Sciences , 2006,
Abstract: BACKGROUND: Multiple Sclerosis (MS) is the most common demyelinating disease. An autoimmune basis has been confirmed for pathogenesis of MS. Prolactin (PRL) has roles in these mechanisms. Its serum levels change in MS according to some reports. The purpose of this study was to survey these changes in MS patients. METHODS: Sixty MS patients were included in this cross-sectional study. The same number of controls matched for sex and age were studied. Pregnant, lactating women, consumers of specific medications and patients with underlying diseases were excluded from our study. RIA was used for determination of serum levels of PRL. RESULTS: In this study, PRL level in male patients was 14.23 ± 11.47 ng/ml compared to controls with mean level of 7.21 ± 4.12 ng/ml (P value <0.001). Mean PRL level in female patients was 20.18 ± 11.04 ng/ml whereas controls had a mean level of 14.45 ± 6.93 ng/ml (one-tailed P value <0.05). So there were significant differences in serum PRL level between case and control groups in both men and women CONCLUSIONS: PRL has a positive relation with MS in both sexes. Further studies for determination of causality relation and drug effect in endocrine system on MS pathogenesis are suggested. KEY WORDS: Multiple Sclerosis, prolactin, male, female
Serum levels of prolidase and ischemia modified albumin in patients with multiple sclerosis  [PDF]
Mehmet U?ur ?evik,Yavuz Yücel,Adalet Ar?kano?lu,Sefer Varol
Journal of Clinical and Experimental Investigations , 2012,
Abstract: Objectives: Increased levels of free radicals and oxidantmolecules and decreased levels of antioxidant moleculeshave been defined in patients with multiple sclerosis(MS). Ischemia-modified albumin (IMA) levels have beenadvocated as a biomarker for evaluating the oxidativestress status. The aim of this study was to investigate therelationship between oxidative stress and MS.Materials and methods: We compared serum ischemiamodified albumin levels and prolidase activity of 42 patientswith MS (30 female, 12 male) and 30 age-matchedhealthy controls (21 female, 9 male).Results: Ischemia modified albumin levels of MS patients(73,07±26,53 ng/mL) were significantly higher than thoseof controls (60,18±18,01 ng/mL) (p=0.024). However,there were no significant differences in prolidase levelsbetween patients and healthy controls (p=0.856).Conclusions: Increased ischemia modified albumin levels,supports the role of oxidative stress in patients withmultiple sclerosis. J Clin Exp Invest 2012; 3(4): 518-520Key words: Multiple sclerosis, ischemia modified albumin,prolidase, oxidative stress
Gender effect on neurodegeneration and myelin markers in an animal model for multiple sclerosis
Alessandro Massella, Giulia D'Intino, Mercedes Fernández, Sandra Sivilia, Luca Lorenzini, Silvia Giatti, Roberto C Melcangi, Laura Calzà, Luciana Giardino
BMC Neuroscience , 2012, DOI: 10.1186/1471-2202-13-12
Abstract: 1. A strong gender-dependent difference in myelin (MBP) and myelin precursor (PDGFαR) marker mRNA expression levels is observed in control animals in the spinal cord, but not in the cerebellum. This is the only gender-dependent difference in the expression level of the indicated markers in healthy animals; 2. both PDGFαR and MBP mRNAs in the spinal cord and MBP in the cerebellum are down-regulated during EAE in gender-dependent manner; 3. in the cerebellum, the expression profile of neuron-associated markers (GAD65, GAD67) is characterized by a substantial down-regulation during the inflammatory phase of the disease, which does not differ between male and female rats (two-way ANOVA); 4. there is an up-regulation of NGF, trkA and p75 mRNA expression in the early phases of the disease (14 and 21 days post-immunization), which is not different between male and female.It is reported herein that the regulation of markers involved in demyelination and neuroprotection processes occurring during EAE, a well-established MS animal model, is gender- and time-dependent. These findings might contribute to gender- and phase disease-based therapy strategies.Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS), which can progress over decades. The progressive failure of remyelination leads to the cumulative loss of axons, grey matter atrophy and prevalent neurodegeneration responsible for chronic disability and cognitive decline [1]. There is a considerable difference in the way MS affects females and males, as has been highlighted by epidemiology studies and MRI analyses [2-4]. The way of gender-influence in MS is complex and still obscure. From a pathogenic point of view, females tend to have stronger Th1-mediated immune responses and are more prone to develop autoimmune diseases, including MS [5]. However, gender might influence white matter establishment and maintenance of the mature structure of white tracts, thus affecting their
Serum Homocysteine level in patients with Multiple Sclerosis  [cached]
F Ashtari,Sh Salehi Abari,V ShayganNejad
Journal of Research in Medical Sciences , 2005,
Abstract: Background: The etiology of multiple sclerosis (MS), a chronic demyelinative disease-is unknown. The damage of blood–brain barrier (BBB) vasculature is a characteristic of MS and Homocystein (Hcy) can damage BBB, then increase in total Hcy may be important in MS pathogenesis. The aim of this study was to compare the serum level of total Hcy in MS patients with control group. Methods: In a case control study, serum level of total Hcy measured in 35 MS patient and compared with 30 healthy matched controls. All patients had definitive MS according to Poser criteria, without history of myocardial infarction, stroke, neuropathy, transient ischemic attack, homocystinuria or renal failure. Results: The serum concentration of total homocystein was significantly higher in multiple sclerosis patients than healthy controls. The mean total Hcy level was 17.92± 6.9 mmol/lit in cases and 14.6±2.92 mmol/lit in controls (P=0.013). Conclusion: Serum total Homocystein may have a role in MS pathogenesis and reduction of it should be studied moreover. Key words: Multiple Sclerosis, Homocystein, Serum level
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