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Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to a community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home, musculoskeletal pain was reported by 57% of those interviewed(*).
Types of Musculo-Skeletal disorders in elder
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.
In the study carry out a cross-sectional survey on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout, Dr. Dai SM, and the research team at the Second Military Medical University, in the interviewe a total of 6584 adults (3394 women, 3190 men) with the response rate of 86.6%. showed that symptoms occurred more frequently in the following sites: knee 7.0% (95% CI 6.4-7.6%), lower back 5.6% (95% CI 5.0-6.2%), shoulder 4.7% (95% CI 4.2-5.2%), and neck 2.4% (95% CI 2.0-2.8%). Women complained of rheumatic symptoms more frequently than men. The standardized rates of RA, AS, gout, symptomaticknee osteoarthritis, and soft tissue rheumatism were 0.28% (95% CI 0.15-0.41%), 0.11% (95% CI 0.03-0.19%), 0.22% (95% CI 0.11-0.33%), 4.1% (95% CI 3.6-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively(1a).
Most frequent symptoms of gout as a result of tophus(4), according to studies including
1. Warmth(1), pain(1), particular endpoint pain(2), swelling(1), erythema(1), and extreme tenderness(2)(called podagra. when it effects the big toe), according to the Cadence Physician Group/Orthopaedics(1)
2. Very red or purplish skin on the affect joint(5)
In fact, symptoms are quite noticeable, you may feel well when you go to bed but wake up during the night with intense pain in one or few joints and sometime with fever. The symptoms may go away in a few days, but can return from time to time. Chronic gout can cause lumps(4) below the skin around the affect areas.
The causes of gout is as the result of high levels of uric acid in the body that can lead to forming of crystals causes of inflammation due to your body can not get rid of uric acid or have made too much uric acid(4). Reduced intake of meats and seafood and foods containing higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) may be necessary(7)(8).
According to the New York University School of Medicine/Langone Medical Center, the prevalence of gout and hyperuricemia has increased dramatically during the last several decades, to the point that gout is the most common inflammatory arthritis in the United States, affecting approximately 8 million Americans(9) and contributing to great numbers of hypertension, chronic kidney disease, and cardiovascular disease(9).
B. Risk factors
1. Improper diet
If you body can not get rid uric acid quickly, intake foods with high levels of purine such as Alcohol, Beverages, Beer, Anchovies, Smelt, Fish, Eggs, Herring, Mackerel, Sardine, Sweetbread, Liver, Kidney, etc., is at increased risk of gout(7)(8)(10). Several dietary factors increased the risk of incident gout, including meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose(10).
2. Alcohol consumption
Dr. Singh JA and scientists at the Birmingham VA Medical Centre, indicated, of the 751 titles and abstracts, 53 studies met the criteria and were included in the review. Several risk factors were studied. Alcohol consumption increased the risk of incident gout, especially beer and hard liquor(10)(7).
Others suggested that combined with their activities as urinate transporters and their strong associations with serum uric acid concentrations,
3. Medical conditions
Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes are associated to increased risk of gout(10). Patient with Chronic kidney disease are at higher risk of gout as a result of Serum uric acid control in gout was poor among patients without CKD and even worse among those with CKD(11). Distinct group differences by content of uric acid seem to arise from early onset of chronic renal failure in women.
Gout is also drug-related(21). Thiazide and loop diuretics users are at increased risk of gout(12)(10), according to Johns Hopkins University Bloomberg School of Public Health.
Some ethnic groups are particularly susceptible to gout, probaby due to genetic predisposition(13)(14).
6. Age and sex are associated to risk of the develop of gout(14)(15).
GLUT9 and ABCG2 appeared to be important modulators of uric acid levels and likely of the risk of gout. Together with a growing list of environmental risk factors, these genetic data add considerably to our understanding of the pathogenesis of hyperuricemia and gout(16)(17)(19).
8. Family history
Accoridng to the total of 543 cases of juvenile gout from the Ho-Ping Gout Database, and 5269 gouty cases with onset age of 40 to 50 years, family history is associated to increased risk of gout(18)(19)
9. Obesity, over weight, weight change
Obesity and overweight are associated with a higher risk of incident gout and/or gout flare(10)(19).
Higher adiposity and weight gain are strong risk factors for gout in men, while weight loss is protective(5).
Early menopause is associated with a higher risk of incident gout and/or gout flare(10). According to the16 years of follow-up (1 240 231 person-years), 1703 incident gout cases, conducted by the Taipei Municipal Hospital Gout Research Group, compared with premenopausal women, postmenopausal women had a higher risk of incident gout. Risk of gout is decreased among postmenopausal hormone users(22).
11. Recent surgery or trauma
According to Cleveland Clinic, risk of early postoperative gout is higher after bariatric surgery in comparison of patients undergoing other procedures(23)(24). There is a report of monoarticular gout following trauma in Medical College of Wisconsin literature(25).
According to the UK Gout Society, diseases associated to gout may include
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. High blood pressure means raising pressure in your heart.If it stays high over time it can damage the body in many ways.
Patients with gout are associated to chronic kidney disease has been well documented in epidemiological literature(26). The joint study led by the Keele University suggested, "Chronic kidney disease and nephrolithiasis are commonly found amongst patients with gout. Gout is independently associated with both chronic kidney disease and nephrolithiasis. Patients with gout should be actively screened for chronic kidney disease and its consequences"(33).
Dr. Krishnan E said, "Chronic kidney disease manifesting as reduced glomerular function or as presence of blood or protein in the urine increases the risk of incident gout"(34).
Unhealthy diet such as typical American diet with high in saturated and trans fat and lower intake of vegetables and fruits has been found to associated to hypertriglyceridemia in epiodemilogical literature in data bases of PubMed(41)(42)(43), particular to hypertriglyceridemia in men(46).
In the searching of the association of hypertriglyceridemia in patients with gout, according to the Osaka University Medical School, there is a close correlation between the degree of uric acid production and triglyceride (TG) metabolism in 148 male subjects with primary gout(45).
Unhealthy diet such as typical American diet with high in satyrated and trans fat and lower intake of vegetables and fruits has been found to associated to Hypertriglyceridemia and Hypercholesterolemia in epidemiological literature in data bases of PubMed(41)(42)(43).
Dr. Tu FY and colleagues of some well known institutions in Taiwan, according to the data from the Taiwan national health insurance database for 2004 to 2006, showed that hypercholesterolemia, were the common comorbidities of gout(56).
Recent studies suggested that avocado(49)(50), Almond(51)(52) and green tea(53)(54) may consist a therapeutic values used combination for reduced risk and treatment of high blood cholesterol in patients with gout.
Hyperuricemia, a condition with over expression of uric acid in the blood through liver most often found in patients with gout. According to Dr. Li YM. said, "It has been widely accepted that the increase in the level of uric acid significantly raises the risks of gout, cardiovascular disease, and type 2 diabetes."
It is acceptance epidemiological studies that high fruit and soybean products dietary intervention could be an effective alternative to a standard diet for achieving clinically important reductions in SUA for asymptomatic hyperuricemia patients(61). And major dietary patterns such as animal products and fried food are associated to risk of hyperuricemia(62).
According to the Chiang Mai University, green tea extract (GTE) also promoted hypouricemic and anti gout effects through modestly lowering serum uric acid (SUA) level and decreasing uric acid clearance(63).
Diabetes is a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.
Obesity, one of the disease of metabolic syndrome is a medical condition of excess body fat accumulated overtime, while overweight is a condition of excess body weight relatively to the height.
Change of life style and diet pattern are also recommended(74).
Beside cancer, heart disease kills more than 2,000 Americans everyday. Approximately 60 million Americans have heart disease. Most of heart diseases are caused by high blood pressure contributes to hardening of the arteries. High levels of bad cholesterol (LDL) build up in the arteries as a result of tuncontrolled diet with high levels of saturated fat and trans fat. According to study, risk of heart attached is increased in older women with gout(80).
Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or it's complications. Stroke is caused by uncontrolled diet that is high in saturated and trans fats resulting in cholesterol build up in the arteries and high blood pressure.
11. Peripheral vascular(artery) disease
Peripheral vascular disease is a condition of poor circulation of blood, affecting the functions of heart and brain. Because of of its implication involving risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life, some researchers suggested of the importance in identified patients with PAD have become necessary(91). According to the a large cohort of primary care patients, patients with gout are associated to increase risk of vascular disease, particular in female patients with gout(92).
Dr. Baker JF and colleagues at the University of Pennsylvania said, " in multivariate model, a history of gout was associated with an odds ratio of 1.33. Serum uric acid level is independently associated with a higher (but statistically nonsignificant) risk of PAD"(93).
Psoriasis is an autoimmune diseases induced abnormal skin path with expression of redness, itchy, and scaly. According to the joint study led by the University of Trieste, the increased incidence of a large number of diseases which share an inflammatory origin probably due to the pro-inflammatory cytokine spillover from active psoriatic lesions leading to a large inflammation on distant tissues(95).
Recent studies by some renowned institutions suggested that green tea(99) and grape(100) may be the next generation of ingredient extracted from natural sources for reduced risk and treatment of psoriasis.
Tophi is a forming of lumps building up around the joint due to chemical called uric acid. According to the University Hospital Southampton NHS Foundation Trust, tophi may be managed and treated by non-surgical and surgical procedures(102).
2. Kidney stone
Kidney stone is a composed of mineral salts formed in the kidneys. Men account for the 80% of those with kidney stones and are at risk of the forming between 30 and 40 years of age. About 75% of kidney stones are calcium stones.
3. Joint damage
Acute gout or acute gouty arthritis can induce joint damage thoough deposit of uric acid crystals in joint spaces. Patients with gout are associated to complication of joint damage, according to the joint study led by University of Auckland, monosodium urate crystals are frequently present in joints affected by radiographic damage in gout(115).
Dr. Dalbeth N and professors at the University of Auckland in the review of joint damage in aptients with gout, suggested that intensive urate-lowering therapy plays a critical role in improvement in structural damage, particularly bone erosion(116).
Consumption of beer, loop or thiazide diuretics, ciclosporin, tacrolimus, ethambutol, pyrazinomide, nicotinic acid, also are found stimulate the progression of recurrent gout, according to Dr. Robin Fox, GP(120). Other risk factors for recurrent gout include medical conditions such as Psoriasis Myeloproliferative disorders, Administration of cytotoxic drugs (tumour lysis syndrome), Inherited enzyme deficiencies and Lead poisoning(occupations)(120).
Untreated gout may cause even more deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie), leading to advanced gout with tophi developed in several areas, including fingers, hands, feet, elbows,.......Occasionally,untreated gout can lead to advanced arthritic changes. and chronic discomfort of the hallux MTPJ, necessitating surgical intervention to help alleviate symptoms, according to Dr. Balutis E and Dr., Pino A.(123).Refractory gout in patients who have ongoing symptoms of active disease and cannot maintain a target serum urate less than 6 mg/dl were treated successfully with long-term pegloticase treatment, improvements in clinical status, in the form of flare and tophus reduction and maintained goal range urate-lowering responses during up to 2.5 years of additional treatment(124).
According to the Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb. Report No.: 15(16)-EHC026-EF.AHRQ Comparative Effectiveness Reviews(125).
if you are experience SHARP pain in the joint with visual symptoms of collection of urate crystal deposit and other clinical signs and symptoms of gout, your doctor may order the below tests
1. Joint fluid test
Withdraw fluid from affected joint to test for sign of urate crystal accumulation for confirmation of gout.
2. Blood test
Blood test is necessary to measure levels of uric acid for gout and creatinine for kidney function in your blood. According to the University of Auckland, measured blood test in people with gout has caused confusion about the details of urate measurement in suboptimal care(126), as the measurement may not be accurate as some some people with high levels of uric acid levels, have never experienced gout. And some people have signs and symptoms of gout, but don't have higher levels of uric acid in their blood(127).
3. X-ray imaging(125)
The aim of the test is to rule other causes of inflammation of joints. In case of negative or inconclusive, other tests such as ultrasound and dual energy CT scan to provide additional information in patients(128),
The aim is to detect any urate crystals deposit in a joint or in a tophus for confirmation of gout when X ray is inconclusive and negative(128). Dr. Codreanu C and Dr. Enache L said, "adding US to the clinical and serological features will significantly improve the sensitivity of proposed criteria. The ability of high resolution US to detect crystalline deposits of monosodium urate in joints and soft tissues is well recognized"(129)
5. Dual energy CT scan(125)
The aim of the test is to detect any any urate crystals deposit in a joint or in a tophus even without sign of acute inflammation. "Dual-energy computedtomography (CT) contributes over conventional single-energy CT,........ Particular emphasis will be placed on acute gout, bone marrow edema, acute renal colic, acute cardiovascular and neurovascular emergencies aswell as characterization of abdominal incidentalomas" according to the joint study led by the University of British Columbia.
The Misdiagnosis and delay diagnosis
According to the University of Kansas School of Medicine, out of 9,108 consecutive new patients seen in an outpatient rheumatology clinic, 155 (1.7%) diagnosed as having gout, 164 (1.8%) had been incorrectly diagnosed as having gout in the community(131).
According to the Geisinger Medical Center, there is a report of chylous cyst was misdiagnosed as recurrent chest wall gouty tophus due to form birefringent crystals upon drying(137).
In the review of Forty-two patients with psoriatic arthritis who were referred to a tertiary medical center from 1983 to 1987, eight patients with foot and ankle involvement were diagnosed and treated for either gout or compression of a digital nerve due to failure to identify psoriatic skin lesions and the associate foot and ankle symptoms with psoriatic arthritis.(138).
Researchers found that long-term moderate coffee consumption is associated with a lower risk of incident gout, particular in women(139). According to the joint study led by the Naresuan University Hospital, there is an associations between vitamin C, alcohol,coffee, tea, milk and yogurt with uric acid and the risk of gout(140).
In Japanese men and women aged 49-76 years, "There were inverse associations of coffee consumption with serum UA concentrations and hyperuricemia in men regardless of adjustment for covariates" Said by Dr. Pham NM and colleagues at the Kyushu University(141).
2. Maintaining adequate fluid intake, particular at night
Dehydrate is associated with the increased risk of gout, particular at night time, epidemiological study suggested(142). Drinking water or skim milk can improve gout control, according to findings from two studies that highlight the important contribution of lifestyle factors on gout prevention and management(144), and recent use of diuretics is associated with a significantly increased risk for recurrent gouty arthritis(143).
3. Weight reduction
Obesity cause cause pressure to the joint. Obesity is not only a risk factor for incident gout but is associated with an earlier age at gout onset(147). According to the a total of 543 cases of juvenile gout from the Ho-Ping Gout Database and 5269 gouty cases with onset age of 40 to 50 years, family history of overweight and hereditary background are significantly associated to increased risk of juvenile gout(145).
Dr. Lee J and the research team at the The Catholic University of Korea, said," Gout is a chronic inflammatory disease the development of which is associated with obesity-induced metabolic abnormalities."(146).
4. Dietary and life style pattern changes
a. Reduce alcohol
Alcohol intake is strongly associated with an increased risk of gout. This risk varies substantially according to type of alcoholic beverage: beer confers a larger risk than spirits, whereas moderate wine drinking does not increase the risk(150). The association between excessive alcohol consumption and risk of gout has been suspected since ancient times which was confirmed by the study by the Harvard Medical School, Boston(149).
Unfortunate to alcohol drinker, regardless of type of alcoholic beverage, episodic alcohol consumption,was associated with an increased risk of recurrent gout attacks, including potentially with moderate amounts(151).
b. Reduce intake of foods with high levels of purine, such as sardines, herring, kidney and sweetbreads, shrimp, etc.(152). According to the Third National Health and Nutrition Examination Survey, in the review of the data from 14,809 participants (6,932 men and 7,877 women) ages 20 years and older for the years 1988-1994, higher levels of meat and seafood consumption are associated with higher serum levels of uric acid(153) and sugar-sweetened soft drink consumption is associated with serum uric acid levels and frequency of hyperuricemia(154).
c. Diet with foods to prevent gout
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(156). Coffee and vitamin C(155) 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(156).
Diet with foods such as cherries and strawberries to prevent gout(157), as evidence of the impact of strawberry intake on gout has been report(157).
5. Reduce intake of medications which can cause gout and recurrent gout by reviewing them with your doctor, as certain medicine such as Thiazide and loop diuretics(158).
Regular physical exercise is associated to reduce risk of gout(159).
“Exercises to relieve gout should be done steady and cautiously as to avoid further irritation to the joints. The best exercises for gout are range of motion types: strength training, stretching and building endurance. Yoga is an exercise that incorporates all four; however, there are other exercises that can be done individually also” According to the article of How to Exercise If You Have Gout(160).
The top anti inflammatory Foods
Turmeric with the similar property as garlic in enhancing immune system fighting against inflammation caused by either free radicals and foreign invasion(191). Recent study suggested, IL-1β inhibited by turmeric(195) is a potent proinflammatory cytokine of the innate immune system involved in host defense against infection. may increase production of IL-1β which plays a pathogenic role in various inflammatory diseases, such as rheumatoid arthritis, gout(194).
Green tea, a precious drink in traditional Chinese culture has been served exceptional in socialization for more than 4000 thousand years. Due to its commercial values and health effects, green tea now was cultivated all over the world in suitable climate. According to the Naresuan University Hospital, dietary of green tea is associated to attenuate risk of of yugout(197), through its effect on lower SUA level and decreases uric acid clearance via significantly elevated serum antioxidant capacity(198).
Shiitake mushroom is an edible mushroom, genus Lentinula, belongings to family Marasmiaceae, native to East Asia and widely cultivated for consumption for its health benefits and commercial purpose in many Asian countries. According to the joint study led by the University of Florida, intake of Shiitake mushroom improved immunity, through cell proliferation and activation and increased sIgA production, reduced inflammation via cytokine and serum CRP levels(200). Dr. Urano W and colleagues at the Tokyo Women's Medical University said, "Decrease in SUA during acute gouty arthritis is associated with increased urinary excretion of uric acid; an inflammatory process may play a role in the mechanism"(201).
Onion is a plants in the genus Allium, belongings to the family Alliaceae, a close relation of garlic. It is often called the "king of vegetables" because of its pungent taste and found in a large number of recipes and preparations spanning almost the totality of the world's cultures. According to the Universidad Nacional de Cuyo, garlic (G) and onion (O) exhibited anti-inflammatory properties through antioxidant in attenuated oxidative stress(203) as well as (poly)phenols altered cytokine release, in protection against age-related inflammation and chronic diseases, including gout(204).
Ginger is the genus Zingiber, belongings to the family Zingiberaceae, native to Tamil, used in traditional and Chinese medicine to treat dyspepsia, gastroparesis, constipation, edema, difficult urination, colic, etc. According to the VIT University, Trikatu, a herbal compound including ginger exhibited significant analgesic, anti-pyretic and anti-inflammatory effect against gout through precipitation of monosodium urate crystals in the joints(206).
The Top immune enhancers
Enhancing immunity has shown to reduced risk of inflammatory diseases(218). The University of Calgary study insisted "Uric acid crystals [monosodium urate (MSU)] have emerged as an important factor for both gouty arthritis and immune regulation. This simple crystalline structure appears to activate innate host defense mechanisms in multiple ways and triggers robust inflammation and immune activation"(219)
1. Omega 3 fatty acids
Omega-3 fatty acids, phytochemincals in the class of Lipids, found abundantly in dark-green leafy vegetables, grains, legumes, nuts, etc. play an impotant role in reduced risk of weaken immunity inducing inflammatory diseases, including gout(220). Dr. Simopoulos AP said, "omega-3 polyunsaturated fatty acids (PUFA) which possess the most potent immunomodulatory activities," and "Animal experiments and clinical intervention studies indicate that omega-3 fatty acids have anti-inflammatory properties and, therefore, might be useful in the management of inflammatory and autoimmune diseases."(221).
Selenium is one of most powerful antioxidant, played an important role in enhancing immune system fighting against forming of free radicals and foreign invasion, epidemiological evidences suggested.
In the follow up of serum selenium (Se) concentrations in 117 hemodialysis patients (HPs) during a 2-year longitudinal study, the University of Granada found that dyslipidemia and hyperuricemia found have a negative correlation between the serum Se and uric acid levels(224).
The observation of total antioxidant capacity, including selenium was significantly higher in non-responders and well correlated with hyperuricemia(225).
Zinc may plays an important role for the development of osteoarthritis, according to Randers Regional Hospital, patient with osteoarthritis are found to have significantly higher serum zinc concentrations and lower urine zinc concentrations in comparison to patient with osteoporosis(226).
In Gout, Zinc stimulates insulin action and insulin receptor tyrosine kinase activity in patient with type II diabetes reducing the risk of Insulin resistance induced the complication of hyperuricaemia(227).
4. Vitamin B2
Vitamin B2, awater soluble, also known as riboflavin has a chemical compound formula of C17H20N4O6. Like many other vitamin B complexes, it plays an important role in providing energy to our body by the metabolism of fat, carbohydrates and protein. According to the joint study led by National Cancer Center, vitamin B2 levels were significantly lower in the hyperuricemia subjects than in the controls, in the study of 28,589 people who participated in a health examination between 2008 and 2011(229) due to higher alcohol intake and lower vegetable and dairy product intake.
Vitamin B6 is water soluble and a member of vitamin B complex, played an important role in amino acids metabolism for to maintaining the proper function in our body. Vitamin B6 deficiency may be associated to risk of hyperglycaemia and hyperuricaemia(231). In deed, according to the Universidad Complutense de Madrid, consumption of Cereals, vegetables, legumes and fruit, together with milk and eggs, constituted the most important ingredients of the diet in a closed community showed to reduced risk of deficiencies of iron, magnesium, zinc, vitamin B(6) and vitamin D in induction of hyperuricaemia, the main cause of gout(232).
Dietary consumption and life style plays an important role in association to risk and attenuated risk and progression of gout(208)..
1. Green tea
Green tea containing more amount of antioxidants than any drinks or food with the same volume, is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Regular intake of green tea has shown to reduced levels of uric acid by epidemiological and research studies and literature(210)
1. Quercetin and Rutin
Quercetin is a plant pigments belongings to the group of flavonoids and its conjugate rutin is a quercetin-3-O-rutinoside and sophorin, according to Dr. Zhu JX and research team at the School of Life Sciences, Nanjing University expressed inhibition of enzyme activities in mouse liver in relation to their absorption and metabolism, and their potential application to treat gout and hyperuricemia(161). Dr. Shi Y and Dr. Williamson G said" quercetin treatment, plasma uric acid concentrations were significantly lowered by -26·5 µmol/l (95 % CI, -7·6, -45·5; P=0·008), without affecting fasting glucose, urinary excretion of uric acid or blood pressure" in a randomised, double-blinded, placebo-controlled, cross-over trial(162). The antioxidant also exerted a strong anti-inflammatory effect that may be useful for the treatment of acute gouty arthritis, TianJin University of Traditional Chinese Medicine(163)
Morin (3,5,7,2′,4′-pentahydroxyflavone), a phytochemical found in the twigs of Morus alba L. documented in traditional Chinese medicinal literature to treat conditions akin to gout, was demonstrated to exert potent inhibitory action on urate uptake in rat renal brush-border membrane vesicles(164). In the study of Ramulus Mori, the branch of Morus alba, is widely used in traditional Chinese medicine prescriptions to treat gout and hyperuricemia, researchers at the Nanjing University suggested that the effectiveness of the herbal medicine in treating gout, probably due to the presence of antioxidants, including morin(165).
According to the Nanchang University, luteolin exhibited a stronger synergistic effect with kaempferol than did morin at the lower concentration(166).
3. Other phytochemicals
13 flavonoids including myricetin, kaempferol, icariin, apigenin, luteolin, baicalin, silibinin, naringenin, formonoetin, genistein, puerarin, daidzin and naringin dihydrochalcone selected to investigate for their hypouricemic action in mice, also significantly reduced liver uric acid level in hyperuricemic animals(167).
Myricetin is one of the flavonoid class of polyphenolic compounds, found abundantly in fruits and vegetables, including berries.
According to Dr. Li Y and colleagues, Myricetin and luteolin expressed binding to the xanthine oxidase and cyclooxygenase-2 in attenuate the complex pathogenesis of gout, a metabolic disease(168). The Sri Ramakrishna Institute of Paramedical Sciences study also exhibited the protective effect of asepigallocatechin, acacatechin, myricetin, naringenin, daidzein and glycitein in reduced the expression of in gout patients(169).
Icariin, a flavonol glycoside, type of flavonoid is a 8-prenyl derivative of kaempferol 3,7-O-diglucoside. According to the Nanjing University, icariin exhibited anti hyperuricemic and over expression of gout effects through inhibition on the liver xanthine oxidase (XOD) activities(167).
Apigenin, a natural product belonging to the flavone class, remarkedly lowered serum uric acid levels in potassium oxonate induced hyperuricemic mouse, according to the study by the Beijing Institute of Pharmacology & Toxicology(173). Apigenin-7-O-β-D-glucoside, derivative of apigenin isolated from Olea europaea leaf (Ph.Eur.) extract, exhibited strongly the anti-gout property through expression of inhibitory effects on xanthine oxidase (XO)(174).
According to Dr. Li Y and colleagues, Myricetin and luteolin expressed binding to the xanthine oxidase and cyclooxygenase-2 in attenuate the complex pathogenesis of gout, a metabolic disease(168).
Dr. Choi HK in the study of dietary risk factors for rheumatic diseases said, "Because diet is an unavoidable universal exposure for people, even a small effect that can be achieved by dietary manipulation may produce a large impact on the population's health" and "A recent prospective study investigated several purported dietary factors for gout and confirmed some of the long-standing suspicions (red meats, seafood, beer, and liquor), exonerated others (total protein, wine, and purine-rich vegetables), and also identified potentially new protective factors (dairy products)"(185).
1. The Free radical scavengers
1.1. Vitamin A
Vitamin A, a bi-polar molecule formed by bonds between carbon and hydrogen, is a fat soluble vitamin, which can not be stored in the live, converted from beta-carotene, a powerful antioxidant.
Dr. Ford ES and Dr. Choi HK, in the differentaition of the concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States, said, "Concentrations of uric acid were significantly and positively associated with concentrations of vitamin A and inversely with concentrations of beta-carotene"(176), of that support the evaluation of the Vancouver finding.
1.2. Vitamin C
Vitamin C, also known as L-ascorbate is a water soluble vitamin with a chemical structure formula of C6H6O6. The vitamin cannot be stored in the body for more than 24 hours. Oral administration of vitamin C is associated to reduced risk of levels of serum uric acid (sUA) in chronic gout patients(178).
Vitamin D is a fat-soluble secosteroids found in small amount in few foods, including salmon, mackerel, sardines and tuna. The vitamin plays an important role in modulation of cellular proliferation, apoptosis induction, tumor growth suppression and promotion in absorption of minerals, including calcium, iron, magnesium, phosphate and zinc.
A. In conventional medicine perspective
Acetaminophen is an analgesic drug used by conventional medicine for treatment of headaches, arthritis, etc., as well as reducing fever, often as an alternative to aspirin without causing gastrointestinal adverse effecta. Acetaminophen such as Tylenol can help to relive the pain of Gout.
b. Side effects if overdose, are not limit to
b.1. Nausea and vomiting
b.2. Appetite loss
b.6. Abdominal pain
The University of Adelaide, in a double-blind, placebo-controlled trial, showed that application of acetaminophen was associated with adverse effects of suppression of serum neutralizing antibody response and increased nasal symptoms and signs(233) and hepatic damage(234) and toxicity(234).
A.2. The study of Gout–what are the treatment options? indicated that The options available for the treatment of acute gout (236)are
a. NSAIDs, also known as nonsteroidal anti-inflammatory agents/analgesics are commonly prescribed to control gout attacks in patients with hyperuricaemia.
Colchicine, due to economic affordable to many patients has been prescribed for treatment of gout with less adverse effects such as better tolerated, especially in patients with peptic ulcer, gastrointestinal bleeding or dyspepsia or who are taking anticoagulants(237), in acute gout patients.
Dr. Bjarnason I, and the research team at King’s College School of Medicine and Dentistry, in the study of Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans, suggested "Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation)" and
"NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems" and "The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials"(239).
Dr. Davies NM and colleagues at the University of Sydney insisted, Non-steroidal anti-inflammatory drugs (NSAIDs) may also cause damage distal to the duodenum, through involving specific biochemical and subcellular organelle damage followed by inflammatory tissue reaction(240).
a. Colchicine, used for a long period in gout, was approved for the first time in 2009 by the FDA for the prophylaxis and the treatment of acute attack, on the basis of a pivotal trial that showed the efficacy in the very short term – that is 24 h of a well-tolerated, low-dose regimen of Colcrys (colchicine, URL Pharma, Philadelphia, USA) to reduce pain in patients with acute gout – when given early(242). Use of medication should monitor through tapering, high-sensitivity CRP monitoring, bleeding risk and contraindications to ASA/NSAID therapy(244).
The main function of the medicine is to block the inflammatory processes and result in its utility for treating and preventing acute gout flare. Colchicine may also be used for treatment of other chronic inflammatory diseases involved the over expression of these molecular pathways(245).
b. Side effects are not limit to
4. Hair loss
6. Loss of appetite
7. Nausea; sore gums
8. Stomach pain
According to the review of the research paper of "Thiocolchicoside: review of adverse effects" liver injury, pancreatitis, seizures, blood cell disorders, severe cutaneous disorders, rhabdomyolysis and reproductive disorders have been found in gout patients with the use of the medication(243).Long term usage of the medication also exhibited central nervous system (CNS) adverse effects(244).
Corticosteroids, also known as terpod hormone, are an anti-inflammatory medicine prescribed for a wide range of conditions in reduced inflammation and suppressed the immune system.a. According to study, systemic corticosteroids could be used in severe poly articular flares(246). Anti-IL1 should provide a therapeutic alternative for severe cortico dependent gout with tophus(246). To prevent acute flares and reduce tophus volume, uric acid serum level should be reduced and maintained below 60mg/L (360μmol/L). The medicine is also considered as one of most frequent prescription for treatment of gout patients(247).
b. Side effects are not limit to
b.1. Stomach irritation
b.2. Rapid heartbeat
b.5. A metallic taste in the mouth
According to the University of Alberta, application of glucocorticoids has shown to induce pressure in the cardiovascular system include dyslipidemia and hypertension(249) as well as exhibiting certain psychiatric symptoms, including depression(250) and psychiatric complications such as psychosis, mania, hypomania, depression, apathy, anxiety, panic, depersonalization, delirium, confusion, hallucinations, delusions, paranoia, cognitive impairment and dementia(251).
Dr. Mitra R said, "Glucocorticoid (GC) exposure is the most common etiology of drug-induced (secondary) osteoporosis." and "GC stimulates osteoclast-mediated bone resorption and reduces osteoblast-mediated bone formation, which results in increased overall net bone resorption'(248).
4. Corticotrophin(Acortan, ACTH, Acthar, Acton, Cortigel, Trofocortina)
According to the University of Patras Medical School, ACTH injection. is effective and safe for the treatment of gout in hospitalized patients in replacement of problematicnon-steroidal anti-inflammatory drugs, steroids or colchicine in this patient population(253) for its better in management of gout and control of hyuperuricemia(254).
b. Side effects are not limit to
In the study of 162 children with infantile spasms were treated with ACTH at the Children’s Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960–76. In a large proportion (37%) of the children the treatment caused pronounced side effects, and the mortality was 4.9%.(255), such as hypertension, osteoporosis, hypokalaemic alkalosis, and other marked electrolyte disturbances.
5. Intra-articular corticosteroids
a. Intraarticular steroid injections are injected directly into an affected joint to improve joint function in patinet with gout. According to the study led by the Flexion Therapeutics, Inc., intra-articular corticosteroids porduced by the company significantly improved histological scores with no adverse effect on the HPA axis, through reduced pathophysiology of multiple joint diseases such as osteoarthritis (OA), RA and gout(256).
Unfortunately, Dr. Wechalekar MD and colleagues at the Repatriation GeneralHospital, suggested, "There is presently no evidence from randomised trials to support the use of intra-articular glucocorticoid treatment in acute gout. Evidence suggests intra-articular glucocorticoids may be a safe and effective treatment in osteoarthritis and rheumatoid arthritis"(257).
b. Side effects are not limit to(258)
b.2. Facial flushing
b.3. Local skin atrophy and depigmentation
b.4. Crystalline synovitis
b.5. Allergic reaction
b.6. Uterine haemorrhage
In herbal medicine perspective
Apricot tree is classified with the family of the plum belongings to the family Rosaceae with yellow to orange color, often tinged red on the side exposed to the sun.
In fact, University of Tokushima study of caffeic acid insisted, The phenolic compounds ameliorated xanthine oxidase (XO) which which is related to several diseases, e.g. gout(262), through its antioxidant activity when comparison to the conventional allopurinol(261).
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Epidemiological evidence showed that green green tea process anti cancers and anti progression of numbers of diseases(264), including gout(265)(266)
Quercetin, another green tea main component of antioxidant also displays lowered plasma uric acid concentrations significantly, equivalence to in approximately 100 g red onions, for 4 weeks in healthy males(268).
Alfalfa is a flowering plant in the genus Medicago, belongings to the family Fabaceae, cultivated all over the world as hay for cattle feeding. The leaves, sprouts, and seeds has been used in traditional medicine over thousands of year to treat high cholesterol, asthma, osteoarthritis, rheumatoid arthritis, diabetes, enhance digestive system, bleeding disorder, kidney and urinary tract infection, etc.
In the article by By jeffwend, the author wrote that Alfalfa can help to increase uric acid levels in the urine which can help reduce the amount of uric acid available to crystallize(270), probably due to the effectiveness of ethyl acetate extracts isolated from the herb in ameliorated production of pro-inflammatory cytokines and alleviate acute inflammatory hazards(271).
Dr. Ferrari FC and colleagues at the Universidade Federal de Ouro Preto, in the investigation of Leaves infusion of Pimenta pseudocaryophyllus (Gomes) Landrum, expressed the inhibition of ethyl acetate extracts in anti-hyperuricemic effects through uricosuric effects and inhibition of xanthine oxidase throughits anti-inflammatory property(272).
4. Devil’s claw
Devil's claw also known as wood spider, is a plant of genus Harpagophytum in the family of Pedaliaceae, native to South Africa, used as herb in traditional and herbal medicine to treat fever, rheumatoid arthritis, skin, gallbladder, pancreas, stomach and kidneys conditions, etc.Harpagoside, a Glycoside, the chemical, principle extracted from the Devil’s Claw root, contributes the natural anti-inflammatory properties and used as a Gout remedy and other painful disorders of the musculoskeletal system(274). The major phytochemical harpagoside, as a major iridoid glycoside, exhibited anti-inflammatory and COX inhibitory activity against rheumatism, gout, palsy and amenorrhea(276), according to the National Institute of Pharmaceutical Education and Research.
According to the University of KwaZulu-Natal, Harpagophytum procumbens root may be very effective used in the management and/or control of painful, arthritic and other inflammatory conditions, as well as for adult-onset, type-2 diabetes mellitus as the roots is used exclusive in some communities of South Africa(275).
Furthermore, phytochemical phenylpropanoid glycoside acteoside found in the herb(277) also ameliorated the levels of serum uric acid and hyperuricemic in mice through expression of inhibited mouse liver xanthine dehydrogenase XDH and xanthine oxidase XO activity(278), the Second Military Medical University suggested.
5. Purple Sweet Potato
Sweet potato is a large, starchy, sweet tasting tuberous roots vegetable, genus Ipomoea, belongings to the family Convolvulaceae. Its young leaves can be made into a delicious dish in Chinese foods. Some species of batatas are actually poisonous.
Anthocyanin extracts from purple sweet potato in comparison with conventional medicine allopurinol, on serum uric acid levels in hyperuricemic mice, reduced the serum uric acid concentration to 4.10 ± 0.04 mg/dLa single oral dose of 100 mg/kg(279).
In Traditional Chinese medicine perspective
A. Treatment according to TCM assistant in the article of "Chinese herbal formula(s) can treat or relief Gout"(27), in Chinese medicine, gout is a condition of a joint painful wind syndrome caused by
1. Formula for Damp-Heat induced gout
1.1. Painful obstruction due to the containment of Damp-Heat in the channels of that can lead to acute articular rheumatism, acute attack of gout, arthritis, hot joints, joint pain, tremors, dark urine, etc.
1.2. Chinese Herbal Formula Xuan Bi Tang used to clear and damp-Heat, unblock the Channels, eliminate painful obstruction, etc. Ingredients include
a. Guang Fang Ji (Radix Aristolochiae Fangchi, Aristolochia Root, Stephania) – 15g. -expels damp heat in upper jiao, expels superficial swellings, induces urination
b. Xing Ren (Semen Pruni Armeniacae, Apricot Seed) – 15g. -regulates lung Qi and water metabolism
c. Yi Yi Ren (Semen Coicis Lachryma Jobi) – 15g. -tonify spleen, clear dampness, relieve painful obstructions
d. Can Sha (Excrementum Bombycis Mori, Silkworm Feces) – 9g. -tonify spleen, clear dampness, relieve painful obstructions
e. Ban Xia (Rhizoma Pinelliae Tematae, Pinellia Rhizome) – 9g. -dries dampness, transforms tubidity
f. Lian Qiao (Fructus Forsythiae Suspensae, Forsythia Fruit) – 9g. -clears superficial heat
g. Zhi Zi (Fructus Gardeniae Jasminoidis, Cape Jasmine Fruit, Gardenia) – 9g. -clear heat, drains dampness, induces urination
h. Hua Shi (Talcum, Talcum) – 15g. -clear heat, drains dampness, induces urination
i. Chi Xiao Dou (Semen Phaseoli Calcarati) – 9g. -clears heat, drains dampness, induces urination(281)
2. Recurrent Wind-Cold-Damp
2.1. Recurrent Wind-Cold-Damp painful obstruction in which localized constraint generates Heat of that can lead to acute attack of gout, arthritis, difficulty in movement, joint pain, edema of lower extremities, painful lower limbs, rheumatism;, swelling of joints, etc.
2.2. Chinese herbal formula Gui Zhi Shao Yao Zhi Mu Tang used to disperses Damp and Wind, unblocks the Channels. moves Yang, etc.
a. Gui Zhi (Ramulus Cinnamomi Cassiae, Cinnamon, Cassia Twig) – 12g. -warms and unblocks channels
b. Ma Huang (Herba Ephedrae, Ephedra Stem, ma-huang) – 6g. -unblocks channels, relieves superficial swellings
c. Fu Zi (Radix lateralis Aconiti Carmichaeli, Szechuan Aconite Root, Aconite) – 6g. -warms channels, relieves pain
d. Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, Anemarrhena Rhizome) – 12g. -clear heat from the joints, nourish yin
e. Shaoyao (Radix Paeoniae , Peony Root) – 9g. -clear heat, nourish yin
f. Bai Zhu (Rhizoma Atractyloids Macrocephaelae, Atractylodes White Rhizome) – 15g. -harmonizes ying and wei Qi levels (Bai Shao)
g. Fang Feng (Radix ledebouriellae, Ledebouriella Root, Siler) – 12g. -expels wind and dampness
h. Sheng Jiang (Rhizoma Zingiberis officinalis Recens, Fresh Ginger Rhizome) – 15g. -promotes Qi circulation
i. Gan Cao (Radix Glycyrrhizae uralensis, Licorice Root) – 6g. -harmonizes other herbs within formula, regulates middle jiao(282).
3. Wind-Damp, Phlegm and Blood stasis
3.1. Wind-Damp, Phlegm and Blood stasis lead to acute attack of gout. arthritis, difficulty in movement, joint pain, edema of lower extremities, swelling of joints;, chills, etc.
3.2. Chinese herbal formula Shu Feng Huo Xue Tang used to disperses Damp and Wind, eliminates Blood stasis
a. Gui Zhi (Cinnamon twig, cassia twig) 2.5g
b. Qiang Huo (Notopterygium root, chiang-huo) 2.5g
c. Bai Zhi (Angelica root) 2.5g
d. Huang Bai (amur cork tree bark, phellodendron bark) 2.5g
e. Wei Ling Xian (Chinese clematis root, clematis) 2.5g
f. Cang Zhu (Atractylodes rhizome) 2.5g
g. Chuan Xiong (Sichuan lovage root, cnidium, Chuanxiong root) 2.5g
h. Hong Hua (Safflower flower, Carthamus) 1g
i. Gan Jiang (Dried ginger rhizome) 1g
j. Dang Gui (Chinese angelica root) 2.5g
k. Dan Nan Xing (P Arisaematis cum Fel Bovis) 2.5g
l. Han Fang Ji (Stephania root) 2.5g(283)
B. Other research and studied formulas
1. Modified Simiaowan (MSW)
Shuang-Qi gout capsule is another formula used widely in traditional Chinese medicine for treatment of of joint pain, inflammation and gout arthritis. According to the China Pharmaceutical University, application of the formula effectively inhibit the inflammation, analgesia, through the modulation of emission of pro-inflammatory cytokines and the curative effect is dose dependent manner(286).
In fact, in the review of a total of 120 cases of gouty arthritis randomly divided into the treatment group and control group with 60 cases in each group study, researchers indicated the effectiveness of the decoction in treatment of gout as the formula significantly improved the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP(291).
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(*) Musculoskeletal disorders and disability in persons aged 85 and over: a community survey. by van Schaardenburg D1, Van den Brande KJ, Ligthart GJ, Breedveld FC, Hazes JM.(PubMed)
(1) Diagnosis and management of gout in total knee arthroplasty by Buck M1, Delaney M.(PubMed)
(2) Rilonacept in the treatment of acute gouty arthritis: a randomized, controlled clinical trial using indomethacin as the active comparator by Terkeltaub RA, Schumacher HR, Carter JD, Baraf HS, Evans RR, Wang J, King-Davis S, Weinstein SP.(PubMed)
(3) The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout by Stewart S1, Dalbeth N2, McNair P3, Parmar P4, Gow P5, Rome K3.(PubMed)
(4) Tophi as first clinical sign of gout by Thissen CA1, Frank J, Lucker GP.(PubMed)
(5) Symptoms of gout(NHS choice)
(6) [Fever and back pain--a case report of spinal gout].[Article in German] by Schorn C1, Behr C, Schwarting A.(PubMed)
(7) [Hyperuricemia and gout; the role of diet].[Article in Spanish]by Álvarez-Lario B1, Alonso-Valdivielso JL2.(PubMed)
(8) A perspective on diet and gout by Kedar E1, Simkin PA.(PubMed)
(9) Hyperuricemia, gout, and related comorbidities: cause and effect on a two-way street by Karis E1, Crittenden DB1, Pillinger MH1.(PubMed)
(10) Risk factors for gout and prevention: a systematic review of the literature by Singh JA1, Reddy SG, Kundukulam J.(PubMed)
(11) Chronic kidney disease in gout in a managed care setting by Fuldeore MJ1, Riedel AA, Zarotsky V, Pandya BJ, Dabbous O, Krishnan E.(PubMed)
(12) Diuretic Use, Increased Serum Urate and the Risk of Incident Gout in a Population-based Study of Hypertensive Adults: the Atherosclerosis Risk in the Communities Cohort by Mara A. McAdams DeMarco, MS, PhD,1 Janet W. Maynard, MD, MHS,2 Alan N. Baer, MD,2 Allan C. Gelber, MD, MPH, PhD,1,2 J. Hunter Young, MD, MHS,1,3 Alvaro Alonso, MD, MPH, PhD,4 and Josef Coresh, MD, PhD1,3(PMC)
(13) Global epidemiology of gout: prevalence, incidence and risk factors by Kuo CF1, Grainge MJ2, Zhang W3, Doherty M3.(PubMed)
(14) Gout: a review of nonmodifiable and modifiable risk factors by MacFarlane LA1, Kim SC2.(PubMed)
(15) The Toll-Like Receptor 4 (TLR4) Variant rs2149356 and Risk of Gout in European and Polynesian Sample Sets by Rasheed H1,2, McKinney C1, Stamp LK3, Dalbeth N4, Topless RK1, Day R5,6, Kannangara D5,6, Williams K5,6, Smith M7, Janssen M8, Jansen TL9, Joosten LA10, Radstake TR11, Riches PL12, Tausche AK13, Lioté F14,15, Lu L16, Stahl EA17, Choi HK16, So A18, Merriman TR1.(PubMed)
(16) Genetics of gout by Choi HK1, Zhu Y, Mount DB.(PubMed)
(17) ABCG2/BCRP dysfunction as a major cause of gout by Matsuo H1, Takada T, Ichida K, Nakamura T, Nakayama A, Suzuki H, Hosoya T, Shinomiya N(PubMed)
(18) Juvenile gout in Taiwan associated with family history and overweight by Chen SY1, Shen ML.(PubMed)
(19) Clinical features of familial gout and effects of probable genetic association between gout and its related disorders by Chen SY1, Chen CL, Shen ML, Kamatani N.(PubMed)
(20) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study by Choi HK1, Atkinson K, Karlson EW, Curhan G.(PubMed)
(21) Hyperuricaemia and gout by Shipley M1.(PubMed)
(22) Menopause, postmenopausal hormone use and risk of incident gout by Hak AE1, Curhan GC, Grodstein F, Choi HK.(PubMed)
(23) The effect of bariatric surgery on gout: a comparative study by Romero-Talamás H1, Daigle CR1, Aminian A1, Corcelles R1, Brethauer SA1, Schauer PR2.(PubMed)
(24) Development of acute gouty attack in the morbidly obese population after bariatric surgery by Antozzi P1, Soto F, Arias F, Carrodeguas L, Ropos T, Zundel N, Szomstein S, Rosenthal R.(PubMed)
(25) Monoarticular gout following trauma: MR appearance by Ruiz ME1, Erickson SJ, Carrera GF, Hanel DP, Smith MD.(PubMed)
(29) The effect of hydro-alcoholic celery (Apiumgraveolens) leaf extract on cardiovascular parameters and lipid profile in animal model of hypertension induced by fructose by Dianat M1, Veisi A1, Ahangarpour A1, Fathi Moghaddam H1.(PubMed)
(30) Flavonoids from fruit and vegetables: a focus on cardiovascular risk factors by Toh JY1, Tan VM, Lim PC, Lim ST, Chong MF.(PubMed)
(31) Decaffeinated green tea extract improves hypertension and insulin resistance in a rat model of metabolic syndrome by Ihm SH1, Jang SW, Kim OR, Chang K, Oak MH, Lee JO, Lim DY, Kim JH.(PubMed)
(36) Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients. by Stockler-Pinto MB1, Mafra D, Moraes C, Lobo J, Boaventura GT, Farage NE, Silva WS, Cozzolino SF, Malm O.(PubMed)
(39) Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients by Johnson DW1, van Eps C, Mudge DW, Wiggins KJ, Armstrong K, Hawley CM, Campbell SB, Isbel NM, Nimmo GR, Gibbs H.(PubMed)
(47) Fruit and vegetable consumption and hypertriglyceridemia: Korean National Health and Nutrition Examination Surveys (KNHANES) 2007-2009 by Yuan C1,2, Lee HJ3, Shin HJ1,4, Stampfer MJ1,2,5, Cho E5,6,7.(PubMed)
(48) Severe Hypertriglyceridemia in Glut1D on Ketogenic Diet by Klepper J1, Leiendecker B2, Heussinger N1, Lausch E3, Bosch F4.(PubMed)
(49) The modulating effect of Persea americana fruit extract on the level of expression of fatty acid synthase complex, lipoprotein lipase, fibroblast growth factor-21 and leptin--A biochemical study in rats subjected to experimentalhyperlipidemia and obesity by Monika P1, Geetha A2.(PubMed)
(50) Effect of Persea americana (avocado) fruit extract on the level of expression of adiponectin and PPAR-γ in rats subjected to experimental hyperlipidemia and obesity by Padmanabhan M, Arumugam G.(PubMed)
(52) Statins and almonds to lower lipoproteins (the STALL Study). by Ruisinger JF1, Gibson CA2, Backes JM3, Smith BK4, Sullivan DK5, Moriarty PM6, Kris-Etherton P7.(PubMed)
(54) Comparative studies on the hypolipidemic and growth suppressive effects of oolong, black, pu-erh, and greentea leaves in rats by Kuo KL1, Weng MS, Chiang CT, Tsai YJ, Lin-Shiau SY, Lin JK.(PubMed)
(57) Lipid abnormalities in Taiwan aborigines with gout by Chou CT1, Chao PM.(PubMed)
(58) A Snack Dietary Pattern Increases the Risk of Hypercholesterolemia in Northern Chinese Adults: A Prospective Cohort Study by Na L1, Han T1, Zhang W1, Wu X1, Na G1, Du S1, Li Y1, Sun C1.(PubMed)
(59) Dietary supplementation contributes to lifestyle improvement in hypercholesterolemic patients in real-life contexts by Bruckert E1, Masana L, Chapman MJ, Descamps O, Bosi E, Allaert FA.(PubMed)
(60) [Studies on association between nonalcoholic fatty liver disease and hyperuricemia: current status and future prospects].[Article in Chinese] by Li YM1.(PubMed)
(61) Comparison of the effect of high fruit and soybean products diet and standard diet interventions on serum uric acid in asymptomatic hyperuricemia adults: an open randomized controlled trial BY Zhang M1, Gao Y2, Wang X1, Liu W3, Zhang Y3, Huang G1.(PubMed)
(62) Major dietary patterns and risk of asymptomatic hyperuricemia in Chinese adults by Zhang M1, Chang H, Gao Y, Wang X, Xu W, Liu D, Li G, Huang G.(PubMed)
(63) Effects of green tea extract on serum uric acid and urate clearance in healthy individuals by Jatuworapruk K1, Srichairatanakool S, Ounjaijean S, Kasitanon N, Wangkaew S, Louthrenoo W.(PubMed)
(64) [Epidemiological study on hyperuricemia and gout in Foshan areas, Guangdong province.][Article in Chinese] by Yu JW1, Yang TG, Diao WX, Cai XQ, Li T, Zhong H, Hu DL, Chen CQ, Chen ZX.(PubMed)
(71) The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults by Iso H1, Date C, Wakai K, Fukui M, Tamakoshi A; JACC Study Group(PubMed)
(79) Blueberry and mulberry juice prevent obesity development in C57BL/6 mice by Wu T1, Tang Q, Gao Z, Yu Z, Song H, Zheng X, Chen W.(PubMed)
(81) Gout and Risk of Myocardial Infarction: A Systematic Review and Meta-Analysis of Cohort Studies by Liu SC1, Xia L2, Zhang J1, Lu XH3, Hu DK1, Zhang HT4, Li HJ5.(PubMed)
(82) Blueberry Anthocyanins-Enriched Extracts Attenuate Cyclophosphamide-Induced Cardiac Injury. by Liu Y1, Tan D2, Shi L1, Liu X1, Zhang Y1, Tong C1, Song D2, Hou M1.(PubMed)
(91) Peripheral Artery Disease: Evolving Role of Exercise, Medical Therapy, and Endovascular Options by Olin JW1, White CJ2, Armstrong EJ3, Kadian-Dodov D4, Hiatt WR5(PubMed)
(92) Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK clinical practice research datalink by Clarson LE1, Hider SL1, Belcher J1, Heneghan C2, Roddy E1, Mallen CD1.(PubMed)
(93) Serum uric acid level and risk for peripheral arterial disease: analysis of data from the multiple risk factor intervention trial by Baker JF1, Schumacher HR, Krishnan E.(PubMed)
(94) Prevalence, risk factors and rheological profile of arterial vascular disease; first results of the Aachen study by Kiesewetter H1, Jung F, Kotitschke G, Nüttgens HP, Witt R, Winkelhog C, Ladwig KH, Waterloh E, Roebruck P, Schneider R, et al.(PubMed)
(95) Increased airway inflammation in patients with psoriasis by Damiani G1, Radaeli A2, Olivini A2, Calvara-Pinton P3, Malerba M2.(PubMed)
(96) Methotrexate in psoriasis: 26 years' experience with low-dose long-term treatment by Haustein UF1, Rytter M.(PubMed)
(97) Psoriasis, psoriatic arthritis and risk of gout in US men and women by Merola JF1, Wu S2, Han J3, Choi HK4, Qureshi AA5.(PubMed)
(98) Psoriasis and uric acid: a population-based cross-sectional study by Lai YC1, Yew YW2.(PubMed)
(99) Green tea protects against psoralen plus ultraviolet A-induced photochemical damage to skin by Zhao JF1, Zhang YJ, Jin XH, Athar M, Santella RM, Bickers DR, Wang ZY.(PubMed)
(103) Allopurinol for chronic gout by Seth R1, Kydd AS, Buchbinder R, Bombardier C, Edwards CJ.(PubMed)
(104) Uricosuric medications for chronic gout by Kydd AS1, Seth R, Buchbinder R, Edwards CJ, Bombardier C.(PubMed)
(105) Dietary supplements for chronic gout by Andrés M1, Sivera F, Falzon L, Buchbinder R, Carmona L.(PubMed)
(106) Lifestyle interventions for chronic gout by Moi JH1, Sriranganathan MK, Edwards CJ, Buchbinder R.(PubMed)
(107) Minimally invasive surgical treatment for kidney stone disease by Rodríguez D1, Sacco DE2.(PubMed)
(108) Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones responses on a Latin American questionnaire[Article in English, Spanish] by Manzo BO1, Bertacchi M2, Lozada E3, Rasguido A4, Aleman E5, Cabrera M6, Rodríguez A7, Manzo G3, Sánchez H3, Blasco J8.(PubMed)
(109) CARD8 rs2043211 polymorphism is associated with gout in a Chinese male population by Chen Y1, Ren X, Li C, Xing S, Fu Z, Yuan Y, Wang R, Wang Y, Lv W.(PubMed)
(110) The association between renal stone disease and cholesterol gallstones: the easy to believe and not hard to retrieve theory of the metabolic syndrome by Ahmed MH1, Barakat S, Almobarak AO.(PubMed)
(111) Effects of green tea on urinary stone formation: an in vivo and in vitro study by Jeong BC1, Kim BS, Kim JI, Kim HH.(PubMed)
(112) 1,2,3,4,6-Penta-O-galloyl-beta-D-glucose reduces renal crystallization and oxidative stress in a hyperoxaluric rat model by Lee HJ1, Jeong SJ, Lee HJ, Lee EO, Bae H, Lieske JC, Kim SH.(PubMed)
(115) Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study by Dalbeth N1, Aati O1, Kalluru R1, Gamble GD1, Horne A1, Doyle AJ2, McQueen FM3.(PubMed)
(116) Exploratory study of radiographic change in patients with tophaceous gout treated with intensive urate-lowering therapy by Dalbeth N1, Doyle AJ, McQueen FM, Sundy J, Baraf HS.(PubMed)
(117) MDHAQ/RAPID3 to recognize improvement over 2 months in usual care of patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, as well as rheumatoid arthritis by Castrejón I1, Bergman MJ, Pincus T.(PubMed)
(119) Purine-rich foods intake and recurrent gout attacks by Zhang Y1, Chen C, Choi H, Chaisson C, Hunter D, Niu J, Neogi T.(PubMed)
(120) Management of recurrent gout by Robin Fox, GP1(PMC)
(121) Cherry consumption and decreased risk of recurrent gout attacks by Zhang Y1, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi HK.(PubMed)
(126) Urate testing in gout: why, when and how by Dalbeth N1, Winnard D, Gow PJ, Boswell DR, Te Karu L, Lindsay K, Arroll B, Stamp LK.(PubMed)
(127) Tests and diagnosis By Mayo Clinic Staff(127)
(128) Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray by Rettenbacher T1, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W, Herold M.(PubMed)
(129) Is ultrasound changing the way we understand rheumatology? Including ultrasound examination in the classification criteria of polymyalgia rheumatica and gout by Codreanu C1, Enache L2.(PubMed)
(130) Dual-Energy Computed Tomography: Advantages in the Acute Setting by McLaughlin PD1, Mallinson P2, Lourenco P2, Nicolaou S2.(PubMed)
(139) Coffee consumption and risk of incident gout in women: the Nurses' Health Study by Choi HK1, Curhan G.(PubMed)
(140) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2.(PubMed)
(141) The relation of coffee consumption to serum uric Acid in Japanese men and women aged 49-76 years by Pham NM1, Yoshida D, Morita M, Yin G, Toyomura K, Ohnaka K, Takayanagi R, Kono S.(PubMed)
(142) Nocturnal Risk of Gout Attacks by Hyon K. Choi, MD, DrPH,1 Jingbo Niu, MD, DSc,1 Tuhina Neogi, MD, PhD, FRCPC,1 Clara A. Chen, MHS,1 Christine Chaisson, MPH,1 David Hunter, MBBS, PhD,2 and Yuqing Zhang, DSc1(PMC)
(143) Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study by Hunter DJ1, York M, Chaisson CE, Woods R, Niu J, Zhang Y.(PubMed)
(144) Water, Skim Milk Consumption May Improve Gout Control By: AMY ROTHMAN SCHONFELD JANUARY 1, 2010,(Eheumatology News)
(145) Juvenile gout in Taiwan associated with family history and overweight by Chen SY1, Shen ML.(PubMed)
(146) Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study by Lee J1, Lee JY2, Lee JH3, Jung SM4, Suh YS5, Koh JH6, Kwok SK7, Ju JH8, Park KS9, Park SH10.(PubMed)
(147) Obesity and younger age at gout onset in a community-based cohort by DeMarco MA1, Maynard JW, Huizinga MM, Baer AN, Köttgen A, Gelber AC, Coresh J.(PubMed)
(148) Incident gout in women and association with obesity in the Atherosclerosis Risk in Communities (ARIC) Study by Maynard JW1, McAdams DeMarco MA, Baer AN, Köttgen A, Folsom AR, Coresh J, Gelber AC.(PubMed)
(149) Alcohol intake and risk of incident gout in men: a prospective study by Choi HK1, Atkinson K, Karlson EW, Willett W, Curhan G.(PubMed)
(150) Alcohol intake and risk of incident gout in men: a prospective study by Choi HK1, Atkinson K, Karlson EW, Willett W, Curhan G.(PubMed)
(151) Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study by Neogi T1, Chen C2, Niu J3, Chaisson C2, Hunter DJ4, Zhang Y3.(PubMed)
(152) Purine-rich foods, dairy and protein intake, and the risk of gout in men by Choi HK1, Atkinson K, Karlson EW, Willett W, Curhan G.(PubMed)
(153) Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey by Choi HK1, Liu S, Curhan G.(PubMed)
(154) Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey by Choi JW1, Ford ES, Gao X, Choi HK.(PubMed)
(155) A prescription for lifestyle change in patients with hyperuricemia and gout by Choi HK1.(PubMed)
(156) A prescription for lifestyle change in patients with hyperuricemia and gout by Choi HK1.(PubMed)
(157) Impact of strawberries on human health: insight into marginally discussed bioactive compounds for the Mediterranean diet by Tulipani S1, Mezzetti B, Battino M.(PubMed)
(158) Use of diuretics and risk of incident gout: a population-based case-control study by Bruderer S1, Bodmer M, Jick SS, Meier CR.(PubMed)
(158) Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. by Hunter DJ1, York M, Chaisson CE, Woods R, Niu J, Zhang Y.(PubMed)
(159) Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men by Paul T Williams(PubMed)
(160) How to Exercise If You Have Gout by Sequoia
(162) Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised, double-blinded, placebo-controlled, cross-over trial by Shi Y1, Williamson G1.(PubMed)
(171) Novel insights into the inhibitory mechanism of kaempferol on xanthine oxidase by Wang Y1, Zhang G, Pan J, Gong D.(PubMed)
(173) Discovery of xanthine oxidase inhibitors and/or α-glucosidase inhibitors by carboxyalkyl derivatization based on the flavonoid of apigenin by Su ZR1, Fan SY1, Shi WG1, Zhong BH2.(PubMed)
(174) Olea europaea leaf (Ph.Eur.) extract as well as several of its isolated phenolics inhibit the gout-related enzyme xanthine oxidase by Flemmig J1, Kuchta K, Arnhold J, Rauwald HW.(PubMed)
(175) Independent association of serum retinol and β-carotene levels with hyperuricemia: A national population study by Choi WJ1, Ford ES, Curhan G, Rankin JI, Choi HK(PubMed)
(176) Associations between concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States by Ford ES1, Choi HK.(PubMed)
(177) Gout and vitamin A intoxication: is there a connection? by Mawson AR1, Onor GI.(PubMed)
(178) Dietary supplements for chronic gout by Andrés M1, Sivera F, Falzon L, Buchbinder R, Carmona L.(PubMed)
(179) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2.(PubMed)
(180) Epidemiology of gout by Roddy E1, Choi HK2.(PubMed)
(181) Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial by Stamp LK1, O'Donnell JL, Frampton C, Drake JM, Zhang M, Chapman PT.(PubMed)
(182) Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials by Juraschek SP1, Miller ER 3rd, Gelber AC.(PubMed)
(182) Polymorphisms in the vitamin D receptor and risk of gout in Chinese Han male population by Liu SG1, Li YY, Sun RX, Wang JL, Li XD, Han L, Chu N, Li CG.(PubMed)
(183) Serum vitamin D and C-reactive protein levels are independently associated with diastolic dysfunction by Akin F1, Ayça B, Köse N, Celik O, Yilmaz Y, Akin MN, Arinc H, Ozkok A, Covic A, Kanbay M.(PubMed)
(184) Decreased serum concentrations of 1,25(OH)2-vitamin D3 in patients with gout by Takahashi S1, Yamamoto T, Moriwaki Y, Tsutsumi Z, Yamakita J, Higashino K.(PubMed)
(185) Dietary risk factors for rheumatic diseases by Choi HK1.(PubMed)
(187) Alliin, a garlic (Allium sativum) compound, prevents LPS-induced inflammation in 3T3-L1 adipocytes by Quintero-Fabián S1, Ortuño-Sahagún D2, Vázquez-Carrera M3, López-Roa RI4.(PubMed)
(188) Aged Garlic Extract Modifies Human Immunity by Percival SS1.(PubMed)
(189) Inflammation: a possible mechanism for a causative role of hyperuricemia/gout in cardiovascular disease by Perez-Ruiz F1, Becker MA2.(PubMed)
(190) Detrimental role of hyperuricemia on the cardio-reno-vascular system by Stack A1, Manolis AJ2, Ritz E3.(PubMed)
(193) Study on the anti-gout activity of chlorogenic acid: improvement on hyperuricemia and gouty inflammation by Meng ZQ1, Tang ZH, Yan YX, Guo CR, Cao L, Ding G, Huang WZ, Wang ZZ, Wang KD, Xiao W, Yang ZL.(PubMed)
(197) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2(PubMed)
(198) Effects of green tea extract on serum uric acid and urate clearance in healthy individuals by Jatuworapruk K1, Srichairatanakool S, Ounjaijean S, Kasitanon N, Wangkaew S, Louthrenoo W.(PubMed)
(199) [Multiple actions of EGCG, the main component of green tea].[Article in French] by L'Allemain G1.(PubMed)
(200) Consuming Lentinula edodes (Shiitake) Mushrooms Daily Improves Human Immunity: A Randomized Dietary Intervention in Healthy Young Adults by Dai X1, Stanilka JM1, Rowe CA1, Esteves EA2, Nieves C Jr1, Spaiser SJ1, Christman MC3, Langkamp-Henken B1, Percival SS1.(PubMed)
(201) The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis by Urano W1, Yamanaka H, Tsutani H, Nakajima H, Matsuda Y, Taniguchi A, Hara M, Kamatani N.(PubMed)
(202) Interleukin-6 (IL-6) in synovial fluid and serum of patients with rheumatic diseases by Swaak AJ1, van Rooyen A, Nieuwenhuis E, Aarden LA.(PubMed)
(203) Garlic and onion attenuates vascular inflammation and oxidative stress in fructose-fed rats by Vazquez-Prieto MA1, Rodriguez Lanzi C, Lembo C, Galmarini CR, Miatello RM.(PubMed)
(204) Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised, double-blinded, placebo-controlled, cross-over trial by Shi Y1, Williamson G1.(PubMed)
(206) Trikatu, a herbal compound that suppresses monosodium urate crystal-induced inflammation in rats, an experimental model for acute gouty arthritis by Murunikkara V1, Rasool M.(PubMed)
(209) Effects of green tea extract on serum uric acid and urate clearance in healthy individuals by Jatuworapruk K1, Srichairatanakool S, Ounjaijean S, Kasitanon N, Wangkaew S, Louthrenoo W.(PubMed)
(210) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2.(PubMed)
(211) Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey by Choi HK1, Curhan G.(PubMed)
(212) Effects of coffee consumption on serum uric acid: systematic review and meta-analysis by Park KY1, Kim HJ2, Ahn HS2, Kim SH1, Park EJ1, Yim SY3, Jun JB4.(PubMed)
(213) The relation of coffee consumption to serum uric Acid in Japanese men and women aged 49-76 years by Pham NM1, Yoshida D, Morita M, Yin G, Toyomura K, Ohnaka K, Takayanagi R, Kono S.(PubMed)
(214) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2.(PubMed)
(219) Monosodium urate crystals in inflammation and immunity by Shi Y1, Mucsi AD, Ng G.(PubMed)
(224) Altered serum selenium and uric acid levels and dyslipidemia in hemodialysis patients could be associated with enhanced cardiovascular risk by Martí del Moral L1, Agil A, Navarro-Alarcón M, López-Ga de la Serrana H, Palomares-Bayo M, Oliveras-López MJ.(PubMed)
(225) Urinary nitrite/nitrate concentrations and total antioxidant capacity in patients with chronic hepatitis C in therapy with interferon and ribavirin by Stanzial AM1, Benoni G, Cuzzolin L, Gabrielli GB, Pasino M, Perfetti P, Corrocher R.(PubMed)
(226) Differences in zinc status between patients with osteoarthritis and osteoporosis by Ovesen J1, Møller-Madsen B, Nielsen PT, Christensen PH, Simonsen O, Hoeck HC, Laursen MB, Thomsen JS.(PubMed)
(227) Zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance by El Dib R1, Gameiro OL, Ogata MS, Módolo NS, Braz LG, Jorge EC, do Nascimento P Jr, Beletate V.(PubMed)
(228) Zinc supplementation for the prevention of type 2 diabetes mellitus by Beletate V1, El Dib RP, Atallah AN.(PubMed)
(229) Comparison of nutrient intake and diet quality between hyperuricemia subjects and controls in Korea by Ryu KA1, Kang HH1, Kim SY1, Yoo MK1, Kim JS2, Lee CH3, Wie GA1.(PubMed)
(230) Cross-sectional analysis of nutrition and serum uric acid in two Caucasian cohorts: the AusDiab Study and the Tromsø study by Zykova SN1, Storhaug HM2, Toft I3,4, Chadban SJ5,6, Jenssen TG7,8, White SL9.(PubMed)
(231) Anthropometry, lipid- and vitamin status of 215 health-conscious Thai elderly by Pongpaew P1, Tungtrongchitr R, Lertchavanakul A, Vudhivai N, Supawan V, Vudhikes S, Prayurahong B, Tawprasert S, Kwanbunjan K, Migasena P, et al.(PubMed)
(232) Nutritional assessment, health markers and lipoprotein profile in postmenopausal women belonging to a closed community by Sánchez-Muniz FJ1, Carbajal A, Ródenas S, Méndez MT, Bastida S, Raposo R, Ruiz T.(PubMed)
(252 Effects of adrenocorticotropic hormone (ACTH) in gout(Research Gate)
(253) ACTH as first line treatment for acute gout in 181 hospitalized patients by Daoussis D1, Antonopoulos I, Yiannopoulos G, Andonopoulos AP.(PubMed)
(254) Update on the management of hyperuricemia and gout by Pillinger MH1, Keenan RT.(PubMed)
(255) ACTH therapy in infantile spasms: side effects by R Riikonen and M Donner(PMC)
(256) Sustained efficacy of a single intra-articular dose of FX006 in a rat model of repeated localized knee arthritis by Kumar A1, Bendele AM2, Blanks RC3, Bodick N4.(PubMed)
(257) Intra-articular glucocorticoids for acute gout by Wechalekar MD1, Vinik O, Schlesinger N, Buchbinder R.(PubMed)
(258) Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe? by David W. Kruse(PMC)
(259) Flavonoids of Cynara scolymus possess potent xanthinoxidase inhibitory activity in vitro but are devoid of hypouricemic effects in rats after oral application by Sarawek S1, Feistel B, Pischel I, Butterweck V.(PubMed)
(260) Learning to eat vegetables in early life: the role of timing, age and individual eating traits by Caton SJ1, Blundell P2, Ahern SM2, Nekitsing C2, Olsen A3, Møller P3, Hausner H3, Remy E4, Nicklaus S4, Chabanet C4, Issanchou S4, Hetherington MM2.(PubMed)
(261) Identification of a potent xanthine oxidase inhibitor from oxidation of caffeic acid by Masuda T1, Shingai Y2, Takahashi C2, Inai M2, Miura Y2, Honda S2, Masuda A3.(PubMed)
(262) Structure-activity relationship of caffeic acid analogues on xanthine oxidase inhibition by Chan WS1, Wen PC, Chiang HC.(PubMed)
(263) Discovery of xanthine oxidase inhibitors and/or α-glucosidase inhibitors by carboxyalkyl derivatization based on the flavonoid of apigenin by Su ZR1, Fan SY1, Shi WG1, Zhong BH2.(PubMed)
(264) #Healthy #Foods - Green tea - Leaves of Camellia sinensis by Kyle J. Norton
(265) Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised, double-blinded, placebo-controlled, cross-over trial by Shi Y1, Williamson G1.(PubMed)
(266) The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout by Towiwat P1, Li ZG2.(PubMed)
(268) Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised, double-blinded, placebo-controlled, cross-over trial by Shi Y1, Williamson G1.(PubMed)
(269) Effects of green tea extract on serum uric acid and urate clearance in healthy individuals. by Jatuworapruk K1, Srichairatanakool S, Ounjaijean S, Kasitanon N, Wangkaew S, Louthrenoo W.(PubMed)
(270) Alfalfa For Gout, Updated on August 24, 2012(Treat and prevent gout with Alfalfa Tablets)
(275) Analgesic, antiinflammatory and antidiabetic properties of Harpagophytum procumbens DC (Pedaliaceae) secondary root aqueous extract by Mahomed IM1, Ojewole JA.(PubMed)
(276) Anti-inflammatory effect of Ajuga bracteosa Wall Ex Benth. mediated through cyclooxygenase (COX) inhibition by Gautam R1, Jachak SM, Saklani A.(PubMed)
(277) New and known iridoid- and phenylethanoid glycosides from Harpagophytum procumbens and their in vitro inhibition of human leukocyte elastase by Boje K1, Lechtenberg M, Nahrstedt A.(PubMed)
(278) Hypouricemic effects of phenylpropanoid glycosides acteoside of Scrophularia ningpoensis on serum uric acid levels in potassium oxonate-pretreated Mice by Huang CG1, Shang YJ, Zhang J, Zhang JR, Li WJ, Jiao BH.(PubMed)
(279) Hypouricemic effects of anthocyanin extracts of purple sweet potato on potassium oxonate-induced hyperuricemia in mice by Hwa KS1, Chung DM, Chung YC, Chun HK.(PubMed)