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Purine-rich foods intake and recurrent gout attacksAnn Rheum Dis 2012;71:1448–1453
Tuesday, 19th Februari 2013Ferdy Ferdian, dr
Amaylia Oehadian, dr., SpPD-KHOM
Background• Gout is a common and excruciatingly painful
inflammatory arthritis caused by monosodium crystal deposition
• Purine intake is associated with hyperuricaemia and an increased risk of incident gout
• no study to date has examined whether purine-rich food intake triggers recurrent gout attacks over a short period of time
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Background• This study try to examine and quantify the
relation between purine intake and the risk of recurrent gout attacks among gout patients
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Background• What is Gout?• Gout is a metabolic disorder characterized by
elevated serum uric acid levels and deposits of urate crystals in synovial fluids and surrounding tissues
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
increased purine synthesis, decreased
renal excretion
A high dietary intake of purine, alcohol intake
Increase uric acid in the blood (hyperuricemia)
Deposition of uric acid into the joints
GOUT
Background
Background• Who Is Likely To Develop Gout?• Genetic• Gender and age• Obesity• Alcohol• Purine rich diet• Medication (Diuretics, Salicilate, Cyclosporin, etc)
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Methods• Online Case-Crossover Study• To be eligible for the study, a subject – had to report gout diagnosed by a physician– have had a gout attack within the past 12 months– be at least 18 years of age– reside in the USA– provide informed consent, and – agree to release medical records pertaining to gout
diagnosis and treatment
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Methods• To confirm a diagnosis of gout, they obtained
medical records pertaining to the participant’s gout history and/or a checklist of the features listed in the American College of Rheumatology (ACR) Preliminary Classification Criteria for Gout completed by the subject’s physician
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Methods• The total amount of purine intake over 2
days was divided into quintile groups• They examined the relation of total purine
intake to the risk of recurrent gout attacks using a conditional logistic regression model
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
MethodsQuantiles
Q1 Q2 Q3 Q4 Q5
Quantile are points taken at regular intervals from the cumulative distribution function of a random variable
Baseline
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Baseline
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Result• 1247 recurrent gout attacks• 92% in lower extremity• 90% were treated with colchicine, NSAIDs,
systemic corticosteroids, intra-articular corticosteroid injections or a combination of these medications
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Result• Median amount of purine intake • 2-day control period : 1.66 g
~ 1.4 kg of beef ~ 2.9 kg of spinach
• 2-day hazard period : 2.03 g ~ 1.7 kg of beef ~ 3.6 kg of spinach
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Result
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Result
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
1.42 1.341.77
2.41
1.120.99
1.32 1.39
Discussion• The highest quintile of purine intake, mainly
from animal sources, over a 2-day period increases the risk of recurrent gout attacks almost by five times compared with the lowest quintile of purine intake
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Discussion• Short-term impact of purine from plant sources
on the risk of gout attacks was substantially smaller than that from animal purine sources
• In a large prospective study of incident gout, the long-term, habitual consumption of purine-rich vegetables WAS NOT associated with the risk of incident gout
Discussion• The effect of purine intake on the risk
of recurrent gout attacks persisted across subgroups by sex, age, use of alcohol, diuretics, allopurinol, NSAIDs and colchicine
• Even among allopurinol users acute purine intake can increase the risk of recurrent gout attacks by more than five times.
Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Critical appraisal• No critical appraisal
Thank you
Preliminary criteria for the classification of the acute arthritis of primary gout ACR 1977 01. More than one attack of acute arthritis02. Maximum inflammation developed within 1 day03. Monoarthritis attack04. Redness observed over joints05. First metatarsophalangeal joint painful or swollen06. Unilateral first metatarsophalangeal joint attack07. Unilateral tarsal joint attack08. Tophus (proven or suspected)09. Hyperuricemia10. Asymmetric swelling within a joint on x ray11. Subcortical cysts without erosions on x ray12. Monosodium urate monohydrate microcrystals in joint fluid during attack13. Joint fluid culture negative for organisms during attack
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü T-F. Preliminary criteria for the classification of the acute arthritis of primary goutArthritis Rheum 1977;20:895---900.