High vegetable consumption and regular exercise are associated with better quality of life in patients with gout

Hyunsue Do,Hyo-Jin Choi,Byoongyong Choi,Chang-Nam Son,Sang-Hyon Kim,You-Jung Ha,김지현,Min Jung Kim,Kichul Shin,Hyun-Ok Kim,Ran Song,Sung Won Lee,Joong Kyong Ahn,Seung-Geun Lee,Chang Hoon Lee,Kyeong Min 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.5

Background/Aims: The Gout Impact Scale (GIS), a part of the Gout Assessment Questionnaire 2.0, is used to measure gout-specific health-related quality of life (HRQOL). Although several studies have been conducted on the factors affecting the HRQOL of patients with gout, few have focused on lifestyle factors. This study aimed to investigate the correlation between lifestyle habits and HRQOL using the GIS in patients with gout. Methods: We used data from the Urate-Lowering TheRApy in Gout (ULTRA) registry, a prospective cohort of Korean patients with gout treated at multiple centers nationwide. The patients were aged ≥18 years and met the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria. They were asked to complete a GIS and questions regarding their lifestyle habits at enrollment. Results: The study included 232 patients. ‘Gout concern overall’ scores in the GIS were significantly lower in patients who exercised more frequently and consumed soft drinks and meat less, and ‘well-being during attack’ scores were significantly lower in patients who consumed vegetables and exercised more frequently. The frequency of vegetable consumption had a negative linear relationship with the ‘well-being during attack’ and ‘gout concern during attack’ scores (p = 0.01, p = 0.001, respectively). The frequency of exercise had a negative linear relationship with the ‘gout concern overall’ and ‘gout concern during attack’ scores (p = 0.04 and p = 0.002, respectively). Conclusions: Patients with gout who frequently consumed vegetables and exercised regularly experienced less impact of gout, exhibiting a better GIS that represented HRQOL.

Patient Perspectives and Preferences Regarding Gout and Gout Management: Impact on Adherence

Chung Min Kyung,Kim Sung Soo,천윤홍,Hong Seung-Jae,Choi Hyo Jin,Seo Mi Ryoung,Hwang Jiwon,Ahn Joong Kyong,Lee Sang-Heon,Min Hong Ki,Cha Hoon-Suk,이신석,Lee Jennifer,Moon Ki Won,Lee Chang-Keun,Kim Hyun-Ok,Su 대한의학회 2021 Journal of Korean medical science Vol.36 No.32

Background: Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods: A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results: Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits. Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion: Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.

Gout와 통풍(痛風)의 어원 형성과 번역 과정에 관한 의사학적 고찰

조재흥(CHO Jae-Heung),정재영(JUNG Jae Young) 대한의사학회 2015 醫史學 Vol.24 No.2

This study aims to address questions regarding the translation of ‘gout’ into ‘tongfeng (痛風)’ in East Asia. To this end, the formation process of the origins, ‘gout’ from Western medicine and ‘tongfeng’ from Oriental medicine, and the translational process were investigated through the relevant records and literature dating from the 16th century on. Symptoms associated with gout were originally mentioned in ancient Egypt and various terminologies were used to refer to gout, such as podagra, cheiragra and gonogra. The word ‘gout’, which is derived from Latin, was used for the first time in the 13th century. The reason for this linguistic alteration is thought to be the need for a comprehensive term to cover the various terms for gout in symptomatic body parts, since it can occur concurrently in many joints. However, it took hundreds of years before gout was independently established as a medical term. In oriental medicine, terms describing diseases with features similar to gout include bibing (痺病), lijiefeng (歷節風), baihufeng (白虎風) and tongfeng (痛風). Among them, the concept of ‘tongfeng’ has been established since the Jin and Yuan dynasties. The cause, prevention and various treatments for tongfeng were proposed throughout the Ming and Qing dynasties. The early translation of gout and tongfeng in East Asia, respectively, is estimated to have occurred in the 18th century. The first literature translating gout in China was ‘An English and Chinese Vocabulary in the Court Dialect (yinghua yunfu lijie, 英華韻府歷階)’. From the publication of this book until the late 19th century, gout was translated into an unfamiliar Chinese character ‘Jiu feng jiao (酒風脚)’, likely because the translation was done mostly by foreign missionaries at the time, and they created a new word on the basis of Western medicine instead of researching and translating similar diseases in oriental medicine. In Japan, the first book translating gout was ‘A Pocket Dictionary of the English and Japanese Language (Eiwa taiyaku shuchin jisho, 英和??袖珍?書)’, Japan’s the first English-Japanese translation dictionary. In this book, gout was translated into tongfeng, a word adopted from oriental medicine. These differences from China are thought to be caused by Rangaku doctors (蘭方醫), who, influenced by oriental medicine in the Jin and Yuan dynasties, played an important role in translating medical terminology at that time.

한국인 통풍 환자의 진단 및 치료 실태 조사

서영일 ( Young Il Seo ),손경민 ( Kyeong Min Son ),정영옥 ( Young Ok Jung ),김인제 ( In Je Kim ),김경리 ( Kyung Lee Kim ),배영덕 ( Young Deok Bae ),김현아 ( Hyun Ah Kim ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.3

Objective. The prevalence of gout has increased so accurate diagnosis and constant treatment is important in its management. The purpose this study was to examine the current trends in the diagnosis and treatment of gout patients in Korea. Methods. We enrolled patients who were diagnosed as having gout and received treatment in university hospital between 2005 and 2008. From the survey, we assessed and analyzed the patient`s baseline characteristics, clinical aspects of gout attack, medical institution and specialized department in the first gouty attack, medical institution and specialized department where the gout was initially diagnosed, methods of diagnosis, treatment during gout attack, and knowledge about gout in patients. Results. A total of 136 patients were included in this study, out of which 123 (90.4%) were male and the mean age was 55.2 (range 25∼85) years. When patients experienced the first gout attack, the most common medical institution that they attended was a private clinic and the most common specialized department was orthopedics. Medication by oral route was the major method (80.9%) used for the treatment of gout, and the most common medication was a non-steroidal anti-inflammatory drug (NSAID) in 55.9%, allopurinol in 38.2% and colchicine in 20.6% of patients. Many gout patients inappropriately received allopurinol following signs of gout arthritis attack, with little information specifically about gout. Conclusion. In our survey, many gout patients received inadequate medications for the treatment of gout and had little knowledge about the disease. For the adequate treatment of gout, patients and doctors need to be educated sufficiently.

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

Zhichang Zhang,Hanzhi Yang,Zhiwen Xu,Jialun Chi,Quanjun Cui 대한정형외과학회 2024 Clinics in Orthopedic Surgery Vol.16 No.4

Background: Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout. Methods: Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow- up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented. Results: Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients (p < 0.001). Gout patients also showed higher rates of pulmonary embolism (p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection (p < 0.001). There was an increased risk of revision for gout patients up to 90 days (p = 0.003), 1 year (p = 0.027), and 2 years (p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days (p = 0.022) and 1 year (p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission (p < 0.001). Conclusions: Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.

Metabolic syndrome: prevalence and risk factors in Korean gout patients

( Jae Hyun Jung ),( Gwan Gyu Song ),( Jong Dae Ji ),( Young Ho Lee ),( Jae-hoon Kim ),( Young Ho Seo ),( Sung Jae Choi ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4

Background/Aims: We performed this study to investigate associations between metabolic syndrome, chronic kidney disease (CKD), and gout. Methods: We reviewed the medical records of 151 patients with gout at the Department of Rheumatology in Korea University Ansan Hospital. The following measures were examined: waist circumference, blood pressure, alcohol consumption, and levels of triglyceride, high density lipoprotein cholesterol, fasting serum glucose, serum uric acid (SUA), creatinine, insulin, and C-peptide. We assessed metabolic syndrome by the homeostasis model assessment of insulin resistance (HOMA-IR) index and renal function by the Modification of Diet in Renal Disease equation; patients were classified according to World Health Organization Asia-Pacific obesity criteria. Results: The prevalence of metabolic syndrome in gout patients (50.8%) was higher than in non-gout patients. The mean SUA level was significantly higher in gout patients with metabolic syndrome (9.13 ± 3.15 mg/dL) than in gout patients without metabolic syndrome (8.14 ± 2.07 mg/dL). The mean SUA level was also significantly higher in patients with gout and CKD (9.55 ± 2.86 mg/dL) than in patients with gout but no CKD (7.74 ± 2.27 mg/dL). In gout patients, HOMA-IR was positively correlated with waist circumference (r = 0.409, p = 0.001). Conclusions: The prevalence of metabolic syndrome in patients with gout was 50.8%, which is higher than the prevalence in the general Korean population. Hyperuricemia in gout patients was correlated with metabolic syndrome and CKD. Insulin resistance may provide clues to better understand the relationship between metabolic syndrome, CKD, and gout.

Dual Energy CT를 이용한 통풍 검사의 유용성과 요산결절로 오인될 수 있는 artifact에 대한 고찰

한영길(Young Gil Han),부재철(Jae Cheol Boo),김도윤(Do Yun Kim),임근교(Geun Gyo Im),김순배(Soon Bae Kim) 대한CT영상기술학회 2012 대한CT영상기술학회지 Vol.14 No.1

I. Objective The objective of the study is to examine the usefulness of a dual energy CT which uses two different types of energy to differentiate the soft tissue and bones on the urate crystal of the goat in diagnosing gouts. II. Subjects and Method From April 13th, 2011 to August 16th, 2011, a dual energy foot CT was conducted on 44 of the in-patients who were diagnosed or suspected of the gout. Scan data were reconstructed using 3D-workstation (LEONARDO)’ s gout software and then, two specialists from the diagnostic imaging department assessed whether the artifacts are either the urate crystal or those that may be mistaken for one. The patients included 30 patients whose gout diagnosis were confirmed by other medical opinions her than CT test (male: 27, female 3, average age: 53.3, range: 19~76) and 14 patients who were confirmed negative for gout (male: 11, female: 3, average age: 50.7, range: 28~68) and the diagnostic result on the gout and the presence of urate crystal by a dual energy CT were compared for analysis. III. Results Urate cystal was observed in 27 patients out of 30 whose gout diagnosis were confirmed and it was not observed in three patients. 14 out of 14 patients, who did not have gout, did now show urate crystal in all cases. Based on the confirmed diagnosis, 30 gout patients showed 90% sensitivity to the dual energy CT test and 14 patients who were confirmed negative for gout showed 100% specificity. Furthermore, the false positive rate was found to be 0%, the false negative rate, 10% and the accuracy rate 93%. The evaluation results on the artifact that could be mistaken for urate crystal indicated that the artifacts were observed in the thick skin of 19 patients and toe nail parts of 15 patients among 30 patients with confirmed gout. Among 14 patients who did not have gout, artifacts were observed in the thick skin of seven patients and the toe nail part of four patients. IV. Conclusion The findings from the study indicated that the dual energy CT showed a high accuracy in assessing the urate crystal of the gout. However, because the artifacts which could be mistaken for urate crystal in the thick skin and toil nail area in some patients were found, more thorough observation and consideration on diagnosing the urate cystal would be required. Despite this, a dual energy gout CT has high sensitivity and accuracy and it can even determine the location and the volume of urate crystal which were not accurately determined. Thus, a dual energy gout CT will be helpful in assessing the degree of calcification, location and the progress in the treatment of urate crystal for the gout patients who requires the continuous treatment and follow-ups. 목적 서로 다른 두 게의 에너지를 사용하여 통풍에 대한 요산결절을 연부조직 및 뼈와 구분하여 나타내는 특성을 이용한 dual energy CT의 통풍 검사에 대한 유용성과 진단에 있어서 통풍 결절로 오인될 수 있는 artifact에 대해서 알아보고자 한다. 대상 및 방법 2011년 4월 13일부터 2011년 8월 16일까지 내원 환자 중 통풍을 진단받았거나 통풍이 의심되는 환자 44명을 대상으로 dual energy foot CT검사를 시행하였다. Scan data는 3D-workstation(LEONARDO)의 gout software를 이용하여 재구성한 후 영상의학과 전문의 2명이 요산결절 및 요산결절로 오인될 수 있는 artifact의 여부를 평가하였다. 대상 환자들은 CT검사를 제외한 다른 임상 소견들을 통해 통풍으로 확진된 환자 30명(남자: 27명, 여자 3명, 평균연령: 53.3세, 범위: 19~76세)과 통풍이 아니라고 확진된 환자 14명(남자: 11명, 여자: 3명, 평균연령: 50.7세, 범위: 28~68세)으로 구분하여 통풍에 대한 진단결과와 dual energy CT의 요산결절 여부를 비교 평가하였다. 결과 통풍으로 확진을 받은 환자 30명 중 27명에서 요산결절이 발견되었으며 3명에서는 발견되지 않았고 통풍이 아닌 환자 14명 중 14명 모두에게서 요산결절이 발견되지 않았다. 확진을 근거로 통풍환자 30명에 대한 dual energy CT검사의 민감도는 90%, 통풍이 아닌 환자 14명에 대한 특이도는 100%였다. 그리고 위양성발생률은 0%, 위음성발생률은 10%였고 정확도는 93%로 나타났다. 요산결절로 오인될 수 있는 artifact의 평가 결과는 통풍환자 30명 중 19명 환자의 thick skin과 15명의 toe nail부분에서 artifact가 보였고 통풍이 아닌 환자에서도 14명 중 7명의 thick skin과 4명의 toe nail 부분에서 artifact가 관찰되었다. 결론 본 연구결과 dual energy CT는 통풍에 대한 요산결절의 침착 여부를 평가하는데 높은 정확성을 보였다. 그러나 일부의 환자에게서 발바닥의 굳은살과 발톱부위에 요산결절로 오인될 수 있는 artifact가 발생됨에 따라 요산결절을 진단함에 있어 보다 세심한 관찰과 판단이 요구된다. 그럼에도 불구하고 dual energy gout CT는 높은 민감도와 정확도를 가지며 기존에는 정확하게 알 수 없었던 요산결절의 위치와 부피까지도 파악할 수 있었다. 따라서 지속적인 치료와 follow-up이 요구되는 통풍 환자에게 dual energy gout CT는 요산결절의 침착 정도와 위치, 치료의 경과를 평가하는데 있어서 유용한 도움을 줄 수 있을 것이라 사료된다.

Auricular Tophi Presenting as a Unilateral Auricular Mass Lesion

Myung-Whan Suh,Jae-Wook Lee,명나혜,Jeong-Hyun Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Tophus due to gout is most commonly found in the toes and ankles, but can also be found in the auricle. Although small nodules on the helix are sometimes found in gout patients, a large mass lesion on the back side of the auricle is rare. We report a patient who visited the otology clinic due to an auricular mass lesion, which was diagnosed as a large auricular tophus. A 17- year-old male patient who suffered from gout complained of a right side auricular mass. A 3 cm sized solid mass lesion was detected on the back side of the right canvum conchal cartilage. The mass was soft, non-tender, and well-circumscribed. The lesion was first found 1-2 years earlier. The size of the lesion had been slowly increasing, but had recently stopped growing. The mass was surgically removed for pathologic confirmation and cosmetic reasons. Specimens were composed of 2 irregularly shaped pieces of soft-gray tan and yellowish tissue. The upper larger tophus was attached to the cartilage and the lower smaller tophus was embedded inside the auricular cartilage. Pathologic findings suggested tophus with amorphous deposits and subepithelial tissue. Introduction Gout is a disease in which uric acid crystals are deposited in the body due to a high level of uric acid in the blood. Sometimes it was called as the king's disease, because it was usually found in rich and obese people; however, due to high-nutrition diets, gout is now frequently diagnosed in middle-aged men.1) Also, rapid aging is presumed to be a precipitating factor for the recent high incidence of gout, and the incidence of gout in the head and neck region is presumed to increase in the future due to similar reasons.1)Gout tophi are the end product of long standing high blood uric acid levels. The incidence of tophi is positively correlated with the level of blood uric acid and the duration of gout. The saturating concentration of uric acid in blood at normal body temperature is -7 mg/dL, and if the blood uric acid level is higher than this level, uric acid crystals start to precipitate in the body. It takes -10 years for a gout patient to experience tophi formation. The early stages of gout usually present as an single joint arthritis, but after 20 years, gout tophi can be found in multiple parts of the body in 25% of the patients.2) The most common sites of tophi formation are the fingers, toes, ankles, and knees. However, there are not many reports of a tophus being formed on the auricle and middle ear.4) Auricular tophus can usually be found around the helix, presenting as multiple small nodules. Because they are not related to loss of ear function, both patients and clinicians are not very interested in this condition and tend to ignore it. However, a large auricle mass must be differentiated from other tumorous conditions including malignancy. In this article, we report a patent who had a 3 cm sized mass on the back side of the auricle. We completely removed the mass for pathologic evaluation and it was diagnosed as a large tophus of the auricle. A detailed description of the patient and a review of literature are provided. Case Report A 17-year-old male visited the otologic clinic due to an auricular mass on the right side, which was first detected 1-2 years earlier. The mass was initially small, but tended to grow progressively larger, and had recently stopped growing. The mass was soft, non-tender, well-circumscribed, and was -3 cm in size. It was located on the posterior side of the auricle, was oval shaped, and longer in the vertical direction. The mass was fixed to the auricular cartilage. It was completely covered with normal looking healthy skin and there was no pain or tenderness. It was presumed that the mass was composed of 2 parts; an upper, larger (2 cm) mass and a lower, smaller (1 cm) mass (Fig. 1). The patient had no history of auricular injury. He had been diagnosed as gout at our hospital rheumatology clinic 5 years earlier and was currently taking medication for gout. He also had a history of surgical debridement with lavage of the metatarsophalangeal joint due to toe tophus. His blood uric acid level was 17.2 mg/dL, but after strict diet control, it had recently decreased to 10.0 mg/dL. We counseled the patient on the advantages and disadvantages of surgical removal of the auricular mass. After careful consideration, an excisional biopsy under local anesthesia was planned for cosmetic and diagnostic purposes. A 4 cm sized skin incision was made on the posterior surface of the auricle. The skin flap was elevated from a lateral to medial direction and the mass was dissected from the skin flap without difficulty. The solid, yellowish, and hard mass was composed of 2 separate parts. The upper mass was larger and was attached to the posterior surface of the auricular cartilage (Fig. 2). The upper mass was completely removed and a small portion of the normal auricular cartilage was also removed due to severe adhesion. The lower mass, which was smaller, was buried inside the auricular cartilage. The cartilage covering the posterior portion of the mass was removed toge...

Trends of Gout Prevalence in South Korea Based on Medical Utilization: A National Health Insurance Service Database (2002∼2015)

Jin Su Park,Minjin Kang,송정수,Hyun Sun Lim,Chan Hee Lee 대한류마티스학회 2020 대한류마티스학회지 Vol.27 No.3

Objective. Although gout is the most common form of inflammatory arthritis, data on gout prevalence and management are sparse, especially in Korean populations. This study reevaluated the most recent prevalence and incidence of gout values in Korean people to update the findings from our previous study in 2011. Methods. We used the National Health Insurance Service-National Health Information Database (NHIS-NHID) to identify patients diagnosed with gout in South Korea during 2002∼2015. We selected patients with gout as principal diagnosis or 1st∼4th additional diagnosis. Results. The prevalence of gout increased 5.17-fold, from 0.39% in 2002 to 2.01% in 2015. This increase occurred in all age groups, but was stronger in those aged 80 years or older, with a 13.1-fold increase from 2002 to 2015. The prevalence of gout increased in all regions of South Korea. The prevalence of the disease was also related to income levels: in 2015, medical insurance subscribers with the highest income were twice more likely to have gout than those in the lowest income bracket. By contrast, the prevalence of gout in medical benefit recipients was 5.58- and 5.25-times higher than that of the general population and of those in the highest income bracket, respectively. Conclusion. The prevalence of gout has increased rapidly, although the degree of increase varied according to sex, age, region, and income group. This study sheds some light on the current prevalence of gout among national insurance subscribers in Korea, and will help educate patients and medical staff on the management of gout.

정상인과 통풍 환자의 Hypoxanthine-Guanine Phosphoribosyltransferase 활성도 비교

이찬희 ( Chan Hee Lee ),안홍준 ( Hong Joon Ahn ),이지환 ( Ji Hwan Rhee ),박소진 ( So Jin Park ),윤보영 ( Bo Young Yoon ),한성훈 ( Seong Hoon Han ),이백락 ( Baek Rak Lee ),이윤우 ( Yun Woo Lee ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.2

Objective: It has been known that the enzyme deficiency associated with uric acid production is the minor cause of gout. The purpose of this study is to evaluate the role of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) activity deficiency in the development of gout. Methods: Assay of HGPRT activity was performed on 38 gout patients and 107 controls compromising 82 men and 25 women. In the patients with gout, age of onset, sex, family history of gout, duration of disease, serum uric acid level, and uric acid concentration of 24-hour urine were analyzed. Results: In gout patients and control male group, the HGPRT activity was lowest in the age of forties. But, in female, there was no decreasing tendency with aging. In 4 gout patients, HGPRT activities were severely deficient and their ages of onset were less than 30 years old, and all have a family history of gout. Conclusion: In men, the lowest HGPRT activity in the age of forties could be one of the factors that make the onset of gout is highest in the fifth decade of age. The deficiency of HGPRT enzyme and family history of gout are the important factors in the pathogenesis of early onset gout.