Discussion
hepatic inflammation, chronic kidney disease, lipotoxic liver injury, arthritis, pain, hyperuricemia, Huntington’s disease
HYPERURICEMIA, ARTHRITIS, ACUTE GOUT
In this open randomized controlled trial, the baseline characteristics were similar in the two groups. Significant decreasing levels of serum uric acid were found in the treatment group. No significant increase in pain severity or duration was observed in the treatment versus control group.Treatment for GA includes the management of acute gout flares, prevention of recurrent arthritis, and control of hyperuricemia. The first-line medications for acute gout flares are oral colchicine, NSAIDs, and corticosteroids. After the control of acute gout flares is achieved, xanthine oxidase inhibitors and uricosuric agents can be used as ULT. Allopurinol can be used for the initial management of hyperuricemia in patients with chronic kidney disease [Different ULT drugs including allopurinol, febuxostat, pegloticase, benzbromarone, and probenecid significantly lower serum urate levels compared with placebo [Serum CRP levels were also adequately controlled in the two groups. Early intervention using ULT to induce the aggressive control of serum uric acid levels could have achieved early hyperuricemia control but no development of poor control of GA-related pain. The prophylactic effect of acute gout flare treatment may be due to the effect of colchicine and NSAIDs. Continued treatment with low-dose colchicine may inhibit monosodium urate-induced superoxide production by neutrophils in vivo [Probenecid treats GA by inhibiting uric acid reuptake in the renal tubular transporter. Multiple effects on anionic transporters have been observed in probenecid. Therefore, probenecid has biological effects other than its major role as ULT. Probenecid has neuroprotective effects via inhibiting organic anion transporters in Huntington’s disease [Based on a model involving lipotoxic liver injury, the abnormal activation of pannexin 1 can induce hepatic inflammation, while probenecid may inhibit pannexin 1 channels [Overall, the mean pain severity was similar between groups throughout the 15 days of treatment (Fig. Low-dose colchicine (0.5 mg once or twice daily) or low-dose NSAIDs can serve as prophylactic treatment during ULT in GA [The limitations of this study were as follows: first, it enrolled a small number of participants; second, pain was evaluated using VAS scores without serum markers; third, the serum observation time was relatively short; and fourth, intermittent NSAID usage may have introduced bias due to pain control.