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Purine-rich foods intake and   recurrent gout attacks   Ann Rheum Dis 2012;71:1448–1453      Tuesday, 19th Februari 2013  ...
Background • Gout is a common and excruciatingly painful   inflammatory arthritis caused by monosodium   crystal deposition...
Background • This study try to examine and quantify the   relation between purine intake and the risk   of recurrent gout ...
Background • What is Gout? • Gout is a metabolic disorder characterized by   elevated serum uric acid levels and deposits ...
A high dietary intake of purine, alcohol intake                                                      Background           ...
Background •   Who Is Likely To Develop Gout? •   Genetic •   Gender and age •   Obesity •   Alcohol •   Purine rich diet ...
Methods • Online Case-Crossover Study • To be eligible for the study, a subject      –   had to report gout diagnosed by a...
Methods • To confirm a diagnosis of gout, they obtained   medical records pertaining to the   participant’s gout history an...
Methods • The total amount of purine intake over 2   days was divided into quintile groups • They examined the relation of...
MethodsQuantiles    Q1      Q2      Q3     Q4     Q5Quantile are points taken at regular intervalsfrom the cumulative dist...
Baseline           Zhang et al. Purine-rich foods           intake and recurrent gout           attacks. Ann Rheum Dis    ...
Baseline           Zhang et al. Purine-rich foods           intake and recurrent gout           attacks. Ann Rheum Dis    ...
Result • 1247 recurrent gout attacks • 92% in lower extremity • 90% were treated with colchicine, NSAIDs,   systemic corti...
Result • Median amount of purine intake • 2-day control period : 1.66 g      ~ 1.4 kg of beef      ~ 2.9 kg of spinach • 2...
ResultZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
Result                                             2.41                                      1.77                      1.4...
Discussion • The highest quintile of purine intake, mainly   from animal sources, over a 2-day period   increases the risk...
Discussion• Short-term impact of purine from plant sources  on the risk of gout attacks was substantially  smaller than th...
Discussion • The effect of purine intake on the risk   of recurrent gout attacks persisted across   subgroups by sex, age,...
Critical appraisal• No critical appraisal
Thank you
Preliminary criteria for the classification of the acute arthritisof primary gout ACR 197701. More than one attack of acut...
Jurnal gout
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Jurnal gout

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Jurnal gout

  1. 1. Purine-rich foods intake and recurrent gout attacks Ann Rheum Dis 2012;71:1448–1453 Tuesday, 19th Februari 2013 Ferdy Ferdian, dr Amaylia Oehadian, dr., SpPD-KHOM
  2. 2. 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 timeZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  3. 3. Background • This study try to examine and quantify the relation between purine intake and the risk of recurrent gout attacks among gout patientsZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  4. 4. 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 tissuesZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  5. 5. A high dietary intake of purine, alcohol intake Background increased purine synthesis, decreased renal excretion Increase uric acid in the blood (hyperuricemia) Deposition of uric acid into the joints GOUT
  6. 6. 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
  7. 7. 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 treatmentZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  8. 8. 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 physicianZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  9. 9. 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 modelZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  10. 10. MethodsQuantiles Q1 Q2 Q3 Q4 Q5Quantile are points taken at regular intervalsfrom the cumulative distribution functionof a random variable
  11. 11. Baseline Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  12. 12. Baseline Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  13. 13. 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 medicationsZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  14. 14. 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 spinachZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  15. 15. ResultZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  16. 16. Result 2.41 1.77 1.42 1.34 1.32 1.39 1.12 0.99Zhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  17. 17. 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 intakeZhang et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448–1453
  18. 18. 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
  19. 19. 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
  20. 20. Critical appraisal• No critical appraisal
  21. 21. Thank you
  22. 22. Preliminary criteria for the classification of the acute arthritisof primary gout ACR 197701. 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 attackWallace 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.

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