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Gout and Hyperuricemia


  1. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–3141.
  2. Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988–1994. Am J Kidney Dis 2002;40:37–42.
  3. Richette P, Bardin T. Gout. Lancet 2010; 375:318–28.
  4. Choi HK, Mount DB, Reginato AM, American College of Physicians, American Physiological Society. Pathogenesis of gout. Ann Intern Med. 2005;143(7):499–516.
  5. Enomoto, A. et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature 2002;417, 447–452.
  6. Glantzounis GK, Tsimoyiannis EC, Kappas AM, et al. Uric acid and oxidative stress. Curr Pharm Des. 2005;11(32):4145-51.
  7. Alvarez-Lario B, Macarrón-Vicente J. Is there anything good in uric acid? QJM. 2011.
  8. Hediger, M. A. New view at C. Nature Med. 8, 445–446 (2002).
  9. Roch-Ramel, F. & Guisan, B. News Physiol. Sci. 14, 80–84 (1999).
  10. Keizman D, Ish-Shalom M, Berliner S, Maimon N, Vered Y, Artamonov I, et al. Low uric acid levels in serum of patients with ALS: further evidence for oxidative stress? J NeurolSci 2009; 285:95–9.
  11. Rentzos M, Nikolaou C, Anagnostouli M, Rombos A, Tsakanikas K, Economou M, et al. Serum uric acid and mul- tiple sclerosis. ClinNeurolNeurosurg 2006; 108:527–31.
  12. Auinger P, Kieburtz K, McDermott MP. The relationship between uric acid levels and Huntington’s disease progression. MovDisord 2010; 25:224–8.
  13. Andreadou E, Nikolaou C, Gournaras F, Rentzos M, Boufidou F, Tsoutsou A, et al. Serum uric acid levels in pa- tients with Parkinson’s disease: their relationship to treatment and disease duration. ClinNeurolNeurosurg 2009; 111:724–8.
  14. Kim TS, Pae CU, Yoon SJ, Jang WY, Lee NJ, Kim JJ, et al. Decreased plasma antioxidants in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2006; 21:344–8.
  15. Zhang W, Doherty M, Pascual E et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006a;65:1301–11.
  16. Sun SZ, Flickinger BD, Williamson-Hughes PS, Empie MW. Lack of association between dietary fructose and hyperuricemia risk in adults.NutrMetab. 2010;7(1):16.
  17. Schlesinger N, Norquist JM, Watson DJ. Serum Urate During Acute Gout. The Journal of Rheumatology. 2009;36(6):1287–1289.
  18. Campion EW, Glynn RJ, DeLabry LO.Asymptomatic hyper- uricemia.Risk and consequences in the Normative Aging Study.Am J Med 1987; 82:421–6.
  19. Puig JG, de Miguel E, Castillo MC, Rocha AL, Martinez MA, Torres RJ. Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids 2008;27:592–5.
  20. Doherty M. New insights into the epidemiology of gout.Rheumatology (Oxford). 2009;48Suppl 2:ii2–ii8.
  21. Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 2006;440:237–41.
  22. Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801–808.
  23. Pascual E. Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout.Arthritis Rheum 1991; 34:141–5.
  24. Chhana A, Callon KE, Pool B, et al. Monosodium urate monohydrate crystals inhibit osteoblast viability and function: implications for development of bone erosion in gout. Ann. Rheum. Dis. 2011;70(9):1684–1691.
  25. Pak CY, Moe OW, Sakhaee K, Peterson RD, Poindexter JR. Physicochemical metabolic characteristics for calcium oxal- ate stone formation in patients with gouty diathesis. J Urol 2005; 173:1606–9.
  26. Johnson RJ, Kivlighn SD, Kim YG, Suga S, Fogo AB. Reappraisal of the pathogenesis and consequences of hyper- uricemia in hypertension, cardiovascular disease, and renal disease. Am J Kidney Dis 1999; 33:225–34.
  27. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum 2009; 61:885–92.
  28. Ekundayo OJ, Dell’Italia LJ, Sanders PW, et al. Association between hyperuricemia and incident heart failure among older adults: a propensity-matched study. Int. J. Cardiol. 2010;142(3):279–287.
  29. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and coronary heart disease: a sys- tematic review and meta-analysis. Arthritis Care Res 2010; 62:170–80.
  30. Mazzali M, Kanbay M, Segal MS, Shafiu M, Jalal D, Feig D, et al. Uric acid and hypertension: cause or effect? CurrRheumatol Rep 2010; 12:108–17.
  31. Grayson PC, Kim SY, LaValley M, Choi HK. Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis Care Res. 2011;63(1):102–110.
  32. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA. 2008;300(8):924–932.
  33. Dao HH, Harun-Or-Rashid M, Sakamoto J. Body compos- ition and metabolic syndrome in patients with primary gout in Vietnam. Rheumatology 2010; 49:2400–7.
  34. Choi HK, Ford ES.Prevalence of the metabolic syndrome in individuals with hyperuricemia.Am J Med 2007a; 120:442–7.
  35. Choi HK, De Vera MA, Krishnan E. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile. Rheumatology (Oxford). 2008a;47(10):1567–1570.
  36. Bierer DW, Quebbemann AJ.Effect of L-dopa on renal handling of uric acid.J PharmacolExpTher. 1982;223(1):55–59.
  37. Scott JT. Drug-induced gout. Baillieres Clin Rheumatol. 1991 Apr;5(1):39-60.
  38. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. CurrOpinRheumatol.2011:1.
  39. Caspi D, Lubart E, Graff E, et al. The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients.Arthritis Rheum. 2000;43(1):103–108.
  40. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004b;350(11):1093–1103.
  41. Choi HK, Curhan G. Beer, liquor, wine, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2004a; 51:1023 – 1029.
  42. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004c;363(9417):1277–1281.
  43. Puig JG, Fox IH. Ethanol-induced activation of adenine nucleotide turnover.Evidence for a role of acetate. J Clin Invest 1984; 74: 936–41.
  44. Vandenberg MK, Moxley G, Breitbach SA, Roberts WN. Gout attacks in chronic alcoholics occur at lower serum urate levels than in nonalcoholics. J Rheumatol 1994; 21: 700–04.
  45. Gibson T, Rodgers AV, Simmonds HA, Toseland P. Beer drinking and its effect on uric acid. Br J Rheumatol 1984; 23: 203–09.
  46. Choi JWJ, Ford ES, Gao X, Choi HK. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2008b;59(1):109–116.
  47. Kasper DL Braunwald DE et al. Harrison’s Principles of Internal Medicine . 16th ed. New York , NY : McGraw-Hill Professional; 2005.
  48. De Miguel E, Puig JG, Castillo C, et al. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann. Rheum. Dis. 2011.
  49. Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT). Ann. Rheum. Dis. 2006b;65(10):1312–1324.
  50. Becker MA, Schumacher HR, Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353(23):2450–2461.
  51. Larmon WA (1970) Surgical management of tophaceous gout. ClinOrthopRelat Res 71:56–69.
  52. Ford TC (1992) Surgical management of chronic tophaceous gout. A case report. J Am Podiatr Med Assoc 82(10):514–519.
  53. FDA. FDA approves new drug for gout. FDA NEWS RELEASE. Sept. 14, 2010. Available at Accessed 11/11/2011.
  54. Sundy JS et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011 Aug 17;306(7):711-20.
  55. Ea HK et al. Pegloticase and chronic gout.JAMA. 2011 Nov 9;306(18):1979; author reply 1979-80.
  56. Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout.CurrOpinRheumatol. 2010;22(2):165–172.
  57. Feigelson P. The inhibition of xanthine oxidase in vitro by trace amounts of I-ascorbic acid. J BiolChem 1952;197:843–50.
  58. Juraschek SP, Miller ER III, Gelber AC. Effect of oral vitamin C supplementation on serum uric acid: A meta-analysis of randomized controlled trials. Arthritis Care Res. 2011;63(9):1295–1306.
  59. Huang H-Y, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: Results of a randomized controlled trial. Arthritis Rheum. 2005;52(6):1843–1847.
  60. Bates CJ, Walmsley CM, Prentice A, Finch S. Does vitamin C reduce blood pressure?Results of a large study of people aged 65 or older. J. Hypertens. 1998 Jul;16(7):925.
  61. Block G, Jensen CD, Norkus EP, Hudes M, Crawford PB. Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young Black and White women. Nutr J 2008;7:35.
  62. Jacob RA, Spinozzi GM, Simon VA, et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr. 2003;133(6):1826–1829.
  63. Fam AG. Gout: excess calories, purines, and alcohol intake and beyond. Response to a urate-lowering diet. J Rheumatol . 2005 May;32(5):773-7.
  64. Blau LW. Cherry diet control for gout and arthritis. Tex Rep BiolMed . 1950;8(3):309-11.
  65. Jancin B. Cherry Juice Flowing in Gout Treatment Pipeline.Family Practice News. 2010.
  66. Salazar-Martinez E, Willett WC, Ascherio A, Manson JE, Leitz- mann MF, Stampfer MJ, et al. Coffee consumption and risk for type 2 diabetes mellitus. Ann Intern Med 2004;140:1–8.
  67. Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum. 2007b;56(6):2049–2055.
  68. Kela U, Vijayvargiya R, Trivedi CP. Inhibitory effects of methyl-xanthines on the activity of xanthine oxidase. Life Sci 1980;27:2109–19.
  69. Mascitelli L, Goldstein MR. Does inhibition of iron absorption by coffee reduce the risk of gout? Int. J. Clin. Pract. 2011;65(6):713.
  70. Romero-Gonzalez RR et al. Salting-out gradients in centrifugal partition chromatography for the isolation of chlorogenic acids from green coffee beans. J Chromatogr A. 2009 May 8;1216(19):4245-51. Epub 2009 Feb 10.
  71. Farah A et al. Chlorogenic acids from green coffee extract are highly bioavailable in humans. J Nutr. 2008 Dec;138(12):2309-15.
  72. Lyu L-C, Hsu C-Y, Yeh C-Y, et al. A case-control study of the association of diet and obesity with gout in Taiwan.Am J ClinNutr. 2003;78(4):690–701.
  73. Koguchi T, Koguchi H, Nakajima H, Takano S, Yamamoto Y, Innami S, Maekawa A, Tadokoro T: Dietary fiber suppresses elevation of uric acid and urea nitrogen concentrations in serum of rats with renal dysfunction induced by dietary adenine. Int J VitamNutr Res 2004, 74(4):253-263.
  74. Streppel MT, Arends LR, van t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005 Jan.;165(2):150–156.
  75. Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J. Hypertens. 2005 Mar.;23(3):475–481.
  76. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J ClinNutr 1999 Jan.;69(1):30-42.
  77. Kong LD, Cai Y et al. Inhibition of xanthine oxidase by some Chinese medicinal plants used to treat gout. J Ethnopharmacol . 2000 Nov;73(1-2):199-207.
  78. Yan H, Ma Y, Liu M, Zhou L. The Dual Actions of PaederiascandensExtract as a Hypouricemic Agent: Xanthine Oxidase Inhibitory Activity and Uricosuric Effect. Planta Med. 2008;74(11):1345–1350.
  79. Chen L, Yin H, Lan Z, et al. Anti-hyperuricemic and nephroprotective effects of Smilax china L. J Ethnopharmacol. 2011;135(2):399–405.
  80. Kumar V, Ajeesh R, Vidyasagaran K, Chourasia S. Evaluation of pulp content and physical characters of Thriphala in Western Ghats, India. Environment and Ecology. 2014;33(4):1454-1459.
  81. Motamarri S, Karthikeyan M, Kannan M, Rajasekar S. Terminalia belerica Roxb.—A phytopharmacological review. Int J Res Pharma.2012;3:96-99.
  82. Usharani P, Nutalapati C, Pokuri VK, Kumar CU, Taduri G. A randomized, double-blind, placebo-, and positive-controlled clinical pilot study to evaluate the efficacy and tolerability of standardized aqueous extracts of Terminalia chebula and Terminalia bellerica in subjects with hyperuricemia. Clinical pharmacology: advances and applications. 2016;8:51-59.
  83. Cock IE. The medicinal properties and phytochemistry of plants of the genus Terminalia (Combretaceae). Inflammopharmacol.Oct 2015;23(5):203-229.
  84. Pauff JM, Hille R. Inhibition Studies of Bovine Xanthine Oxidase by Luteolin, Silibinin, Quercetin, and Curcumin. J. Nat. Prod. 2009;72(4):725–731.
  85. Lin C-M, Chen C-S, Chen C-T, Liang Y-C, Lin J-K.Molecular modeling of flavonoids that inhibits xanthine oxidase.BiochemBiophys Res Commun. 2002;294(1):167–172.
  86. Li Y et al. Virtual and In vitro bioassay screening of phytochemical inhibitors from flavonoids and isoflavones against Xanthine oxidase and Cyclooxygenase-2 for gout treatment.ChemBiol Drug Des.2011 Oct 3.doi: 10.1111/j.1747-0285.2011.01248.x. [Epub ahead of print]
  87. Flemmig J et al. Oleaeuropaea leaf (Ph.Eur.) extract as well as several of its isolated phenolics inhibit the gout-related enzyme xanthine oxidase. Phytomedicine. 2011 May 15;18(7):561-6. Epub 2010 Dec 8.
  88. Mo S-F, Zhou F, Lv Y-Z, et al. Hypouricemic action of selected flavonoids in mice: structure-activity relationships. Biol. Pharm. Bull. 2007;30(8):1551–1556.
  89. Hu QH, Wang C, Li JM, Zhang DM, Kong LD. Allopurinol, rutin, and quercetin attenuate hyperuricemia and renal dysfunction in rats induced by fructose intake: renal organic ion transporter involvement. AJP: Renal Physiology. 2009;297(4):F1080–F1091.
  90. Wang Y, Zhu JX et al. Administration of procyanidins from grape seeds reduces serum uric acid levels and decreases hepatic xanthine dehydrogenase/oxidase activities in oxonate-treated mice. Basic ClinPharmacolToxicol. 2004 May;94(5):232-7.
  91. Di Giovine FS, Malawista SE, Nuki G, Duff GW: Interleukin 1 (IL 1) as a mediator of crystal arthritis. Stimulation of T cell and synovial fibroblast mitogenesis by urate crystal-induced IL 1. J Immunol. 1987;138:3213–3218.
  92. Dinarello CA. Blocking interleukin-1β in acute and chronic autoinflammatory diseases.Journal of Internal Medicine. 2010;269(1):16–28.
  93. Busso N, So A. Mechanisms of inflammation in gout.Arthritis Res. Ther. 2010;12(2):206.
  94. Schumacher HR. The pathogenesis of gout.Cleve Clin J Med. 2008;75Suppl 5:S2–4.
  95. Moon D-O, Kim M-O, Choi YH, Park Y-M, Kim G-Y.Curcumin attenuates inflammatory response in IL-1β-induced human synovial fibroblasts and collagen-induced arthritis in mouse model. International Immunopharmacology. 2010;10(5):605–610.
  96. Belcaro G, Cesarone MR, Dugall M, et al. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev. 2010;15(4):337–344.
  97. Wann AK, Mistry J, Blain EJ, Michael-Titus AT, Knight MM. Eicosapentaenoic acid and docosahexaenoic acid reduce interleukin-1β-mediated cartilage degradation. Arthritis Res. Ther. 2010;12(6):R207.
  98. Shakibaei M, Csaki C, Nebrichi S, Mobasheri A. Resveratrol suppresses interleukin-1β-induced inflammatory signaling and apoptosis in human articular chondrocytes: Potential for use as a novel nutraceutical for the treatment of osteoarthritis. Biochem.Pharmacol. 2008;76(11):1426–1439.
  99. Tate GA, Mandell BF, Karmali RA, et al. Suppression of monosodium urate crystal-induced acute inflammation by diets enriched with gamma-linolenic acid and eicosapentaenoic acid. Arthritis Rheum. 1988;31(12):1543–1551.