Francesco S Facchini1. 1. Department of Medicine, San Francisco General Hospital and University of California San Francisco, 94143, USA. fste2000@yahoo.com
Abstract
OBJECTIVES: Previous evidence supports a role for iron in the pathogenesis of gout. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Conversely, iron removal inhibited these responses as well as urate-crystal-induced foot pad inflammation in rats in-vivo. The objective of the present study was to investigate whether or not iron removal may improve the outcome of gouty arthritis in humans as well. METHODS: Quantitative phlebotomy was used to remove iron in 12 hyperuricaemic patients with gouty arthritis and maintain their body iron at near-iron deficiency (NID) level (i.e. the lowest body iron store compatible with normal erythropoiesis and therefore absence of anaemia). RESULTS: During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year -2, -1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. During NID, attacks were also more often of milder severity. CONCLUSIONS: During a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission to a marked reduction of incidence and severity of gouty attacks.
OBJECTIVES: Previous evidence supports a role for iron in the pathogenesis of gout. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Conversely, iron removal inhibited these responses as well as urate-crystal-induced foot pad inflammation in rats in-vivo. The objective of the present study was to investigate whether or not iron removal may improve the outcome of gouty arthritis in humans as well. METHODS: Quantitative phlebotomy was used to remove iron in 12 hyperuricaemic patients with gouty arthritis and maintain their body iron at near-iron deficiency (NID) level (i.e. the lowest body iron store compatible with normal erythropoiesis and therefore absence of anaemia). RESULTS: During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year -2, -1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. During NID, attacks were also more often of milder severity. CONCLUSIONS: During a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission to a marked reduction of incidence and severity of gouty attacks.
Authors: Tahzeeb Fatima; Cushla McKinney; Tanya J Major; Lisa K Stamp; Nicola Dalbeth; Cory Iverson; Tony R Merriman; Jeffrey N Miner Journal: Arthritis Res Ther Date: 2018-08-15 Impact factor: 5.156