References and Professional Synopsis: Dalbeth N, Choi HK, Joosten LAB, Khanna PP, Matsuo H, Perez-Ruiz F, Stamp LK. Gout. Nat Rev Dis Primers. 2019 Sep 26;5(1):69. doi: 10.1038/s41572-019-0115-y. PMID: 31558729.
This is a comprehensive review of gout, which is a chronic disease caused by monosodium urate (MSU) crystal deposition. Gout typically presents as an acute, self-limiting inflammatory monoarthritis that affects the joints of the lower limb. Elevated serum urate level (hyperuricemia) is the major risk factor for MSU crystal deposition and development of gout. Although traditionally considered a disorder of purine metabolism, altered urate transport, both in the gut and the kidneys, has a key role in the pathogenesis of hyperuricemia. Anti-inflammatory agents, such corticosteroids, NSAIDs and colchicine, are widely used for the treatment of gout flare; recognition of the importance of NLRP3 inflammasome activation and bioactive IL-1β release in initiation of the gout flare has led to the development of anti-IL-1β biological therapy for gout flares. Sustained reduction in serum urate levels using urate-lowering therapy is vital in the long-term management of gout, which aims to dissolve MSU crystals, suppress gout flares and resolve tophi. Allopurinol is the first-line urate-lowering therapy and should be started at a low dose, with gradual dose escalation. Low-dose anti-inflammatory therapies can reduce gout flares during initiation of urate-lowering therapy. Models of care, such as nurse-led strategies that focus on patient engagement and education, substantially improve clinical outcomes and now represent best practice for gout management.
References and Professional Synopsis: Menghini L, Recinella L, Leone S, Chiavaroli A, Cicala C, Brunetti L, Vladimir-Knežević S, Orlando G, Ferrante C. Devil’s claw (Harpagophytum procumbens) and chronic inflammatory diseases: A concise overview on preclinical and clinical data. Phytother Res. 2019 Sep;33(9):2152-2162. doi: 10.1002/ptr.6395. Epub 2019 Jul 4. PMID: 31273865.
The authors performed a review by focusing on the applicative potential of devil’s claw in managing inflammation- and oxidative stress-related diseases. Devil’s claw and its components, particularly harpagoside, show significant pharmacological properties, suggesting potential therapeutic effects in a wide spectrum of pathologies, such as arthritis, osteoporosis, type 1 diabetes mellitus, inflammatory bowel, and neurodegenerative diseases. It thus highlighted the need to perform well-designed clinical trials to confirm the potential applications in clinics.
References and Professional Synopsis: Nakagawa T, Lanaspa MA, Johnson RJ. The effects of fruit consumption in patients with hyperuricemia or gout. Rheumatology (Oxford). 2019 Jul 1;58(7):1133-1141. doi: 10.1093/rheumatology/kez128. PMID: 31004140.
The document reviews the effects of fruit consumption on hyperuricemia and gout, focusing on the role of fructose and other nutrients in fruits.
Key points include:
1) Fructose and Uric Acid: Fructose metabolism produces uric acid, potentially increasing the risk of hyperuricemia and gout.
High fructose corn syrup (HFCS) in soft drinks is particularly problematic.
2) Complex Effects of Fruits: While fruits contain fructose, they also have beneficial nutrients like vitamin C, epicatechin, flavonols, potassium, and fiber, which can mitigate the negative effects of fructose.
3) Clinical Studies: Some studies show fruit intake is associated with a lower risk of gout, while others suggest certain fruits or fruit juices (e.g., orange juice) may increase the risk.
4) Protective Nutrients includes Vitamin C (enhances uric acid excretion and reduces serum uric acid levels), fiber (slows fructose absorption, reducing its impact on uric acid production), potassium (lowers blood pressure and counteracts the effects of uric acid and fructose), and catechins and flavonoids (reduce xanthine oxidase activity, lowering uric acid formation and inflammation). It is thus recommended to reduce intake of refined sugars and fruit juices, but encourage consumption of natural fruits, especially those high in vitamin C and low in fructose, like cherries.
The overall conclusion is that while fructose in fruits can raise uric acid levels, the presence of other beneficial nutrients in fruits generally makes them a healthy choice, particularly when compared to refined sugars and fruit juices.
References and Professional Synopsis: Coppola C, Greco M, Munir A, Musarò D, Quarta S, Massaro M, Lionetto MG, Maffia M. Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts. Curr Issues Mol Biol. 2024 Apr 29;46(5):4063-4105. doi: 10.3390/cimb46050251. PMID: 38785519; PMCID: PMC11119992.
The document is a review on Osteoarthritis, focusing on insights into diagnosis, pathophysiology, therapeutic avenues, and the potential of natural extracts for management. Some natural extracts mentioned for osteoarthritis (OA) management include:Curcumin (from turmeric), Bromelain (from pineapple), Boswellia serrata (Indian frankincense), Harpagophytum procumbens (devil’s claw), Aescin (from horse chestnut), Matricaria chamomilla (chamomile), Glycine soja (wild soybean), Zingiber officinale Roscoe (ginger), Quercetin (a flavonoid found in many fruits and vegetables). These extracts are noted for their anti-inflammatory and antioxidant properties, which can help manage OA symptoms.
References and Professional Synopsis: Rabade A, Viswanatha GL, Nandakumar K, Kishore A. Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis. Inflammopharmacology. 2024 Jun;32(3):1759-1775. doi: 10.1007/s10787-024-01460-9. Epub 2024 Apr 6. PMID: 38581640.
The document is an updated systematic review and meta-analysis evaluating the efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis. It concluded that chondroitin sulfate showed significant reduction in pain intensity and improvement in physical function compared to placebo and glucosamine sulfate demonstrated a significant reduction in tibiofemoral joint space narrowing, indicating a disease-modifying effect. Both agents exhibited good safety profiles and were well tolerated, with common adverse events including gastrointestinal disturbances, headaches, skin allergies, urinary tract infections, and respiratory tract infections.
References and Professional Synopsis: Ameye LG, Chee WS. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Res Ther. 2006;8(4):R127. doi: 10.1186/ar2016. PMID: 16859534; PMCID: PMC1779427.
The document is a research article that systematically reviews the scientific evidence on the effects of nutritional compounds on osteoarthritis, focusing on nutraceuticals and functional foods. Specifically, methylsulfonylmethane (MSM) helps with osteoarthritis symptoms by providing moderate evidence of efficacy. It has been shown to significantly improve pain and functional scores in patients with knee osteoarthritis. Specifically, MSM has been found to reduce pain and improve physical function as measured by the WOMAC index and Likert scale pain index in clinical trials.