Best Practice & Research Clinical Rheumatology: New progress in crystal arthritis

 

Mechanism

Mechanism

Stücker and colleagues outline intraarticular close relationship between the BCP and CPP crystals, which emphasize the pyrophosphate metabolism disorders caused by formation of protein crystals BCP or CPP
.

Stücker and colleagues outline intraarticular close relationship between the BCP and CPP crystals, which emphasize the pyrophosphate metabolism disorders caused by formation of protein crystals BCP or CPP
.

They outlined the mechanisms by which calcium crystals may lead to the progression of osteoarthritis :

They outlined the mechanisms by which calcium crystals may lead to the progression of osteoarthritis :

lBCP and CPP crystals are related to two different chondrocyte phenotypes;

lBCP and CPP crystals are related to two different chondrocyte phenotypes;

lBCP deposition is related to chondrocyte hypertrophy ;

lBCP deposition is related to chondrocyte hypertrophy ;

lCPP deposition is related to the senescence of chondrocytes
.

lCPP deposition is related to the senescence of chondrocytes
.

Williams and Rosenthal discussed the progress of the basic biology of CPPD : ANKH and OPG mutations were found in rare familial CPPD
.

Although cartilage has always been the focus of CPPD research, they believe that the disorder of osteoclasts in the subchondral bone may play a key role in the development of CPPD

Williams and Rosenthal discussed the progress of the basic biology of CPPD : ANKH and OPG mutations were found in rare familial CPPD

CPPD treatment CPPD treatment

Treatment options for CPPD are still limited
.

Stack and McCarthy summarized the current treatment options for CPPD, and pointed out that anti-inflammatory strategies are inferred from gout

Treatment options for CPPD are still limited

The management of CPPD is particularly complicated in clinical practice because of the lack of randomized controlled trials for established therapies or new drugs

gout

Speaking gout, genome-wide association studies and Merriman Leask described ( GWAS ) the rapid advance of our understanding of the biological basis of hyperuricemia and gout in
.

Uric acid excretion is complex and involves many different transporters

Speaking gout, genome-wide association studies and Merriman Leask described ( GWAS ) rapidly advancing GWAS of our understanding of the biological basis of hyperuricemia and gout in

Woodward and Halperin used these genetic findings as a basis for a detailed review of uric acid homeostasis

In clinical studies of gout, the evaluation of treatment methods is hindered by inconsistent measurement standards at the onset of gout .
Stewart, Dalbeth, and Gaffo believe that gout attacks are complex, non-dual events (as often measured) .
Gout attacks vary in intensity and duration (also affected by anti-inflammatory drugs) .
Over time, there are also differences in the frequency of relapses or outbreaks between subjects .
The multi-dimensional experience of gout patients with gout attacks can be explained by a series of symptoms, including the characteristics of the attack, and the effects of the attack on function, psychological factors, family and social life .
Patients defined remission as zero gout attacks (spanning 6 or 12 months) and low disease activity as 1 attack every 6 months (or 1-3 attacks every 12 months) .

Stamp and Farquhar reviewed the 2020 ACR Gout Management Guidelines
.

Describes the efficacy of IL-1 inhibition on gout attacks

Stamp and Farquhar reviewed the 2020 ACR Gout Management Guidelines

Stamp and Farquhar discussed , it has been fully confirmed xanthine oxidase inhibitors, uricosuric agents promoting the benefits of polyethylene glycol and enzyme treatment
.
About febuxostat heart blood vessel safety and minimize polyethylene glycol enzyme immunoassay immunogenicity of specific issues
.
The author's results of the FAST study (6% lost to follow-up vascular immunity ) are more reliable than the results of the CARES study (45% lost to follow-up), so it is recommended to introduce patients to the risk of cardiovascular disease in patients treated with febuxostat
.
In order to reduce the immunogenicity of pegloticase, pre- and co-administration of immunosuppressive agents has literature value
.
Ongoing trials are exploring the potential benefits of loading doses of PEGylase in reducing immunogenicity
.
The author recommends targeted uric acid-lowering strategies based on the guidelines and clinical trial data
.
These recommendations include the treatment of patients with CKD, where allopurinol ≥3 can be safely and slowly titrated to reach the SU target
.
Patient education strategies (effectively done through nursing visits ) or reminders (automatic reminders from pharmacies have less impact) can improve compliance and clinical outcomes
.

Finally, patients and many providers are still interested in diet to control gout
.
Danve, Sehra, and Neogi reviewed the effects of specific diets, weight loss, and specific dietary factors on uric acid levels, gout attacks, or recurrent gout attacks
.
The author reminds us that although diet is important, compared with genetics or drug interventions, diet contributes little to the above results, and healthcare professionals should take care to avoid blaming patients for dietary problems .
For most patients, dietary intervention alone is not enough to control gout, so it should be used as an adjunct to drug therapy .

Finally, patients and many providers are still interested in diet to control gout
.
Danve, Sehra, and Neogi reviewed the effects of specific diets, weight loss, and specific dietary factors on uric acid levels, gout attacks, or recurrent gout attacks
.
The author reminds us that although diet is important, compared with genetics or drug interventions, diet contributes little to the above results, and healthcare professionals should take care to avoid blaming patients for dietary problems .
For most patients, dietary intervention alone is not enough to control gout, so it should be used as an adjunct to drug therapy .

Although this question highlights important advances in understanding the disease mechanisms and management methods of crystal arthritis, there are still many unresolved research questions
.
The impact of the Covid-19 pandemic on patients with crystalline arthritis remains largely unknown.
Only a few studies report the health outcomes or disease management of patients with gout, and at the time of writing, there are no public data on CPPD patients
.

Although this question highlights important advances in understanding the disease mechanisms and management methods of crystal arthritis, there are still many unresolved research questions
.
The impact of the Covid-19 pandemic on patients with crystalline arthritis remains largely unknown.
Only a few studies report the health outcomes or disease management of patients with gout, and at the time of writing, there are no public data on CPPD patients
.

In addition, for CPPD, it is clear that a multi-center collaboration is needed to further understand the biological basis of the disease, further define the clinical phenotype, and use validated outcome measures to test established and new treatments
.
For gout, although the biological basis of hyperuricemia has been established, it is still unclear which other factors will lead to the development of clinically obvious gout and the development of serious diseases
.
In addition, although the treatment strategies for gout are well known, there is still a long-standing gap between the established best management guidelines and the reality of gout management in clinical practice
.

In addition, for CPPD, it is clear that a multi-center collaboration is needed to further understand the biological basis of the disease, further define the clinical phenotype, and use validated outcome measures to test established and new treatments
.
For gout, although the biological basis of hyperuricemia has been established, it is still unclear which other factors will lead to the development of clinically obvious gout and the development of serious diseases
.
In addition, although the treatment strategies for gout are well known, there is still a long-standing gap between the established best management guidelines and the reality of gout management in clinical practice
.

 

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