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Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements
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  • Published on:
    Connecting Gout with Sleep Apnea

    One aspect of gout which is too often overlooked in guidelines and in practice is that most gout flares are initiated during sleep. The sleep connection has been known at least since Dr. Thomas Sydenham, himself a gout sufferer, wrote about it in 1683. A recent study [1] confirms Dr. Sydenham's observation. It is a very important clue to the pathogenesis of gout whether symptomatic or not.

    Many gout flares are a direct result of sleep apnea, and overcoming the sleep apnea can cure the gout. Four epidemiologic studies have been reported that show gout to be significantly more prevalent in people diagnosed with sleep apnea than it is in people never diagnosed with sleep apnea [2,3,4,5]. Here are the physiological reasons for those results. The chronic intermittent hypoxemia of sleep apnea has three effects which can lead to an overnight gout flare in short order. Effect #1 is intermittent cellular catabolism in which adenosine triphosphate degradation is accelerated, leading to nucleotide turnover which culminates irreversibly in the intermittent cellular generation of excess uric acid fed into the blood [6,7], faster than any food would cause. Effect #2 is concurrent intermittent hypercapnia and acidosis [8], so the blood can hold less uric acid in solution. Effect #3 is a long term deterioration of the kidneys' glomerular filtration rate [9] so that removal of uric acid from the blood is slowed. Thus, with sleep apnea there are repeated abrupt increases i...

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    Conflict of Interest:
    None declared.
  • Published on:
    Half of diabetics don't know they are. Is it possible bedside diagosing pre-clinical stage of hyperuricemia and gout?
    • Sergio Stagnaro, Director Quantum Biophysical Semeiotic Research Laboratory

    T2DM can be divided into Five Stages (1-2). The altered metabolism of uric acid, often associated with DM, may be diagnosed from birth, starting with its Uricemic Constitution-dependent, Inherited Real Risk (3, 4). As all other inherited real risks, such a predisposition to hyperuricemia and gout is removed by Reconstructing Mitochondrial Quantum Therapy (5).

    References.
    1) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm
    2) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/libro_costituzionisemeiotiche.htm
    3) Stagnaro S., West PJ., Hu FB., Manson JE., Willett WC. Diet and Risk of Type 2 Diabetes. N Engl J Med. 2002 Jan 24;346(4):297-298. [Medline]
    4) Stagnaro Sergio. Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: multicentre study of the Mediterranean Group for the Study of Diabetes. Eur J Clin Nutr. 2007 Feb 7; [Epub ahead of print] [Medline]
    5) Caramel S., Marchionni M., Stagnaro S. Morinda citrifolia Plays a Central Role in the Pr...

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    Conflict of Interest:
    None declared.