Gout Patients Should Be Screened for Erectile Dysfunction

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Erectile dysfunction (ED) is common and often severe in men suffering from gout, according to the results of a cross-sectional survey of men who presented to a rheumatology clinic.

“These results strongly support the proposal to screen all men with gout for the presence of ED. Increasing awareness should in turn lead to earlier medical attention and treatment for this distressing condition,” said lead author Naomi Schlesinger, MD, chief, Division of Rheumatology, and professor of medicine at Rutgers–Robert Wood Johnson Medical School, in New Brunswick, New Jersey.

The results of the study were presented here at the European League Against Rheumatism (EULAR) Congress 2014.

The most common inflammatory arthritis in men older than 40 years, gout is caused by deposits of urate crystals in the joints and is associated with uricemia. The crystals cause inflammation, pain, and swelling, and the inflammatory component of the disease is linked to risk factors for cardiovascular disease and coronary artery disease.

The cross-sectional study included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013. Of these, 83 had gout.

Participants filled out a Sexual Health Inventory in Men (SHIM) questionnaire, which evaluates the ability to have an erection, the firmness of the erection, the ability to penetrate sufficiently for sexual intercourse, and sexual satisfaction. A score of ≤21 indicates ED; a score of ≤10 indicates severe ED.

“Men don’t usually volunteer sexual complaints,” said Dr. Schlesinger. “The gout patients in our study were generally delighted and grateful that someone finally asked them about ED.”

The mean SHIM score for all participants was 16.88. Patients with gout had a mean SHIM score of 14.38 compared with 18.53 in patients without gout (P < .0001).

A significantly greater percentage of patients with gout had ED compared with patients without gout (76% vs 52%, P = .0007). Also, significantly more men with gout had severe ED vs men without gout (43% vs 30%, P = .007).

The presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout (P = .0001), and was significantly more likely to be severe (P = .0002).

A multivariate analysis adjusted for age, hypertension, low-density cholesterol level, glomerular filtration rate, obesity, and depression found that the association between gout and ED was statistically significant (P = .0096).

Silent Coronary Artery Disease

 “It is estimated that 1 in 5 men who present with ED have silent coronary artery disease. A man with ED, even with no cardiac symptoms, is a cardiac patient until proven otherwise,” said Dr. Schlesinger. “Perhaps we could say that the 3 ‘EDs’ are related: endothelial dysfunction leads to erectile dysfunction leads to early death.

“Gout patients who present with ED have an increased rate of cardiovascular risk factors and concomitant silent coronary artery disease and should be evaluated,” she added.

 Maya Buch, MD, from the Leeds Institute of Rheumatology and Musculoskeletal Medicine, at the University of Leeds, United Kingdom, praised the authors of this study for providing new information on these conditions with overlapping risk factor — gout and cardiovascular disease.
 “These patients are at risk for cardiomyopathies, and there is no literature on ED and gout. We know that patients with gout have multiple comorbidities, and it’s clear that rheumatologists need to address that,” she explained.

“I was surprised at how many patients with gout have ED. In addition to treating hyperuricemia in our patients with gout, we need to pay attention to cardiovascular risk factors. I hope that this study makes doctors more receptive to evaluating patients for ED,” she added.

Dr. Schlesinger has disclosed no relevant financial relationships. Dr. Buch has received honoraria and consulting fees from AbbVie, Bristol-Myers Squibb, and Roche-Chugai and has a research grant from Pfizer, Inc.

 European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.

Written By: Alice Goodman

Article Source: http://www.medscape.com/viewarticle/826773

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How to Prevent Gout

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How many times have you said or heard someone say they can’t participate in a certain activity because of bad knees or a bad back or shoulder?

Probably more times than you can count.

While most people associate joint pain and stiffness with age-related inflammation and cartilage breakdown, otherwise known as arthritis, there’s another cause of these discomforts that isn’t nearly as well known — gout.

What is Gout?

Gout occurs when you have high levels of uric acid that causes crystals to deposit in joints and tissues, resulting in swelling, stiffness, and pain.

Uric acid is made during your body’s metabolism of purines, which are made by the body. Purines are needed, as they’re the building blocks of your DNA. However, some people make too much purine or their kidneys can’t get rid of it efficiently.

In addition to being made by your body, there are also food sources of purines that many people eat on a daily basis. Foods and drinks that are high in purine content are organ meats, bacon, beef, pork and lamb, anchovies, scallops, and beer.1 Purines from your diet are converted into uric acid.

Should You be Concerned about Gout?

You’re almost 10 times more likely to have gout if your blood uric acid levels are above 9 mg/dL.2 Increased uric acid can be genetic,3 but men and post-menopausal women produce more uric acid so they’re at a higher risk.

So even if you don’t have high uric acid levels, but you have a family history or fit one of the two high-risk groups, it’s best to take precautions.

Natural Strategies to Lower Uric Acid

It’s highly encouraged that you first change your diet and lifestyle — limit meats, alcohol, and sugar-sweetened beverages, drink more water, consume low-fat dairy products, and exercise daily. These changes are necessary for managing uric acid levels, but they might not be enough, so you may benefit from adding the following:

Terminalia bellerica

Recent research has shown the ability of a fruit extract called T. bellerica to support uric acid balance. It works by inhibiting two enzymes that play a role in the metabolism of uric acid, xanthine oxidase (which converts xanthine into uric acid) and iNOS (which causes joint inflammation). Subjects who had high blood uric acid who took 500 mg of T. bellerica twice daily reduced their uric acid levels by an average of 27.59% without any of the side effects associated with drug therapy.4

Vitamin C

Vitamin C has also shown to block the enzyme xanthine oxidase5 and may help support kidney function6 (which is essential for getting rid of excess uric acid). A review of 13 studies showed that taking an average of 500 mg vitamin C per day resulted in a 0.35 mg/dL decrease in blood uric acid levels.7

Tart Cherry

Tart cherry has been growing in popularity as it has been shown to help with exercise recovery and ease post-workout soreness. However, cherry extract has also exhibited the ability to protect against gout attacks by lowering uric acid and inflammation.8

Coffee

As if you need another reason to enjoy your daily cup (or cups) of “joe”— coffee contains polyphenol antioxidants that may play a role in its ability to reduce gout risk. Two large studies, one with 89,433 women and the other with 45,869 men showed that those who consumed more than four cups of coffee a day had the largest reductions in gout risk. Women had a larger decrease when they consumed caffeinated coffee, but both women and men also showed uric acid improvements with decaffeinated coffee.9,10

The Bottom Line

Elevated uric acid can cause gout-related joint pain, but it’s also associated with other health issues like cardiovascular disease,11 diabetes,12 and stroke.13

As such, there’s no better time than now to start making lifestyle changes or supplementing with nutrients likeTerminalia bellerica, vitamin C, and cherry extract!

Article Source: http://blog.lifeextension.com/2016/03/how-to-prevent-gout.html?utm_source=facebook&utm_medium=social&utm_campaign=normal

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References:

  1. Available at: http://www.webmd.com/arthritis/tc/diet-and-gout-topic-overview. Accessed February 22, 2016.
  2. Am J Med. 1987 Mar;82(3):421-6.
  3. Am J Med. 2012 May;125(5):499-504.
  4. Rani U, Kishan P, Chandrasekhar N. A randomized, double blind, placebo controlled, parallel-group study to evaluate the effect of Terminalia chebula, Terminalia bellerica and Febuxostat in patients with hyperuricemia. Publication pending.
  5. J Biol Chem.1952 May;197(2):843-50.
  6. Arthritis Rheum. 2005 Jun;52(6):1843-7.
  7. Arthritis Care Res (Hoboken). 2011 Sep;63(9):1295-306.
  8. J Nutr.2003 Jun;133(6):1826-9.
  9. Arthritis Rheum. 2007 Jun;56(6):2049-55.
  10. Am J Clin Nutr. 2010 Oct;92(4):922-7.
  11. Arthritis Care Res (Hoboken). 2010 Feb;62(2):170-80
  12. Rheumatology (Oxford). 2008 Oct;47(10):1567-70.
  13. Arthritis Rheum. 2009 Jul 15;61(7):885-92.