Talk:Gout/Archive 2

Insert the following information and references after the original first sentence in the Prevention section, as the beginning of a second paragraph; use the orginal second sentence as the beginning of a third paragraph:

A diet rich in sucrose may lead to gout as it raises the level of insulin, which is inversely associated with excretion of uric acid from the body.^[1] As the concentration of uric acid in the body increases, so does the concentration of uric acid in the joint liquid and beyond a critical concentration, the uric acid begins to precipitate into crystals. Researchers have implicated sugary drinks high in fructose in a surge in cases of gout.^[2][3]

--68.40.122.133 (talk) 21:46, 9 October 2016 (UTC)

Thanks for your note. Sorry but none of those sources comply with WP:MEDRS, which calls for literature review articles published in the biomedical literature, or statements from major medical/scientific bodies - these are all secondary sources. The article you cite is a primary source (not a secondary source) and the news articles are not what MEDRS calls for. I checked pubmed for the most recent review and updated the prevention section; no mention of sugar in that review. (the pre-update and updated content does mention fructose) Maybe the next review will address this sugar study; then tend to come out every couple of years. Jytdog (talk) 00:44, 10 October 2016 (UTC)

doi:10.1016/S0140-6736(16)00346-9 JFW | T@lk 14:19, 23 October 2016 (UTC)

Four papers!

• Review of diagnosis doi:10.7326/M16-0462
• Review of treatment doi:10.7326/M16-0461
• Guideline for diagnosis: doi:10.7326/M16-0569
• Guideline for treatment: doi:10.7326/M16-0570

JFW | T@lk 11:58, 1 November 2016 (UTC)

This might be interesting, since it has been recognized as a disease since Hector was a pup. In this [] we see that colchicum was offered as a treatment since Galen's time. Kortoso (talk) 18:52, 11 January 2017 (UTC)

Is Gout caused by a high intake of beer or alcohol, historically it was well known that those who imbibed a lot of wine or spirits would be more subject to gout. Not an expert in the disease but it seems unlikely that beer alone is a casual factor in gout. — Preceding unsigned comment added by 81.105.45.150 (talk) 18:39, 22 March 2017 (UTC)

I know later we have a reference to alcohol causing or more correctly being causal of gout, and alcohol in general, but it seems the original statement needs revision?

^[1]

Not clear what specific change in the article you are requesting. Beer/spirits have been suspected and reported for decades, one summary emphasizing beer as purine-rich here. Look through the early-2000s references by Choi on lifestyle in the article. The 2004 Lancet report by Choi et al. (not cited) was one of the primary human studies showing the association of just one 12 oz. beer per day with gout onset. --Zefr (talk) 19:22, 22 March 2017 (UTC)

Just talking something from daily clinic nursing and treatment: in my family, there are some members who have gotten the illness of Gout. From my observations, I find: For them, yes, beer (especially its alcohol - it's not to say all drinks with alcohol can cause this problem but particularly beer's... ), seafood (especially some　types with full of juice, like　oyster...; Wikipedia introduction: https://en.wikipedia.org/wiki/Oyster)and juice of several types meats (including beef soup etc.) carrying higher purine in urine acid (Wikipedia introduction: https://en.wikipedia.org/wiki/Purine_metabolism ) can cause Gout attacks. We found, indeed, taking certain dried beef, some types of seafood (such as dried squid...) and cooking them with much vegetable, usually wouldn't bring attacks. I guessed it was caused by Purine metabolism's water-solubility and over-saturation in our body liquid. When Purine densities were over too much, crystals automatically filtered out of our cell-walls (bones and flesh), and then out of skin, which would block blood circulation. But, if we ate a few of some dried foods (like dried beef), juices dried out will take　away a large part of purine in foods, which leave some only nutrients (fibres and proteins) can be absorbed which benefits our health. But, animal organs truly couldn't be eaten, even a little... From the study of symptoms, we got a special view: it was similar to a widespread Allergy (Wikipedia introduction: https://en.wikipedia.org/wiki/Allergy), but from bones (or Bone marrow - Wikipedia introduction: https://en.wikipedia.org/wiki/Bone_marrow and blood vessels attached upon bones). Deeply say: its symptoms have all met Allergy's basic elements - towards certain foods or their certain matters (elements), Toxins interacting with proteins, being looked Red and swollen, and being felt the very pains in some areas. Meanwhile, every time before it's occurrence, urine smells specially and is looked yellow enough to red, which reflected the difficulty of kidneys' functions. Then, from its results, we can see: the fire-feeling and joint-pain are similar to bruise (Wikipedia introduction: https://en.wikipedia.org/wiki/Bruise) or bitten by some insects, which I think would be in relative with blood-blocking and channel-folded. Hopefully, more common ways would be researched out for people's daily nursing and self-treatments. You know, Colchicine (Wikipedia introduction: https://en.wikipedia.org/wiki/Colchicine) is a very toxic matter damaging kidneys. If we would borrow some ways from the treatments of both bruise and allergy, and researching, and then guiding body's self-sustaining of Purine metabolism, patients' pains would be decreased. Jason M. C., Han (talk) 14:39, 23 May 2017 (UTC)

All off-topic for the article, but in my own case it was very clear that attacks were brought on by mild dehydration some 36 hours before, signalled by yes, darker yellow urine. What I had been eating or drinking was nothing to do with it, but saunas & long walks in summer were very likely to bring an attack if fairly large amounts of water (or beer) were not taken soon after. AFAIK this factor does not feature in the medical literature, but now they can solve the problem with a pill medicine doesn't seem to take much interest in gout. After I realized the position, I was able to stay off the pill for several years by just monitoring urine colour and drinking extra fluid when needed. You might try that. Johnbod (talk) 14:53, 23 May 2017 (UTC)

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Archive URL is good. --Zefr (talk) 15:30, 23 March 2017 (UTC)

Doc James (talk · contribs · email) 15:42, 18 July 2017 (UTC)

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clarify meaning so people don't need to look up "tophus"

change: Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or tophus.

to: Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid, called tophus. 50.0.246.32 (talk) 23:23, 14 June 2018 (UTC)

 Done Although I'm not entirely sure whether the deposits are known as "a" tophus or whether a collection of tophi is referred to simply as "tophi", which seems counterintuitive. I've left it as tophus. Any editor who feels this is mistaken please feel free to revert my changes (I added the word "called") per the edit request.  spintendo  00:31, 15 June 2018 (UTC)

No. Tophus is a collection of the crystal outside the joint. You may see a bump or nodule in the skin or near a joint. You most often will only have pain without a visible build up and the crystals are only microscopic with the joint. I am reverting. MartinezMD (talk) 00:33, 15 June 2018 (UTC)

The intro says dairy can worsen gout. The body says dairy can lessen gout. There's distinction of course, about different kinds of dairy.

This needs to be cleared up about "good" and "bad" dairy. Since the intro should merely summarize the body this inconsistency probably arises by using different source references. Thess references should be combined into a complete summary of dairy's impact on your, and then sumarized in the intro. 73.109.56.234 (talk) 03:44, 10 September 2018 (UTC)

I think you may have misunderstood what was said in the lead of the article. It's consistent. The lead of the article says a diet high in low-fat dairy may be preventive (meaning that it lowers the risk of gout). That's consistent with the body saying that dairy may also be helpful for gout. TylerDurden8823 (talk) 03:46, 10 September 2018 (UTC)

This edit request to Gout has been answered. Set the |answered= parameter to no to reactivate your request.

Edited Doc James (talk · contribs · email) 06:24, 24 February 2019 (UTC)

Testing reply tool Doc James (talk · contribs · email) 06:24, 24 February 2019 (UTC)

Does an article about gout still need to be semi-protected? I'm not seeing much or any vandalism here. Snow Rise, is it possible to remove the semi-protected status? Thisnotnpov (talk) 01:26, 19 August 2019 (UTC)

Why is gout listed in the infobox as belonging to the 'emergency medicine' speciality?! It might be an emergency for the patient, but it's hardly an emergency in a medical sense. Surely it should be listed under 'Rheumatology': its normal classification? I've made this change, because it's clearly wrong, plus some more accurate wording regarding urate lowering therapy drugs. There needs to be some work done on representing a more global, rather than USA-centric article. For instance, under the NSAIDS section, Naproxen or Diclofenac would be the usual first-line choice in the UK, rather than Indometacin. I'll get to this shortly. Fortnum (talk) 15:39, 20 August 2019 (UTC)

All NSAIDs are more or less equivalent. Thus why the article says "No specific agent is significantly more or less effective than any other." Doc James (talk · contribs · email) 13:08, 22 August 2019 (UTC)

Not seeing were the ref says "initiation of febuxostat has a particularly high risk of precipitating a flare" Can you provide a direct quote? Not seeing that claim in the ref in question... Doc James (talk · contribs · email) 13:09, 22 August 2019 (UTC)

Sixth bullet point in the NICE document (Scenario: preventing gout). To quote: "The risk of gout flare is particularly high when initiating febuxostat." Please do not revert my edits unnecessarily like this - closer reading of the source would have avoided my having to revert your mistake. Thanks Fortnum (talk) 13:31, 22 August 2019 (UTC)

Thanks. Added that back. Doc James (talk · contribs · email) 13:36, 22 August 2019 (UTC)

User:Fortnum Were does it support "increase in dosage of urate-lowering therapy"

Prescribing information:Allopurinol. The quote: "When starting or up-titrating allopurinol, flare prophylaxis using colchicine or an NSAID is recommended". Fortnum (talk) 13:57, 22 August 2019 (UTC)

And were does it say Xrays "are not useful for confirming a diagnosis of chronic" gout? Doc James (talk · contribs · email) 13:41, 22 August 2019 (UTC)

Diagnosis - under 'investigations'. I thought you were supposed to be a clinician? I shouldn't have to be holding your hand like this through the literature. It's all in the source - please just consult it before over-hasty reversion.Fortnum (talk) 13:57, 22 August 2019 (UTC)

Sure it says "Joint X-ray: Plain radiographs are often normal. Non specific soft tissue swelling and subcortical cysts may be present. Advanced disease may demonstrate bone erosion."

That is not saying it is not useful in chronic gout. Doc James (talk · contribs · email) 10:07, 23 August 2019 (UTC)

Agree - and marginal erosions with overhanging margins (known colloquially as "rat-bite erosions") are quite useful diagnostically (e.g. PMID 23971443 but I'm sure there are other MEDRS for this). — soupvector (talk) 00:35, 28 August 2019 (UTC)

before i restore a whole lot of stuff just deleted, could the culprit pls explain WHY? i was asking abt several CONTRADICTORY sections (fruit coffee dairy etc having positive or negative effects; iron being totally ignored when in fact it pops up heavily in articles abt gout and NSAIDs) which need to be corrected/added to the article.

i DID frame these as "in my experience...", but only to lead in to the subjects. (compare this to threads in the archives where 50 ppl post ad nauseum abt the personal woes they are suffering! yet MY 3 sentences leading up to "why is this info wrong" is considered off-topic?! what the...??)

besides which, this is the TALK page, not the article. would u rather i "be bold" and correct the article w/o discussing it here first?! 2601:19C:527F:7890:8A7:E885:F42D:78BC (talk) 07:49, 9 February 2024 (UTC)

I didn't delete your post but I agree with the editor that did. "In my experience" and anything related has NO place here. The discussion page is discussion about the article only. If you have a directed addition or edit proposal for the article place it here. Otherwise no one wants to hear it. MartinezMD (talk) 16:16, 9 February 2024 (UTC)

OMG, look at the archives -- like 50 ppl trying to one-up each other with their personal tales of woe...WITHOUT leading to any ultimate point. u didn't seem to have any problem when all that was happening!

me, i just had a few lines SEGUEING towards some ultimately legit queries.

but ok, i'll get straighter to the point.

cud someone better informed than i please:

1) add the relationship with IRON? many sources point out how iron levels plummet during a bout -- is it the gout itself, the treatment (NSAIDs), or both? and WHY?

are urate crystals themselves high in iron, low in iron, or neither?

2) clean up the mess of foods/factors listed as contributing towards, or preventing against, an outbreak? right now it lists fructose as a major cause while "vitamin C" (which generally comes from fructose), cherries (loaded with fructose) and even "fruit" itself(!), are all preventatives. how is this POSSIBLE?

next, it lists "low fat dairy" as a preventative. what does this mean? dairy is all high fat with the exception of skim milk. if the article means skim milk, just say skim milk. it's just confusing to include butter, cheese and ice cream, only to then imply they're disqualified by the "low fat" modifier.

(altho i suppose one can find specialty low fat cheese in the same way that low-fructose robocherries probably exist. is the article really hinging on such things?)

lastly, "coffee" should probably state BLACK coffee specifically, since the default in modern days is a high-fat high-sugar drink. which i DON'T think is what is intended here.

thanks! 2601:19C:527F:7890:65A8:1439:686F:66AF (talk) 03:35, 10 February 2024 (UTC)

The article has been well-reviewed and edited over years, and is up to date with sources.

Comments: 1) There are no reviews establishing that iron is a cause of urate formation, only an association discussed in this publication. Without better evidence, iron as a factor in gout onset cannot be presented.

2) your comments above reflect both a misunderstanding of foods and inattention to reading the sources. This 2023 lay summary should be sufficient for your education, and this 2015 epidemiology review discusses possible onset factors and preventative factors, but none of this is certain, as other literature has provided for decades.

There is no mess to clean up. Nothing you stated warrants a change in the article. All statements concerning urate formation, gout onset, and disease factors require a WP:MEDRS source. Zefr (talk) 05:45, 10 February 2024 (UTC)

one should not have to read the sources if they are summarized correctly. as it currently stands, any normal reader will be scratching his head over how one eats fruit, esp cherries, without getting FRUCTOSE! or why "dairy" and "coffee" are indicated so generally, if only "skim milk" and "black coffee" are actually intended.

if the studies are clearer on these points, can we clean up the article to match?

and thanks for the ferratin study. sorry, it's already over my head. i'm just curious why u say it's an outlier, tho, when THOUSANDS of similar pages/studies google up?

i'm not necessarily asking if iron is a CAUSE, btw. more abt why iron levels nosedive as a RESULT. if it's just a side effect of NSAID treatment (as sources seem to assert), can NSAIDs be supplemented with iron? or is there some INHERENT REASON nsaids *need* to drop iron levels, and that ADDING iron would counteract their effectiveness?

thanks! 2601:19C:527F:7890:65A8:1439:686F:66AF (talk) 19:03, 10 February 2024 (UTC)

There is nothing confusing about the Prevention section stating that some foods may increase the risk of elevating urate levels, and some may reduce it. Key word "may", as there are too many complications of precisely determining food factors in relation to diseases. Comments on foods/drinks are referenced - that is what investigators found and published under peer-review. The MedlinePlus source in External links is a good lay summary of gout.

It is illogical to equate eating cherries (small amounts of fructose intake in typical amounts) vs. drinking a sugar-laden beverage.

On the iron issue, we use reputable reviews in medical publications as sources - the MEDRS guideline above. There are no reviews relating iron levels to gout, so this topic is not included.

I've adequately covered your points, so will not be continuing this conversation. Zefr (talk) 01:59, 11 February 2024 (UTC)

i see nothing anywhere about sugar-laden beverages, so nice straw man there. i guess you're implying that "high fructose corn syrup" is the *only* form of fructose that increases risk? well then, why not just SAY that? the article says "fructose". it is illogical to think any reader would interpret that as meaning "massive amounts" only. and it is beyond illogical to think that small amounts of fructose would REDUCE the risk of gout when large amounts trigger it. yes, of course, small amount may not increase the risk AS MUCH, but how does one get to "reduce"?

small amounts of tobacco increase cancer risk less than large amounts of tobacco, but does anyone say they actually REDUCE said risk? more than, say, going COLD TURKEY?

yet u would have it so with fructose.

and the "may" stuff is amusing, points for that. yeah, it "may" cause something....BUT IT DOESN'T!!!! lol.

one could list anything and everything here if that's the case. mashed potatoes "may" raise the risk...or may reduce it. true! watermelon "may" raise the risk...or may reduce it. true! riding a bike "may" raise the risk...or may reduce it. true!

thank you for not continuing the conversation, at least. i await someone with a better grasp of english semantics. 2601:19C:527F:7890:8017:FAC5:18A:6881 (talk) 02:50, 13 February 2024 (UTC)

There have been recent studies of occupational risk factors for gout. Unanimously all have concluded that carpet cleaning carries by far the highest risk. Editors, please add content related to occupational factors increasing risk of gout. I cannot at the moment, as the article is protected. Thanks, 2601:703:300:820:5C5C:7A94:D011:DB3C (talk) 23:28, 1 December 2019 (UTC)

I know of no such studies and my preliminary search on Google shows nothing either. MartinezMD (talk) 00:23, 2 December 2019 (UTC)

It might be a case of correlation vs causation BlueBellTree (talk) 04:15, 19 December 2024 (UTC)