Preventing of Gouty Arthritis - Essay Example

Literature critique Literature Critique Different duration of colchicines for preventing recurrence of Gouty arthritis Author Type of Research study: The study was case-controlled and of retrospective type. Background Information and Problem statement (Karimzadeh et al., 2005) Acute gout commonly known as gouty arthritis is a common recurrent clinical syndrome and is caused by an over production of uric acid or inability of the kidney to clear uric acid from the system, this leads to sudden accumulation of uric acid crystals in joints leading to swelling and inflammation. It is detected by increased levels of uric acid in the blood. The therapy and prevention of the disease involves the use of urate lowering agents. Article Purpose Discussion Gout is more prevalent in males and affects about 1 % of males in the western population. Gouty arthritis is generally treated by NSAIDS and colchicines. However the data supporting the use and duration of colchicines is sparse. This directed the need to study prophylaxis with colchicines for different durations. This article reviews the trial conducted to study different duration of colchicines for preventing recurrence of Gouty arthritis and critique the methodologies used and recommends areas of future research. Hypothesis statement and discussion Colchicine is used for prophylaxis treatment against recurrent attacks of gout. But the most suitable duration of its administration for gouty arthritis needs to be assessed. The researchers in this study have hypothesized three regimens of dosage that can be beneficial to the patients without causing any harm. Research Design and Method Discussion This clinical trial involved 229 patients who reported with gout to the rheumatology clinic in Isfahan during 2000-2005. Inclusion criteria The patients selected for the study on the following conditions: 1. Patients diagnosed with gout at least one year past. 2. At least one indication showing indications of long term treatment with urate- lowering agents. 3. Demographic data 4. Duration of attacks in previous years 5. History of other related disorders like Renal stone, tophi and physical examination. 6. Previous use of drugs. 7. Previous laboratory data which involved reports of serum uric acid levels, liver and kidney function tests, Blood count, Creatinine, BUN, uric acid levels of 24 hour urine. Exclusion criteria If the patients relapsed before the end of one year they were excluded from the study and treated for acute gouty arthritis. Randomization of sample All patients were treated with allopurinol to lower the level of uric acid stored in the joints and randomly divided into three groups, the dosage of drug was kept constant (1mg/day) in all the groups but the period of treatment differed in every group ranging from 3-6 months (group 1), 7-9 months (group 2),10-12 months (group 3). The study did not include a placebo group. All the groups under study belong to the same age group of people all were in their 50's also since statistics have confirmed for every 7-9 male affected there will be 1 female affected that accounts to be 3% of women, hence few women are included in the study just about 3 % in all groups. The normal upper limit of serum uric acid is 7mg/dl in men and 6 mg/dl in women. A change in uric acid level is one of the predisposing factors for recurrence of acute gouty arthritis hence all the patients selected for the study have a mean uric acid level of 8.5 (mg/dl). For detecting similarity between patients of each group they were divided to two subgroups; with recurrence of arthritis or without any episode of arthritis, and mean level of serum uric acid and age were compared using T-test the difference was insignificant. Thus the researchers have taken care of carefully dividing the groups and the groups are comparable. Also age, gender and race are the confounding variables in the study and these variables are masked by proper experiment design. Although same age group, male female ratio in the study and uric acid levels are the strengths of the study design but one may not be sure about the diet of every patient in the study. Since dietary pattern and use of alcoholic beverages, trauma, hemorrhage or the use of medications that elevate uric acid levels(Francis, 2006) this could act as a potential source of sample bias. Design characteristics All the three groups under study were followed up for 1 year after the treatment regimen was complete. After every three months the patients were evaluated by the following laboratory tests Blood count, liver function test, kidney function test and uric acid level were checked to study any evidence related to recurrence of acute arthritis. For detecting probablity of recurrence of acute arthritis, Kaplan- Meier method from SPSS 11.5 was used, and the survival curves of three groups were compared with Log-Rank test. The validity of the experiment can have threats due to inadequacy of tests instrumental to study the sample performance like a false positive or negative score of a subject. About 10 % of patients with gout have normal serum uric acid level at the time of their attack and hence the correct diagnosis of gout may be missed if the joint is not aspirated owing to normal uric acid level. (Francis, 2006) Data Analysis In this study 190 patients completed follow up. At the end of six months; the probability of recurrence of occurred attack was 46 %,11 % and 6% in groups 1,2,3, and in the end of one year; was 54%, 27.5% and 23 % in group 1,2,3 respectively. The study showed extreme scores of group 1. when verified by Log-Rank test significant difference was seen between group 1 and others (p Read More