Talk:Gout/Archive 2

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Text
This is not correct "The deposit of urate crystals in soft tissues, in particular the joints and kidney, causes pain and inflammation, which can be seen if near the surface as red, inflamed tissue called 'tophi'." Tophi are not red and inflamed. Doc James (talk · contribs · email) 16:01, 6 April 2016 (UTC)
 * From the source given: "Such deposits, when superficial, can be seen grossly as reddish, inflamed masses called topi." You can insist it is the surrounding tissue that is inflamed but that is just nit picking. Try improving the article by providing a definition that gets straight to the point rather than defending what you obviously believe to be your purview. Zedshort (talk) 18:03, 7 April 2016 (UTC)
 * The source provided is which is a little old.
 * Is it this ref that supports this?
 * WRT this content "s a disease caused by abnormal purine metabolism that results in increased levels of uric acid in the blood, and the failure of the kidneys to excrete the uric acid at a sufficient rate. Primary gout is a hereditary disease seen most often in middle-aged males that, however, is not see as frequently in females. Secondary gout is the result of some other disease that produces gout."
 * The second paragraph already says "The cause is a combination of diet and genetic factors. It occurs more commonly in those who eat a lot of meat, drink a lot of beer, or are overweight. The underlying mechanisms involves elevated levels of uric acid in the blood. When the uric acid crystallizes and thecrystals deposit in joints, tendons, and surrounding tissues, an attack of gout occurs."
 * And the fourth paragraph says "Older males are most commonly affected."
 * Therefore what you are adding is simply duplicating content already covered with better sources. Doc James  (talk contribs · email) 18:56, 7 April 2016 (UTC)·
 * I see, and so you think that the original and very badly written definition that begins with a particular example in that definition is better? Having following paragraphs support the definition is helpful not a hinderance. Afterall the introduction starts the article and all of that material is expanded on in the body of the article. If you think the other paras are redundant, please remove them. Stuffing podgora up front is not appropriate, as it is a specific example, so how about removing it? The date of the reference is immaterial as it is a complete definition. Better still how about if I refer to Britannica? Surely that would be better than the dross you support. Zedshort (talk) 20:02, 7 April 2016 (UTC)
 * We generally provide 4 paragraph overviews for diseases. This should be read as a whole. We do not have a one paragraph overview and than repeat it all again in the next three paragraphs and than repeat it all a third time in the body. We just repeat it twice, once in the lead and once in the body. Also do not add blocks of copyrighted text again. Doc James  (talk · contribs · email) 20:09, 7 April 2016 (UTC)
 * Interestingly the EB also puts podagra upfront. Doc James  (talk · contribs · email) 20:49, 7 April 2016 (UTC)
 * First off, who is "we"? Is that the royal we you are using? Honestly that is how you come across. Why don't you read the original definition of gout and honestly ask yourself if a person who is unfamiliar with the subject would gain a clear understanding of the subject? Zedshort (talk) 20:38, 7 April 2016 (UTC)
 * It is the text at WP:LEAD the "we" refers to. Doc James  (talk · contribs · email) 20:44, 7 April 2016 (UTC)
 * Zed, can you propose a new version here instead of copying and pasting large blocks of copyrighted materials from tertiary sources? The wording can be improved, yes, but let's collaborate. And using up to date summaries of reviews in medical journals is better than using encyclopedias.   20:13, 7 April 2016 (UTC)
 * Why don't you just try reading the original article and the forms I proposed and let common sense rule. Zedshort (talk) 20:38, 7 April 2016 (UTC)


 * Was also just coming here to comment on that 1982 encyclopedia, McGraw-Hill Concice Encyclopedia of Science and Technology--this is a very old (per WP:MEDDATE) source and is a generalist tertiary source, it's a low-tier source and much better sources are available and in use in the article. This source should be avoided.   19:02, 7 April 2016 (UTC)


 * Zedshort you have Wikipedia upside down. You write "the introduction starts the article and all of that material is expanded on in the body of the article".  No.  per WP:LEAD, the lead summarizes the body.  Please don't introduce content or sourcing to the lead that is not already in the body. Please also note Zad's comments about your source, above. And please don't copy/paste from other sources, as you did from this source in the difs you are edit-warring over, especially not when there is nothing particularly sparkling or essential in the content.  It doesn't get more pedestrian than Britannica.   In my view, the current introduction is an apt summary of the body.  Rather than continuing to edit war, please consider proposing changes here. Thanks  Jytdog (talk) 20:46, 7 April 2016 (UTC)

Inflammatory arthritis
this comes as a complete layman in medicine so I might be missing jargon or some other detail, but the inflammatory in inflammatory arthritis seems rather redundant considering the meaning of the -itis suffix. I cannot imagine a form of arthritis that is not inflammatory. Is this done to make it easier to read or am I missing something? — Preceding unsigned comment added by Henkalv (talk • contribs) 11:53, 4 June 2016 (UTC)
 * The use is appropriate. See, for example, this page from the Arthritis Foundation. It's a distinction based primarily on the characteristics of the synovial fluid (see ). When there are fewer than 2000 leukocytes (white blood cells, WBC) per cubic mm and less than 75% of them are polymorphonuclear (PMN, which would include granulocytes), the fluid is considered non-inflammatory. The most common condition associated with non-inflammatory synovial fluid is osteoarthritis, which we now know is an inflammatory condition but not as inflammatory as rheumatoid arthritis, septic arthritis, or gout. Hope this helps clarify. &mdash; soupvector (talk) 18:02, 4 June 2016 (UTC)

Rasburicase
Rasburicase is not a human protein and to my knowledge, bears no significant homology with any human protein. Therefore, it cannot trigger a 'autoimmune' response, merely an immune response leading to similar outcomes as the immunization to monoclonal antibodies from mice or rats used in the past. 80.12.33.4 (talk) 19:15, 16 August 2016 (UTC)
 * Done Doc James  (talk · contribs · email) 19:26, 16 August 2016 (UTC)

Add this to Prevention section
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. 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.

--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)

Lancet seminar
10.1016/S0140-6736(16)00346-9 JFW &#124; T@lk  14:19, 23 October 2016 (UTC)

ACP reviews/guidelines
Four papers!
 * Review of diagnosis 10.7326/M16-0462
 * Review of treatment 10.7326/M16-0461
 * Guideline for diagnosis: 10.7326/M16-0569
 * Guideline for treatment: 10.7326/M16-0570

JFW &#124; T@lk  11:58, 1 November 2016 (UTC)

Historical treatments
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)

Question?
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?


 * 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)

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

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Edit definition
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)
 * Yes check.svg 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)

Dairy inconsistency
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)

Semi-protected edit request on 14 June 2018
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)

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

Incorrect Speciality
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)

cks.nice.org.uk
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). &mdash; soupvector (talk) 00:35, 28 August 2019 (UTC)