Spyros N Nikas

The effects of the addition of micronised fenofibrate on uric acid metabolism in patients receiving indapamide.

Summary Objective: Hyperuricaemia is associated with indapamide administration. In contrast, micronised fenofibrate can significantly decrease serum uric acid levels. However, there are no data on the effect of combination therapy of indapamide with micronised fenofibrate on uric acid metabolism. Methods: We studied 20 non-diabetic hypertensive patients with mixed dyslipidaemia in whom serum metabolic parameters, including uric acid levels in serum and urine, were measured before and after eight weeks of indapamide administration (2.5 mg once daily). This study was continued for a further eight weeks, when the indapamide was combined with micronised fenofibrate (200 mg once daily). Results: Indapamide significantly decreased mean systolic and diastolic blood pressure (BP) from 153±9/97±8mmHgto 138 ± 8/93 ± 4mmHg (p < 0.05 for both comparisons). A significant increase in serumuric acid levels occurred after indapamide administration [from a mean value of5.6± 1.3mg/dl (0.33 ± 0.07 mmol/l) to 6.4 ± 1.1 mg/dl (0.38 ± 0.06mmol/l), p< 0.01]. This effect was associated with a decrease in the fractional excretion of uric acid (from a mean value of 9.5 ± 5% to 7 ± 5.5%, p < 0.05). The addition of micronised fenofibrate significantly decreased plasma fibrinogen levels as well as total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB) and triglycerides, and increased high-density lipoprotein cholesterol and ApoA1 levels. Fenofibrate administration was followed by a significant decrease in serum uric acid levels to 4.7± 1.2 mg/dl (0.28 ± 0.07 mmol/l), p < 0.01, owing to a substantial increase in fractionalurate excretion to 11 ± 3%, p < 0.01. Conclusion: The addition of micronised fenofibrate can correct the hyperuricaemic effect of indapamide administration.

The effects of the addition of losartan on uric acid metabolism in patients receiving indapamide

Objective A number of adverse metabolic effects are associated with indapamide administration, including an increase in serum uric acid levels. It has been reported that losartan can significantly decrease serum uric acid levels. However, there are no data on the effects of combination therapy of losartan with indapamide on uric acid metabolism. Methods We studied 20 hypertensive patients in whom serum metabolic parameters, including uric acid levels in serum and urine, were studied before and after eight weeks of indapamide administration (2.5 mg once daily) as well as eight weeks after combination treatment with indapamide (2.5 mg once daily) and losartan (50 mg/day). Results Indapamide evoked a significant decrease in systolic and diastolic blood pressure from a mean value of 157±12 mmHg/96±10 mmHg to a mean value of 139±14 mmHg/92±5 mmHg (p<0.01 for both comparisons). However, a significant increase in serum uric acid levels was noticed after indapamide administration (from a mean value of 4.9±1.6 mg/dl to a mean value of 5.9±1.2 mg/dl, p<0.01), associated with a decrease in the fractional excretion of uric acid (from a mean value of 9±5% to a mean value of 7±5.5%, p<0.05). The addition of losartan caused a further decrease in blood pressure from a mean value of 139±14 mmHg/92±5 mmHg to a mean value of 120±15 mmHg/84±4 mmHg (p<0.01 for both comparisons). This was followed by a significant decrease in serum uric acid levels to 5±1.1 mg/dl (p<0.01) due to a substantial increase in fractional urate excretion (from 7±5.5 to 8.7±6%, p<0.05). Conclusion The addition of losartan could offset the hyperuricaemic effect of indapamide administration.

Healing of psoriatic skin lesions, and improvement of psoriatic arthritis resistant to immunosuppressive drugs, after infliximab treatment

During recent years, much has been learnt about the immunopathology of psoriasis and psoriatic arthritis (PsA). There has been increasing evidence that proinflammatory cytokines, in particular tumour necrosis factor α (TNFα), may play a central part in potentiating the inflammatory process. Both CD4+ and CD8+ T cells are found in psoriatic lesions.1 Thus most of the treatments for psoriasis and PsA are immunosuppressive.2 However, there are several patients refractory to treatment in whom blockade of TNFα by anti-TNFα inhibitors may be useful.3 Five patients (three male, two female; mean (SD) age 41.0 (3.3) years) with longstanding disease (7.9 (3.7) years) refractory to immunosuppressive drugs and corticosteroids were studied. Although some clinical improvement was seen in their musculoskeletal complaints, psoriasis was poorly controlled, requiring frequent inpatient admissions to hospital. Patients were treated with intravenous infliximab (5 …

Asymptomatic splenic infarction in Wegener's granulomatosis

Wegeners granulomatosis (WG) is a necrotising, granulomatous vasculitis that classically involves the clinicopathological triad of upper and lower respiratory tracts and the kidney.1 Less frequently, the disease may affect other organs as well. Serious and occasionally fatal complications within the spleen occur in many autoimmune rheumatic diseases,2 and prompt recognition of these complications is important. In a necropsy series of patients with WG, the spleen was commonly affected: 78–100% of patients had splenic lesions with a combination of necrosis, vasculitis, and granuloma formation.3,4 Clinically apparent splenic disease is rare, however.1 We wish to report briefly the case of a 47 year old woman who presented with manifestations of classical WG and radiological evidence of splenic infarcts. A 47 year old woman during the past month developed fevers to 38.6°C associated with weight loss, diffuse arthralgias, anaemia, and erythrocyte sedimentation rate of more than 100 mm/1st h. During the past three months she complained of nasal congestion …

Effects of Losartan/Diuretic Combination Treatment on Serum Uric Acid Levels in Hypertensive Patients

In the March 15, 2001 issue of the AJC, Oparil et al showed that losartan/hydrochlorothiazide is effective in treating severe hypertension and is well tolerated since drug-related adverse effects occurred in 22.9%. According to the authors, this combination regimen did not significantly affect serum glucose levels and resulted in a decrease in serum uric acid levels.

Painless shoulder mass

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 3 janvier 2015