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Rheumatology Advance Access published online on June 27, 2003
Rheumatology, doi:10.1093/rheumatology/keg402
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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© 2003 Rheumatology 42 © British Society for Rheumatology 2003; all rights reserved

Preliminary report

Near-iron deficiency-induced remission of gouty arthritis

Francesco S. Facchini 1*

1 Department of Medicine, Division of Nephrology, San Francisco General Hospital and University of California, San Francisco, CA and Department of Medicine, Kaiser Foundation Hospitals and the Permanente Medical Group Inc., Oakland, CA, USA

* Corresponding author. E-mail: fste2000{at}yahoo.com.

Received 30 January 2003 ; accepted 8 April 2003

Abstract

Objectives. Previous evidence supports a role for iron in the pathogenesis of gout. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Conversely, iron removal inhibited these responses as well as urate-crystal-induced foot pad inflammation in rats in-vivo. The objective of the present study was to investigate whether or not iron removal may improve the outcome of gouty arthritis in humans as well.

Methods. Quantitative phlebotomy was used to remove iron in 12 hyperuricaemic patients with gouty arthritis and maintain their body iron at near-iron deficiency (NID) level (i.e. the lowest body iron store compatible with normal erythropoiesis and therefore absence of anaemia).

Results. During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year -2, -1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. During NID, attacks were also more often of milder severity.

Conclusions. During a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission to a marked reduction of incidence and severity of gouty attacks.

Key words: Gout, Arthritis, Hyperuricaemia, Oxidative stress, Near-iron deficiency.
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