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The Development of Gout Treat-To-Target booklet

Mustafa N, Isa MR, Baharuddin H

Med J Malaysia, 2024 Jan;79(1):80-84.
PMID: 38287762

INTRODUCTION: The treat-to-target serum uric acid approach is recommended in local and international guidelines on gout management. Instruction for initiation and dose escalation for urate lowering therapy may cause confusion to the patient. Our aim was to develop and validate Gout Treat-To- Target booklet to aid in patient education.
MATERIALS AND METHODS: A content development team which consisted of three consultant rheumatologists developed the booklet. Content validation was performed by a panel of evaluators consisted of eleven physicians (four consultant rheumatologists, two clinical specialists, and five medical officers), who were involved in gout management. Face validation was performed by ten patients with gout.
RESULTS: Item-Content Validity Index ranged from 0.9 to 1 with regards to relevancy, clarity, ambiguity and simplicity. Side effects of uricosuric agents were added to the draft based on an evaluator's comment. Item-Face Validity Index was 1, which indicated that all patients were in 100% agreement with all items.
CONCLUSION: We developed and validated our Gout Treat-to- Target booklet. There was high agreement in I-FVI and I-CVI among physicians and patients.

Matched MeSH terms: Uric Acid*
A simple and sensitive fluorescence based biosensor for the determination of uric acid using H2O2-sensitive quantum dots/dual enzymes

Azmi NE, Ramli NI, Abdullah J, Abdul Hamid MA, Sidek H, Abd Rahman S, et al.

Biosens Bioelectron, 2015 May 15;67:129-33.
PMID: 25113659 DOI: 10.1016/j.bios.2014.07.056

A novel optical detection system consisting of combination of uricase/HRP-CdS quantum dots (QDs) for the determination of uric acid in urine sample is described. The QDs was used as an indicator to reveal fluorescence property of the system resulting from enzymatic reaction of uricase and HRP (horseradish peroxidase), which is involved in oxidizing uric acid to allaintoin and hydrogen peroxide. The hydrogen peroxide produced was able to quench the QDs fluorescence, which was proportional to uric acid concentration. The system demonstrated sufficient activity of uricase and HRP at a ratio of 5U:5U and pH 7.0. The linearity of the system toward uric acid was in the concentration range of 125-1000 µM with detection limit of 125 µM.

Matched MeSH terms: Uric Acid/isolation & purification*; Uric Acid/urine; Uric Acid/chemistry
Fulltext Serum uric acid levels and its association with age-related macular degeneration (ARMD)

Subramani S, Khor SE, Livingstone BI, Kulkarni UV

Med J Malaysia, 2010 Mar;65(1):36-40.
PMID: 21265246 MyJurnal

To investigate the possible association between serum uric acid levels, serum C-Reactive Protein (CRP), and age-related macular degeneration (ARMD). A total 232 patients of the eye department at Hospital Tuanku Ja'afar, Negeri Sembilan, Malaysia were recruited over 9 weeks. Participants were divided into ARMD (Non-Neovascular ARMD, and Neovascular ARMD) and control groups. 107 participants with non-neovascular ARMD, 6 with neovascular ARMD, and 119 controls participated in the study. The control patients had a similar average Serum Uric Acid level to the average of all patients with ARMD (P = 0.617).

Matched MeSH terms: Uric Acid/blood*
Fulltext In vivo detection of monosodium urate crystal deposits by Raman spectroscopy-a pilot study

Abhishek A, Curran DJ, Bilwani F, Jones AC, Towler MR, Doherty M

Rheumatology (Oxford), 2016 Feb;55(2):379-80.
PMID: 26342227 DOI: 10.1093/rheumatology/kev339

Study done in England

Matched MeSH terms: Uric Acid/analysis*
Uric acid induces liver fibrosis through activation of inflammatory mediators and proliferating hepatic stellate cell in mice

Sari DCR, Soetoko AS, Soetoko AS, Romi MM, Tranggono U, Setyaningsih WAW, et al.

Med J Malaysia, 2020 05;75(Suppl 1):14-18.
PMID: 32471964

INTRODUCTION: Uric acid is associated with cardiometabolic risk factor and severity of liver damage. The mechanism of uric acid inducing liver damage is still elusive. This study elucidates the development of liver fibrosis under hyperuricemia.
METHODS AND MATERIALS: Hyperuricemia model was performed in male Swiss Webster mice. Intraperitoneally injection of uric acid (125mg/kg body weight) was done for 7 and 14 days (UA7 and UA14 groups). Meanwhile, the UAL groups were injected with uric acid and followed by the administration of allopurinol (UAL7 and UAL14 groups). On the due date, mice were sacrificed, and liver was harvested. Uric acid, SGOT, SGPT, and albumin level were measured from the serum. The mRNA expression of TLR4, MCP1, CD68, and collagen1 were assessed through RT-PCR. Liver fibrosis was quantified through Sirius red staining, while the number of hepatic stellates cells (HSCs) and TLR4 were assessed through IHC staining.
RESULTS: Uric acid induction for 7 and 14 days stimulated an increase of both SGOT and SGPT serum levels. Followed by enhanced inflammatory mediators: Toll-like receptor-4 (TLR- 4), Monocyte Chemoattractant Protein-1 (MCP-1) and Cluster of Differentiation 68 (CD68) mRNA expression in the liver (p<0.05). The histological findings showed that the UA7 and UA14 groups had higher liver fibrosis scores (p<0.05), collagen I mRNA expression (p<0.05), and the number of HSCs (p<0.05) compared to Control group. Administration of allopurinol showed amelioration of uric acid and liver enzymes levels which followed by inflammatory mediators, liver fibrosis and collagen1, and hepatic stellate cells significantly.
CONCLUSION: Therefore, uric acid augmented the liver fibrosis by increasing the number of hepatic stellate cells.

Matched MeSH terms: Uric Acid/metabolism*
Uric acid, xanthine oxidase and other risk factors of hypertension in normotensive subjects

Newaz MA, Adeeb NN, Muslim N, Razak TA, Htut NN

Clin Exp Hypertens, 1996 Nov;18(8):1035-50.
PMID: 8922344

Uric acid produced by xanthine oxidase (also a source of superoxide radicals) has been known to increase in hypertensive patients. In this study we evaluated the possible involvement of uric acid and xanthine oxidase in the pathogenesis of hypertension by examining their association with mean arterial pressure (MAP) and factors related to blood pressure. These factors include age, quetelet index (weight/height2), cholesterol, creatinine, calcium (Ca), magnesium (Mg), sodium (Na), potassium (K) and urea. Fifty Two (male-19, female-33) normal healthy individuals were studied. Correlation studies of demographic variables showed that age was positively correlated with MAP [r = 0.309, p = 0.026] and cholesterol [r = 0.503, p = 0.000] while quetelet index was positively correlated with age [r = 422, p = 0.000] MAP [r = 0.331, p = 0.016] and xanthine oxidase [r = 0.331, p = 0.016]. MAP was positively correlated with uric acid [r = 0.511, p = 0.000], cholesterol [r = 0.492, p = 0.000] and xanthine oxidase enzyme activity [r = 0.388, p = 0.004] and negatively correlated with plasma calcium [r = 0.603, p = 0.000]. Correlation studies of measured parameters with uric acid and xanthine oxidase showed that uric acid was positively correlated with creatinine [r = 0.627, p = 0.000], plasma magnesium [r 0.442, p = 0.001] and negatively correlated with plasma calcium [r = 0.546, p = 0.000] while xanthine oxidase was negatively correlated with plasma calcium [r = -0.404, p = 0.003] and plasma sodium [r = -0.288, p = 0.038]. Stepwise multiple regression with MAP as dependent variable showed that 65% of total variability of blood pressure can be accounted for by plasma calcium, cholesterol, creatinine, plasma K, plasma Na, uric acid and xanthine oxidase in order of increasing R2 [xanthine oxidase: T-value = 3.26, R2 = 0.653]. It can be concluded that in normotensive subjects, uric acid and xanthine oxidase have significant association with blood pressure and thus are one of the many factors which are involved in the cause or effect of hypertension.

Matched MeSH terms: Uric Acid/blood*
Enhancing uric acid electrochemical detection with copper ion-activated mini protein mimicking uricase within ZIF-8: response surface methodology (RSM) optimization

Abdul Aziz SFN, Hui OS, Salleh AB, Normi YM, Yusof NA, Ashari SE, et al.

Anal Bioanal Chem, 2024 Jan;416(1):227-241.
PMID: 37938411 DOI: 10.1007/s00216-023-05011-z

This study aims to investigate the influence of copper(II) ions as a cofactor on the electrochemical performance of a biocomposite consisting of a mini protein mimicking uricase (mp20) and zeolitic immidazolate framework-8 (ZIF-8) for the detection of uric acid. A central composite design (CCD) was utilized to optimize the independent investigation, including pH, deposition potential, and deposition time, while the current response resulting from the electrocatalytic oxidation of uric acid was used as the response. The statistical analysis of variance (ANOVA) showed a good correlation between the experimental and predicted data, with a residual standard error percentage (RSE%) of less than 2% for predicting optimal conditions. The synergistic effect of the nanoporous ZIF-8 host, Cu(II)-activated mp20, and reduced graphene oxide (rGO) layer resulted in a highly sensitive biosensor with a limit of detection (LOD) of 0.21 μM and a reproducibility of the response (RSD = 0.63%). The Cu(II)-activated mp20@ZIF-8/rGO/SPCE was highly selective in the presence of common interferents, and the fabricated layer exhibited remarkable stability with signal changes below 4.15% after 60 days. The biosensor's reliable performance was confirmed through real sample analyses of human serum and urine, with comparable recovery values to conventional HPLC.

Matched MeSH terms: Uric Acid/analysis
Tophaceous gout in young patients with systemic lupus erythematosus

Veerapen K, Schumacher HR, van Linthoudt D, Neilson EG, Wang F

J Rheumatol, 1993 Apr;20(4):721-4.
PMID: 8496872

Systemic lupus erythematosus (SLE) and gout have been associated infrequently. We describe 3 young adults with SLE who developed tophaceous gout relatively early in the course of their disease. All were underexcretors of uric acid but were studied after the development of renal disease; 2 were treated with diuretics. In 2 cases, gout became obvious while lupus was quiescent.

Matched MeSH terms: Uric Acid/metabolism*
Fulltext Raman spectroscopy applied to the noninvasive detection of monosodium urate crystal deposits

Curran DJ, Rubin L, Towler MR

Clin Med Insights Arthritis Musculoskelet Disord, 2015;8:55-8.
PMID: 26327784 DOI: 10.4137/CMAMD.S29061

An off-the-shelf Raman Spectrometer (RS) was used to noninvasively determine the presence of monosodium urate (MSU) crystals on the metatarsophalangeal joint (MTPJ) of a single gout sufferer. The spectrum sourced from the clinically diagnosed gout sufferer was compared to that sourced from an age-matched healthy subject scanned using the same protocol. Minimal signal processing was conducted on both spectra. Peaks characteristic of MSU crystals were evident on the spectrum sourced from the gout sufferer and not on the spectrum from the healthy control.

Study done in Canada

Matched MeSH terms: Uric Acid
A comparative study of relative incidence of stone types between a transient military population and the indigenous population of the Hawaiian Islands

Wurster JC, Ceccarelli FE, Chinn HY

J Urol, 1970 Oct;104(4):581-5.
PMID: 5476472
Matched MeSH terms: Uric Acid/analysis*; Uric Acid/blood
Fulltext Suggestive evidence of SIc2a9 polymorphisms association in gouty malay males

Mahfudzah A, Nazihah MY, Wan Syamimee WG, Huay, Lin T, Wan Rohani WT

International Medical Journal Malaysia, 2015;14(2):35-40.
MyJurnal

Introduction: Solute carrier family 2, member 9 (SLC2A9) is thought to be an important urate transporter that influences the excretion and reabsorption of serum uric acid, thus has a strong effect on serum urate and risk of gout. SLC2A9 polymorphisms have been extensively studied in various populations in association with gout development. Our aim was to test for association of SLC2A9 SNPs with gout in Malay males.
Methods: 78 gouty patients and 82 normal subjects were recruited and genotyped for rs3733591, rs5028843 and rs11942223 using PCR-RFLP technique. Single association and haplotype association analyses were conducted using SHEsis online software.
Results: rs3733591 and rs5028843 showed association with gout with p value of 0.020 and 0.036, respectively, whilst rs11942223 yielded no association with p value of 0.08 with trend towards susceptibility projecting by OR=3.547, 3.667 and 2.732, respectively. It is noteworthy that haplotype 1/1/1 conferred protection in gout with p value 0.004 (OR=0.324 [0.147-0.716]).
Conclusion: This study might suggest an evidence of association of SLC2A9 SNPs with gout among Malay males.
KEYWORDS: Gout, SLC2A9, Malay males
Study site: Medical Specialist Clinic at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Uric Acid
Fulltext Successful febuxostat desensitization in a patient with febuxostat hypersensitivity: A Malaysian experience

Sulaiman N, Othman AZ, Shahril NS, Abdul Rashid AM, Md Noh MSF

SAGE Open Med Case Rep, 2017;5:2050313X17749080.
PMID: 29318019 DOI: 10.1177/2050313X17749080

Over the years, allopurinol has been widely used as the preferred choice of urate lowering therapy in patients with gout. However, its role in patients with renal impairment is limited; and adverse reactions are well documented. Febuxostat, a newer oral non-purine xanthine oxidase inhibitor has been proven in several trials to be more effective and tolerable compared to allopurinol and may be used in patients with renal impairment. Here, we describe a case of successful febuxostat desensitization in a patient with a history of allopurinol- and febuxostat-induced adverse cutaneous reaction, as well as the protocol utilized.

Matched MeSH terms: Uric Acid
Beneficial effects of mangiferin isolated from Salacia chinensis on biochemical and hematological parameters in rats with streptozotocin-induced diabetes

Sellamuthu PS, Arulselvan P, Fakurazi S, Kandasamy M

Pak J Pharm Sci, 2014 Jan;27(1):161-7.
PMID: 24374436

Salacia chinensis L. is a traditional Southeast Asian herbal medicine and used in the treatment of diabetes. To investigate the antidiabetic properties of mangiferin from Salacia chinensis and its beneficial effect on toxicological and hematological parameters in streptozotocin induced diabetic rats. Mangiferin was orally treated with the dose of 40 mg/kg body weight/day for 30 days to diabetic rats. Biochemical (blood glucose, uric acid, urea and creatinine), toxicological (AST, ALT and ALP) and hematological parameters (red and white blood cells) and their functional indices were evaluated in diabetic treated groups with mangiferin and glibenclamide. Mangiferin treated diabetic rats significantly (p<0.05) lowered the level of blood glucose, in addition, altered the levels of biochemical parameters including urea, uric acid, and creatinine. Toxicological parameters including AST, ALT and ALP were also significantly reduced after treatment with mangiferin in diabetic rats. Similarly, the levels of red blood, white blood cells and their functional indices were significantly improved through the administration of mangiferin. Thus, our results indicate that mangiferin present in S. chinensis possesses antidiabetic properties and nontoxic nature against chemically induced diabetic rats. Further experimental investigations are warrant to make use of its relevant therapeutic effect to substantiate its ethno-medicinal usage.

Matched MeSH terms: Uric Acid/blood
Studies on diuretic and hypouricemic effects of Orthosiphon stamineus methanol extracts in rats

Arafat OM, Tham SY, Sadikun A, Zhari I, Haughton PJ, Asmawi MZ

J Ethnopharmacol, 2008 Aug 13;118(3):354-60.
PMID: 18602231 DOI: 10.1016/j.jep.2008.04.015

AIM OF THE STUDY: Orthosiphon stamineus (Labiatae) is a traditional folk medicine widely used in Southeast Asia for the treatment of several kidney disorders, gout and as a diuretic. This study was conducted to examine the diuretic and hypouricemic effects of Orthosiphon stamineus leaf extracts.
MATERIALS AND METHODS: The diuretic effect of different methanol extracts was examined by treating different groups of Sprague-Dawley rats with single (2g/kg) oral doses of methanol and methanol:water (1:1) extracts. Hydrochlorothiazide (10mg/kg) was used as positive control in acute study. Methanol and methanol water (1:1) extracts at 0.5 g/kg were administered for a period of 7 consecutive days. Cumulative urine volume and electrolytes (Na+ and K+) concentrations at different time intervals were measured. On the other hand, hypouricemic activity of methanol:water extract (1:1) was experimented using different oral single doses (0.25, 0.5, 1 and 2g/kg). Allopurinol was used as positive control. Uric acid concentration in serum was analyzed by using RP-HPLC at 280 nm.
RESULTS: Sodium and potassium excretion increased significantly (p<0.05 and <0.01) in the first 8h of treatment with a single dose (2g/kg) of the extracts in a pattern comparable to that of the known diuretic hydrochlorothiazide. Meanwhile, repeated administration of 0.5 g/kg methanol:water (1:1) extract showed a significant increase in urine volume (from day 3 to day 7) (p<0.01) and electrolytes excretion (Na+ and K+) from day 2 to day 7 (p<0.05 and <0.01). On the other hand, 0.5, 1 and 2g/kg of methanol:water (1:1) extract and the standard allopurinol reduced the serum urate level in hyperuricemic rats at hour 6.
CONCLUSION: These results provided an evidence of the high tendency of methanol:water (1:1) extract of Orthosiphon stamineus towards diuretic and hypouricemic effects in rats.

Matched MeSH terms: Uric Acid/blood*
Sensitive voltammetric determination of paracetamol by poly (4-vinylpyridine)/multiwalled carbon nanotubes modified glassy carbon electrode

Ghadimi H, Tehrani RM, Ali AS, Mohamed N, Ab Ghani S

Anal Chim Acta, 2013 Feb 26;765:70-6.
PMID: 23410628 DOI: 10.1016/j.aca.2012.12.039

A novel glassy carbon electrode (GCE) modified with a composite film of poly (4-vinylpyridine) (P4VP) and multiwalled carbon nanotubes (P4VP/MWCNT GCE) was used for the voltammetric determination of paracetamol (PCT). This novel electrode displayed a combined effect of P4VP and MWCNT on the electro-oxidation of PCT in a solution of phosphate buffer at pH 7. Hence, conducting properties of P4VP along with the remarkable physical properties of MWCNTs might have combined effects in enhancing the kinetics of PCT oxidation. The P4VP/MWCNT GCE has also demonstrated excellent electrochemical activity toward PCT oxidation compared to that with bare GCE and MWCNT GCE. The anodic peak currents of PCT on the P4VP/MWCNT GCE were about 300 fold higher than that of the non-modified electrodes. By applying differential pulse voltammetry technique under optimized experimental conditions, a good linear ratio of oxidation peak currents and concentrations of PCT over the range of 0.02-450 μM with a limit of detection of 1.69 nM were achieved. This novel electrode was stable for more than 60 days and reproducible responses were obtained at 99% of the initial current of PCT without any influence of physiologically common interferences such as ascorbic acid and uric acid. The application of this electrode to determine PCT in tablets and urine samples was proposed.

Matched MeSH terms: Uric Acid/chemistry
Fulltext Significant association between parathyroid hormone and uric acid level in men

Chin KY, Nirwana SI, Ngah WZ

Clin Interv Aging, 2015;10:1377-80.
PMID: 26346636 DOI: 10.2147/CIA.S90233

Previous reports of patients undergoing parathyroidectomy and of patients receiving teriparatide as antiosteoporotic treatment have suggested a plausible relationship between parathyroid hormone (PTH) and uric acid. However, similar data at population level were lacking. The current study aimed to determine the relationship between PTH and uric acid in a group of apparently healthy Malaysian men.

Matched MeSH terms: Uric Acid/blood*
Instrumental neutron activation analysis of kidney stones

Sarmani S, Kuan LL, Bakar MA

Biol Trace Elem Res, 1990 7 1;26-27:497-502.
PMID: 1704755

Kidney stone samples of the types calcium oxalate, uric acid, and xanthine were analyzed for their elemental contents by neutron activation analysis to study both the elemental correlation and influence of element on stone precipitation processes. Elements, such as Al, Au, Br, Ca, Cl, Co, Cr, Fe, Hg, I, K, Mg, Na, Sb, Se, Sr, and Zn, were determined quantitatively. Calcium oxalate stones contained higher concentration of all the elements analyzed compared to uric acid or xanthine stones. The concentrations of Cl, Fe, K, Na, Sr, and Zn were relatively higher than Au, Co, Cr, and Sb. A positive correlation exists between Ca and Zn, whereas a negative correlation exists between Sr and Ca. Zinc may play an important role in the formation of calcium oxalate stone.

Matched MeSH terms: Uric Acid/analysis
Comparison of uric acid levels in some Oriental and Caucasian groups unselected as to gout or hyperuricemia

Duff IF, Mikkelsen WM, Dodge HJ, Himes DS

Arthritis Rheum., 1968 Apr;11(2):184-90.
PMID: 5645731 DOI: 10.1002/art.1780110209
Matched MeSH terms: Uric Acid/blood*
Combinational effect of angiotensin receptor blocker and folic acid therapy on uric acid and creatinine level in hyperhomocysteinemia-associated hypertension

Singh Y, Samuel VP, Dahiya S, Gupta G, Gillhotra R, Mishra A, et al.

Biotechnol Appl Biochem, 2019 Sep;66(5):715-719.
PMID: 31314127 DOI: 10.1002/bab.1799

Homocysteine [HSCH2 CH2 CH(NH2 )COOH] (Hcy) is a sulfur-containing amino acid of 135.18 Da of molecular weight, generated during conversion of methionine to cysteine. If there is a higher accumulation of Hcy in the blood, that is usually above 15 µmol/L, it leads to a condition referred to as hyperhomocysteinemia. A meta-analysis of observational study suggested an elevated concentration of Hcy in blood, which is termed as the risk factors leading to ischemic heart disease and stroke. Further experimental studies stated that Hcy can lead to an increase in the proliferation of vascular smooth muscle cells and functional impairment of endothelial cells. The analyses confirmed some of the predictors for Hcy presence, such as serum uric acid (UA), systolic blood pressure, and hematocrit. However, angiotensin-converting enzyme inhibitors angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) alone are inadequate for controlling UA and creatinine level, although the addition of folic acid may be beneficial in hypertensive patients who are known to have a high prevalence of elevated Hcy. We hypothesized that combination therapy with an ARB (olmesartan) and folic acid is a promising treatment for lowering the UA and creatinine level in hyperhomocysteinemia-associated hypertension.

Matched MeSH terms: Uric Acid/blood*
Fabrication of low-cost sustainable electrocatalyst: a diagnostic tool for multifunctional disorders in human fluids

Sinduja B, Gowthaman NSK, John SA

J Mater Chem B, 2020 10 28;8(41):9502-9511.
PMID: 32996975 DOI: 10.1039/d0tb01681k

In purine metabolism, the xanthine oxidoreductase enzyme converts hypoxanthine (HXN) to xanthine (XN) and XN to uric acid (UA). This leads to the deposition of UA crystals in several parts of the body and the serum UA level might be associated with various multifunctional disorders. The dietary intake of caffeine (CF) and ascorbic acid (AA) decreases the UA level in the serum, which leads to cellular damage. Hence, it is highly needed to monitor the UA level in the presence of AA, XN, HXN, and CF and vice versa. Considering this sequence of complications, the present paper reports the fabrication of an electrochemical sensor using low-cost N-doped carbon dots (CDs) for the selective and simultaneous determination of UA in the presence of AA, XN, HXN, and CF at the physiological pH. The colloidal solution of CDs was prepared by the pyrolysis of asparagine and fabricated on a GC electrode by cycling the potential from -0.20 to +1.2 V in a solution containing CDs and 0.01 M H2SO4. Here, the surface -NH2 functionalities of CDs were used to make a thin film of CDs on the GC electrode. FT-IR spectroscopy confirmed the involvement of the -NH2 group in the formation of the CD film. HR-TEM analysis depicts that the formed CDs showed spherical particles with a size of 1.67 nm and SEM analysis exhibits the 89 nm CD film on the GC electrode surface. The fabricated CD film was successfully used for the sensitive and selective determination of UA. The determination of UA was achieved selectively in a mixture consisting of AA, XN, HXN, and CF with 50-fold high concentration. The CDs-film fabricated electrode has several benefits over the bare electrode: (i) well-resolved oxidation peaks for five analytes, (ii) boosted sensitivity, (iii) shifted oxidation as well as on-set potentials toward less positive potentials, and (iv) high stability. The practical utility of the present sensor was tested by simultaneously determining the multifactorial disorders-causing agents in human fluids. The electrocatalyst developed in the present study is sustainable and can be used for multiple analyses; besides, the electrochemical method used for the fabrication of the CD film is environmentally benign.

Matched MeSH terms: Uric Acid/blood*

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