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Kiadaliri AA, Englund M. Temporal trends and regional disparity in rheumatoid arthritis and gout hospitalizations in Sweden, 1998-2015. Clin Rheumatol 2018; 37:825-830. [PMID: 29359231 PMCID: PMC5835057 DOI: 10.1007/s10067-018-3983-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/05/2022]
Abstract
Hospitalization is an important component of rheumatoid arthritis (RA) and gout economic burden. This study aimed to assess temporal trends and regional disparities in RA and gout hospitalizations among people aged ≥ 20 years in Sweden during 1998–2015. Data on hospital admissions with a principal diagnosis of RA or gout were collected from the National Patient Register. Age-standardized hospitalization rates (ASHRs) were calculated by means of direct standardization. The absolute and relative regional disparities were assessed. The temporal trends in ASHR and proportion of RA and gout hospitalizations from all and musculoskeletal disorders hospitalizations were analyzed using joinpoint regression. Between 1998–2000 and 2013–2015, the ASHR for RA declined by 78.9% from 109.9 to 23.2 per 100,000 Swedish adults, while it almost doubled for gout (from 10.5 to 20.8 per 100,000 Swedish adults). While in 1998–2000, RA hospitalizations were 10.3 times more frequent than gout (0.54 vs 0.05% of all hospitalizations), this ratio declined to 1.1 in 2013–2015 (0.13 vs 0.11% of all hospitalizations). The joinpoint regression revealed that, on average, the ASHR for RA declined by 10.2% (95% CI: 9.3–11.1) per year whereas for gout, it rose by 4.3% (3.2–5.4) per year during 1998–2015. While the relative regional disparities were stable, the absolute regional disparity declined for RA and increased for gout over the study period. While substantial decline in RA hospitalization is encouraging, the substantial rise in gout hospitalization is of concern, reflecting potential increase in prevalence of gout and suboptimal management of the disease.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
- Skåne University Hospital, Clinical Epidemiology Unit, Remissgatan 4, SE-221 85, Lund, Sweden.
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Kim JW, Kwak SG, Park SH. Prescription pattern of urate-lowering therapy in Korean gout patients: data from the national health claims database. Korean J Intern Med 2018; 33:228-229. [PMID: 28823114 PMCID: PMC5768547 DOI: 10.3904/kjim.2016.429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/17/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung-Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
- Correspondence to Sung-Hoon Park, M.D. Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Namgu, Daegu 42472, Korea Tel: +82-53-650-4289 Fax: +82-53-629-8248 E-mail:
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Sigurdardottir V, Drivelegka P, Svärd A, Jacobsson LTH, Dehlin M. Work disability in gout: a population-based case–control study. Ann Rheum Dis 2017; 77:399-404. [DOI: 10.1136/annrheumdis-2017-212063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 01/23/2023]
Abstract
ObjectivesTo examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.MethodsA regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003–2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression.ResultsPatients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95% CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12 years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity).ConclusionsGout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.
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Day RO, Frensham LJ, Nguyen AD, Baysari MT, Aung E, Lau AYS, Zwar N, Reath J, Laba T, Li L, McLachlan A, Runciman WB, Buchbinder R, Clay-Williams R, Coiera E, Braithwaite J, McNeil HP, Hunter DJ, Pile KD, Portek I, WIlliams KM, Westbrook JI. Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial protocol. BMJ Open 2017; 7:e017281. [PMID: 29042386 PMCID: PMC5652564 DOI: 10.1136/bmjopen-2017-017281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate-lowering therapy (ULT) is poor, with rates of less than 50% 1 year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. We aim to evaluate the effectiveness of use of a personal, self-management, 'smartphone' application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. METHODS AND ANALYSIS Setting and designPrimary care. A prospective, cluster randomised (by general practitioner (GP) practices), controlled trial. PARTICIPANTS GP practices will be randomised to either intervention or control clusters with their patients allocated to the same cluster. INTERVENTION The intervention group will have access to the Healthy.me app tailored for the self-management of gout. The control group patients will have access to the same app modified to remove all functions except the Gout Attack Diary. PRIMARY AND SECONDARY OUTCOMES The proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes will be proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a ≥30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed 'dropout' rate 20%. ETHICS AND DISSEMINATION This study has been approved by the University of New South Wales Human Research Ethics Committee. Study findings will be disseminated in international conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12616000455460.
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Affiliation(s)
- Richard O Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Lauren J Frensham
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Amy D Nguyen
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Eindra Aung
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Tracey Laba
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- The Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, Australia
- The Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Ling Li
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew McLachlan
- Faculty of Pharmacy and Centre for Education and Research on Ageing, University of Sydney, Sydney, Australia
| | - William B Runciman
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn Clay-Williams
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - H Patrick McNeil
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Kevin D Pile
- Department of Medicine, Western Sydney University, Sydney, Australia
- Department of Rheumatology, Campbelltown Hospital, Sydney, Australia
| | - Ian Portek
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Rheumatology, St George Hospital, Sydney, Australia
| | - Kenneth Mapson WIlliams
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Landgren AJ, Jacobsson LTH, Lindström U, Sandström TZS, Drivelegka P, Björkman L, Fjellstedt E, Dehlin M. Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study. Arthritis Res Ther 2017; 19:173. [PMID: 28738835 PMCID: PMC5525359 DOI: 10.1186/s13075-017-1376-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. METHODS Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. RESULTS In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI:1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. CONCLUSIONS The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - T Z S Sandström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - P Drivelegka
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - L Björkman
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - E Fjellstedt
- Department of Nephrology and Transplantation, SUS University Hospital, Malmö, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
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Kim JW, Kwak SG, Lee H, Kim SK, Choe JY, Park SH. Prevalence and incidence of gout in Korea: data from the national health claims database 2007-2015. Rheumatol Int 2017; 37:1499-1506. [PMID: 28676911 DOI: 10.1007/s00296-017-3768-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Abstract
The purpose of the present study was to investigate the prevalence and incidence of gout in Korea and predict the future prevalence and incidence of gout. Data were collected from the national health claims database. Patients who had at least one claim for gout between 2007 and 2015 were included in the study. The prevalence of gout from 2007 to 2015 and the incidence of gout from 2009 to 2015 were determined. We estimated sex- and age-specific prevalence and incidence of gout during the period. The prevalence and incidence of gout were predicted using time series analysis. The prevalence of gout (95% CI) increased from 3.49 (3.48-3.51) per 1000 persons in 2007 to 7.58 (7.55-7.60) per 1000 persons in 2015. The incidence of gout (95% CI) was 1.52 (1.51-1.53) in 2009 and rose to 1.94 (1.93-1.95) per 1000 persons in 2015. The prevalence and incidence of gout were higher in men than in women. The older population had a higher prevalence and incidence than the younger population. The increase in prevalence was higher in the older population than the younger population, whereas the increase in incidence was higher in the younger population than the older population. The predicted prevalence and incidence of gout (95% CI) in 2025 were 16.59 (15.85-17.34) per 1000 persons and 3.81 (3.14-4.47) per 1000 persons. The prevalence and incidence of gout increased in Korea between 2007 and 2015. Men and the older population had a higher prevalence and incidence of gout compared to women and the younger population. However, the incidence of gout in the younger population has increased rapidly in recent years.
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Affiliation(s)
- Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Hwajeong Lee
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Sung-Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea.
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Dehlin M, Ekström EH, Petzold M, Strömberg U, Telg G, Jacobsson LTH. Factors associated with initiation and persistence of urate-lowering therapy. Arthritis Res Ther 2017; 19:6. [PMID: 28095891 PMCID: PMC5240247 DOI: 10.1186/s13075-016-1211-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/15/2016] [Indexed: 12/27/2022] Open
Abstract
Background Gout is the most common inflammatory arthritic disease and is caused by crystal deposition secondary to persistent hyperuricemia. Etiological treatment with urate-lowering therapy (ULT) has been available since the 1950s but previous studies have demonstrated suboptimal degree of treatment. In recent years we have seen recommendations for ULT earlier in the course of the disease, but there are few contemporary reports reflecting the current situation. Therefore we set out to investigate proportion receiving and persisting with ULT after gout diagnosis and predictors thereof. Method A population-based cohort study using regional and national population-based registers. Cohort of patients (n = 7709) from western Sweden with incident gout aged 18 years and above from 2011 to 2013. An incident case of gout was defined as having been given a diagnosis of gout (ICD-10 M10, M14.0-14.1) not preceded by a gout diagnosis or a dispensation of ULT during the previous 5 years. Main outcome measures were cumulative incidence and predictors for start of, and persistence with, ULT in gout. Results Within the first year after first gout diagnosis, 32% received ULT. Male sex, presence of diabetes or cardiovascular comorbidity, reduced kidney function but not diagnosed “end-stage kidney failure” increased the likelihood of receiving ULT. Of those starting ULT a majority (75%) did not persist with ULT treatment within the first 2 years. Age <50 years, lack of comorbidities, and “normal kidney function” or “end-stage kidney failure” were associated with non-persistence with ULT. Conclusions Only a minority of patients received ULT and a majority of these did not persist with treatment over the next 2 years. However, the older patients with renal impairment and comorbidities, possibly suffering from a more severe gout disease, were more likely to receive and persist with treatment. There is thus still room for considerable improvement with regards to management of ULT in gout. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1211-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mats Dehlin
- Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.
| | | | - Max Petzold
- Swedish National Data Service, University of Gothenburg, Gothenburg, Sweden.,Health Metrics, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Strömberg
- Health Metrics, University of Gothenburg, Gothenburg, Sweden
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Singh JA. Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer? Ann Rheum Dis 2016; 76:779-781. [DOI: 10.1136/annrheumdis-2016-210519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/12/2016] [Accepted: 12/08/2016] [Indexed: 12/13/2022]
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Abstract
Gout is the most common inflammatory arthritis in adults in the Western world. Characterized by hyperuricemia and the effects of acute and chronic inflammation in joints and bursa, gout leads to an agonizing, chronically painful arthritis. Arthritis can also be accompanied by urate nephropathy and subcutaneous urate deposits (tophi). Exciting new developments in the last decade have brought back the focus on this interesting, crystal-induced chronic inflammatory condition. New insights include the role of NALP3 inflammasome-induced inflammation in acute gout, the characterization of diagnostic signs on ultrasound and dual-energy computed tomography imaging modalities, the recognition of target serum urate less than 6 mg/day as the goal for urate-lowering therapies, and evidence-based treatment guidelines. A better understanding of disease mechanisms has enabled drug discovery - three new urate-lowering drugs have been approved in the last decade, with several more in the pipeline. We now recognize the important role that environment and genetics play in the causation of gout. A focus on the cardiac, renal, and metabolic comorbidities of gout will help translational research and discovery over the next decade.
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Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center, Birmingham, AL, USA.
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
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Merdler-Rabinowicz R, Tiosano S, Comaneshter D, Cohen AD, Amital H. Comorbidity of gout and rheumatoid arthritis in a large population database. Clin Rheumatol 2016; 36:657-660. [PMID: 27837340 DOI: 10.1007/s10067-016-3477-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/01/2016] [Accepted: 11/04/2016] [Indexed: 12/22/2022]
Abstract
Coexistence of rheumatoid arthritis and gout is considered to be unusual. The current study was designed as a population-based cross-sectional study, utilizing the medical database of Clalit Health Services, the largest healthcare provider organization in Israel. Data of adult patients who were previously diagnosed with rheumatoid arthritis was retrieved. For each patient, five age- and sex-matched control patients were randomly selected. Different parameters including BMI, socioeconomic status, and existence of gout as well as smoking and hypertension were examined for both groups. The study included 11,540 patients with rheumatoid arthritis and 56,763 controls. The proportion of gout in the study group was high compared to controls (1.61 vs. 0.92%, P < 0.001). In a multivariate analysis, rheumatoid arthritis was associated with gout (OR = 1.72, 95% CI 1.45-2.05, P = 0.00). The proportion of gout in rheumatoid arthritis patients is not lower than in the general population.
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Affiliation(s)
- Rona Merdler-Rabinowicz
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Tiosano
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kapetanovic MC, Hameed M, Turkiewicz A, Neogi T, Saxne T, Jacobsson L, Englund M. Prevalence and incidence of gout in southern Sweden from the socioeconomic perspective. RMD Open 2016; 2:e000326. [PMID: 27933209 PMCID: PMC5133407 DOI: 10.1136/rmdopen-2016-000326] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and cumulative incidence of gout in southern Sweden with respect to socioeconomic status. METHODS Among residents of Skåne region in the year 2013 (total population 1.3 million), adult persons (age 18 years +) who between 1998 and 2013 received a diagnosis of gout (International Classification of Disease 10th Edition (ICD-10) code M10) by any physician were identified using the Skåne Healthcare Register. We calculated the point prevalence by end of 2013 and annual cumulative incidence in 2013 standardised to the whole Skåne population according to sex, individual information on occupation (white collar/blue collar), income (low/middle/high) and level of education (primary school/high school/university). RESULTS The crude 2013 point prevalence of gout and 2013 cumulative incidence (95% CI) were 1.69% (1.66% to 1.71%) and 24 cases per 10 000 persons (23-25), respectively. Compared to women, men had higher point prevalence (2.44% (2.40% to 2.49%) vs 0.96% (0.93% to 0.98%)) and higher annual cumulative incidence (33 cases per 10 000 (32-35)) versus 15 (14-16)). These figures increased with higher age but decreased with higher level of education, being the lowest in individuals with a university degree. Persons with middle income had highest point prevalence and cumulative incidence of gout, while those with white collar occupations had the lowest. CONCLUSIONS Gout is the most common inflammatory arthritis in southern Sweden with a prevalence of ∼1.7% in the adult population. There is a socioeconomic gradient with more gout present in the lower level of education and with more manual labour.
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Affiliation(s)
- Meliha C Kapetanovic
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Mohaned Hameed
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Aleksandra Turkiewicz
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tore Saxne
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Section for Rheumatology in Lund and Malmö, Lund, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Rai SK, Aviña-Zubieta JA, McCormick N, De Vera MA, Shojania K, Sayre EC, Choi HK. The rising prevalence and incidence of gout in British Columbia, Canada: Population-based trends from 2000 to 2012. Semin Arthritis Rheum 2016; 46:451-456. [PMID: 28040245 DOI: 10.1016/j.semarthrit.2016.08.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Gout is increasingly recognized as the most common form of inflammatory arthritis worldwide; however, no Canadian data on the disease burden of gout are available. We estimated the prevalence, incidence, prescription patterns, and comorbidity burden of gout in an entire Canadian province [British Columbia (BC)] over the last decade. METHODS We utilized PopulationData BC, a province-wide database, to estimate temporal trends in the prevalence and incidence of gout from 2000 to 2012, as well as according to age category. Annual estimates were age-sex-standardized using 2012 as the reference. We also examined annual trends in prescription patterns of common gout medications and assessed the comorbidity burden among gout patients in 2012. RESULTS The 2012 prevalence of gout was 3.8% among the overall population, and the incidence rate was 2.9 per 1000 person-years. Both gout prevalence and incidence increased substantially over the study period. This burden additionally increased according to age category, affecting over 8% of those ages 60-69 years in 2012. Approximately 22% of gout patients received a prescription for urate-lowering therapy (ULT), which remained stable over the study period, while colchicine and oral glucocorticoid use both increased modestly. By 2012, 72%, 52%, and 18% of prevalent gout patients had been diagnosed with hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS The burden of gout in BC, Canada, is substantial, and both the prevalence and incidence have increased over the past decade, while prescription of ULT remains low. These data support the need to improve gout prevention and care.
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Affiliation(s)
- Sharan K Rai
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie McCormick
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kam Shojania
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Hyon K Choi
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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