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Dainty KN, Thibau IJC, Amog K, Drucker AM, Wyke M, Begolka WS. Towards a patient-centred definition for atopic dermatitis flare: a qualitative study of adults with atopic dermatitis. Br J Dermatol 2024; 191:82-91. [PMID: 38287887 DOI: 10.1093/bjd/ljae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The term 'flare' is used across multiple diseases, including atopic dermatitis (AD), to describe increased disease activity. While several definitions of an AD flare have been proposed, no single definition of AD flare is widely accepted and it is unclear what the term 'AD flare' means from the patient perspective. OBJECTIVES To understand AD flares from the adult patient perspective and to explore how adults with AD define an AD flare. METHODS Participants were adults with AD recruited from the National Eczema Association Ambassadors programme, a volunteer patient-engagement programme. They participated in online focus groups to discuss how they describe AD flares from their perspective, how they define its start and stop, and how they relate to existing definitions of flare. Using a grounded theory approach, transcripts were analysed and coded using an iterative process to identify concepts to support a patient-centred conceptual framework of 'flare'. RESULTS Six 90-min focus groups of 3-8 participants each were conducted with 29 US adults (≥ 18 years of age) with AD who had at least one self-reported AD flare in the past year. When participants were presented with examples of previously published definitions of AD flare, participants found them problematic and unrelatable. Specifically, they felt that flare is hard to quantify or put on a numerical scale, definitions cannot solely be about skin symptoms and clinical verbiage does not resonate with patients' lived experiences. Concepts identified by patients as important to a definition of flare were changes from patient's baseline/patient's normal, mental/emotional/social consequences, physical changes in skin, attention needed/all-consuming focus, itch-scratch-burn cycle and control/loss of control/quality of life. Figuring out the trigger that initiated a flare was an underlying concept of the experience of flare but was not considered a contributor to the definition. CONCLUSIONS The results highlight the complexity and diversity of AD flare experiences from the adult patient perspective. Previously published definitions of AD flares did not resonate with patients, suggesting a need for a patient-centred flare definition to support care conversations and AD management.
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Affiliation(s)
- Katie N Dainty
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | | | - Krystle Amog
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Aaron M Drucker
- Women's College Research Institute and Department of Medicine, Women's College Hospital, Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Wyke
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, FL, USA
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Stamp LK, Horne A, Mihov B, Drake J, Haslett J, Chapman P, Frampton C, Dalbeth N. Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy. Arthritis Care Res (Hoboken) 2024. [PMID: 38766703 DOI: 10.1002/acr.25376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/30/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The study objective was to determine predictors of gout flare when commencing allopurinol using the "start-low go-slow" dose escalation strategy. METHODS A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial. RESULTS Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36-5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41-7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48-5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21-13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14-7.12). CONCLUSION Anti-inflammatory prophylaxis when starting allopurinol using the "start-low go-slow" dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.
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Affiliation(s)
- Lisa K Stamp
- University of Otago, Christchurch, Christchurch, and Te Whatu Ora, Waitaha, New Zealand
| | - Anne Horne
- University of Auckland, Auckland, New Zealand
| | | | - Jill Drake
- University of Otago, Christchurch, Christchurch, New Zealand
| | - Janine Haslett
- University of Otago, Christchurch, Christchurch, New Zealand
| | | | | | - Nicola Dalbeth
- University of Auckland, Auckland, and Te Whatu Ora, Te Toka Tumai, New Zealand
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3
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Hickling LM, Allani S, Cella M, Scott W. A systematic review with meta-analyses of the association between stigma and chronic pain outcomes. Pain 2024:00006396-990000000-00605. [PMID: 38776178 DOI: 10.1097/j.pain.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/22/2023] [Indexed: 05/24/2024]
Abstract
ABSTRACT Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date, there is no systematic review exploring the impact of stigma on chronic pain-related outcomes. This systematic review and meta-analysis aimed to examine the association between stigma and key chronic pain outcomes and differences in stigma between pain conditions. Seven databases were searched for studies reporting a measure of association between stigma and at least one pain outcome in adults with chronic pain. Studies were screened by 2 independent researchers. Nineteen studies met eligibility criteria and data were extracted, quality-assessed, and narratively synthesised and meta-analysed where possible. Meta-analyses of bivariate cross-sectional correlations demonstrated significant positive correlations between stigma and pain intensity, disability, and depression, with small to moderate effects. Data from 2 prospective studies and those only reporting multivariate analyses that were not included in meta-analyses further supported these findings. There was some evidence that individuals who experience pain conditions with less clear pathophysiology may report greater stigma, although more research is needed. The review highlights that there is a growing number of studies on stigma in the pain field showing an adverse association between stigma and chronic pain outcomes.
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Affiliation(s)
- Lauren M Hickling
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Selsebil Allani
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Matteo Cella
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Whitney Scott
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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4
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Dalbeth N, Te Karu L, Stamp LK. Gout and its management. Intern Med J 2024; 54:716-723. [PMID: 38654576 DOI: 10.1111/imj.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/27/2024] [Indexed: 04/26/2024]
Abstract
Gout is a common and treatable chronic disease of monosodium urate crystal deposition. It is experienced as extremely painful episodes of joint inflammation that impact all aspects of the person's life. This Clinical Perspectives article provides an update on gout diagnosis, medications and strategies to improve the quality of gout care.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Leanne Te Karu
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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Stamp LK, Dalbeth N. Moving urate-lowering therapy in gout beyond guideline recommendations. Semin Arthritis Rheum 2024; 65:152358. [PMID: 38219395 DOI: 10.1016/j.semarthrit.2023.152358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
The 'treat-to target serum urate strategy' when using urate-lowering therapy has been recommended by most specialist rheumatology societies for many years. An alternative "treat-to-avoid-symptoms" in gout has been suggested, albeit without a clear definition of what this means and how it might be implemented in clinical trials or clinical practice. This has hampered efforts to design clinical trials that compare the "treat-to-target [urate]" and "treat-to-avoid-symptoms" strategies in the long-term management of gout. In this review we consider the rationale for the treat-to-target urate strategy when using urate-lowering therapy, potential definitions of a "treat-to-avoid-symptoms" strategy, or perhaps what is not "treat-to-avoid-symptoms", and approaches that might address this uncertainty.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
| | - Nicola Dalbeth
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
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6
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Han L, Li R, Dalbeth N, Liu M, Yu Q, Jiang C, Ning C, Liu Z, He Y, Li M, Xue X, Jia F, Jia Z, Sun W, Zhang H, Lu J, Wang C, Li C. The value of musculoskeletal ultrasound in predicting gout flares in index joints: A prospective cohort study of people with gout starting urate-lowering therapy. Semin Arthritis Rheum 2024; 67:152418. [PMID: 38422901 DOI: 10.1016/j.semarthrit.2024.152418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate whether ultrasound findings of monosodium urate (MSU) crystal deposition predict frequent gout flares in index joints over 12 months. METHODS This single-center study enrolled people with at least one gout flare involving the MTP1, ankle or knee joint. The most painful or most frequently joint was identified as index joint for analysis. All participants were started on urate-lowering therapy and had an ultrasound scan of the index joints at the baseline visit. OMERACT scores (for tophus, double contour sign and aggregates) were used to analyze whether ultrasound scores predicted frequent (≥2) gout flares in the index joint over 12 months. RESULTS Frequent flares were significantly higher in those with ultrasound findings in all index joints (MTP1: tophus: 85.0% vs 46.0%, P < 0.001, aggregates: 78.8% vs 59.0%, P < 0.01; ankle: tophus: 54.6% vs 20.8%, P < 0.001; aggregates: 60.0% vs 35.9%, P < 0.05; knee: tophus: 68.4% vs 28.6%, P < 0.05). For the MTP1, for each 1-point increase in tophus score, the odds of frequent gout flares increased by 5.19 [(95%CI: 1.26-21.41), 7.91 [(95%CI: 2.23-28.14), and 13.79 [(95%CI: 3.79-50.20)] fold respectively. For the ankle, a tophus score of 3 markedly improved the prediction of the frequent flares [OR= 9.24 (95%CI=2.85-29.91)]. Semi-quantitative sum scores were associated with frequent flares with an OR (95%CI) of 13.66 (3.44-54.18), P < 0.001 at the MTP1, 7.05 (1.98-25.12), P < 0.001 at the ankle. CONCLUSION Ultrasound features of MSU crystal deposition at the MTP1 and knee predict subsequent risk of frequent gout flares in the same joints following initiation of urate-lowering therapy, with the highest risk in those with high tophus scores.
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Affiliation(s)
- Lin Han
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Runze Li
- Department of Medicine, Qingdao University, Qingdao, PR China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mingdi Liu
- Department of Rehabilitation, Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital), Qingdao, PR China
| | - Qing Yu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Caiyun Jiang
- Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Chunping Ning
- Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Maichao Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Xiaomei Xue
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Fenghao Jia
- Department of Psychiatry, Xi 'an Medical University, Xi 'an, PR China
| | - Zhaotong Jia
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Wenyan Sun
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, PR China
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Changgui Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China.
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7
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Zeng D, Yin C, Wei H, Li Y, Yang Y, Nie H, Pan Y, Xu R, Tai Y, Du J, Liu J, Wang P, Liu B, Liu B. Activation of Nrf2 antioxidant signaling alleviates gout arthritis pain and inflammation. Biomed Pharmacother 2024; 170:115957. [PMID: 38042115 DOI: 10.1016/j.biopha.2023.115957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
Excessive deposition of monosodium urate (MSU) crystal in the joint results in gout arthritis, which triggers severe pain and affects life quality. Oxidative stress is a pivotal mechanism that contributes to etiology of gout pain and inflammation. Here we investigated whether activating Nrf2, which plays important roles in regulating endogenous antioxidant response, would attenuate gout arthritis via promoting antioxidant signaling in joint tissues. Gout arthritis model was established by intra-articular injection of MSU (500 μg/ankle) into the right ankle joint of mouse. Pharmacologically activating Nrf2 by activator oltipraz (50, 100 or 150 mg/kg, intraperitoneal) at 1 h before and 5, 23, 47 h after model establishment dose-dependently inhibited joint inflammation, mechanical and heat hypersensitivities in model mice. Oltipraz (100 mg/kg) reversed gait impairments without altering locomotor activity and reduced neutrophil infiltrations in ankle joints. In vitro studies revealed oltipraz (25 μM) inhibited MSU-induced ROS production in mouse macrophages and improved mitochondrial bioenergetics impairments caused by MSU. In vivo ROS imaging combined with biochemical assays confirmed the antioxidant effects of oltipraz on model mice. Nrf2 activation inhibited pro-inflammatory cytokine overproduction in ankle joint and attenuated the overexpression and enhancement in TRPV1 channel in DRG neurons innervating hind limb. Therapeutic effects of oltipraz were abolished by inhibiting Nrf2 or in Nrf2 knockout mice. These results suggest pharmacologically activating Nrf2 alleviates gout pain, gait impairments, inflammation and peripheral sensitization via Nrf2-dependent antioxidant mechanism. Targeting Nrf2 may represent a novel treatment option for gout arthritis.
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Affiliation(s)
- Danyi Zeng
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengyu Yin
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huina Wei
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanyuan Li
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunqin Yang
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huimin Nie
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yushuang Pan
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruoyao Xu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yan Tai
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Junying Du
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinggen Liu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ping Wang
- Department of Pathology, School of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Boyu Liu
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Boyi Liu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China.
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8
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Hu W, Ye Z, Li T, Shi Z. Associations Between Composite Dietary Antioxidant Index and Gout: National Health and Nutrition Examination Survey 2007-2018. Biol Res Nurs 2024; 26:150-159. [PMID: 37616306 DOI: 10.1177/10998004231198166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Introduction: To explore the relationship between the composite dietary antioxidant index (CDAI) and gout to provide support for preventing gout through dietary intervention. Methods: Eligible participants from the 2007 to 2018 National Health and Nutrition Examination Survey aged 20 years and older were included in this cross-sectional study. The weighted chi-square test was used to compare the categorical variables difference between CDAI quartiles groups. The weighted univariate and binary logistic regression analysis were used to test the association between variables and gout. The weighted multivariable logistic regression was used to test the association of CDAI and gout in 4 different models. Subgroup analysis on the associations of CDAI with gout was conducted with stratified factors. Results: The final participants were 26,117, 13,103 (50.17%) were female, 8718 (33.38%) were 40-59 years, 11,200 (42.88%) were white and 1232 (4.72%) had gout. After adjusting for all covariates, the CDAI was associated with gout (odds ratio (OR), .97; 95% CI: .95-1.00). Participants in the highest CDAI quantile group were at low risk of gout (odds ratio (OR), .65; 95% CI: .50-.84) versus those in the lowest quantile group. Subgroup analysis and interaction test showed no significant dependence on diabetes mellitus (DM), marital status, alcohol status, hypertension, poverty income ratio (PIR), education level, body mass index (BMI), smoke status, age, sex, race, and chronic kidney disease (CKD) on this association (all p for interaction >.05). Conclusions: Composite dietary antioxidant index was inversely associated with gout in US adults, and dietary antioxidant intervention might be a promising method in the therapy of gout and greater emphasis should be placed on zinc, selenium, carotenoids, vitamins A, C, and E.
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Affiliation(s)
- Wanqin Hu
- Department of Nursing, Medical College, Jiaying University, Meizhou, China
- Department of Nursing, Hunan Provincial People's Hospital, Changsha, China
| | - Ziwei Ye
- Department of Nursing, Medical College, Jiaying University, Meizhou, China
| | - Tao Li
- Department of pathophysiology, Medical College, Jiaying University, Meizhou, China
| | - Zeya Shi
- Department of Nursing, Hunan Provincial People's Hospital, Changsha, China
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9
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Kang HS, Kim JH, Kim JH, Bang WJ, Choi HG, Kim NY, Park HY, Choi KC, Choi Y, Kwon MJ. Gout and Migraines: Exploring the Complex Link in a 16-Year Longitudinal Study of the Korean Population. J Clin Med 2023; 13:138. [PMID: 38202145 PMCID: PMC10780186 DOI: 10.3390/jcm13010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Despite the growing prevalence of gout and its associated health concerns as a chronic disorder, population-based studies on its link to migraines are scarce. We conducted a 16-year longitudinal study in a Korean population to investigate the relationship between gout and migraines, including different subtypes. We enrolled 23,137 patients with gout and matched them with 92,548 controls based on age, sex, income, and residence. Using Cox proportional hazards models, we calculated hazard ratios to assess the likelihood of migraines while considering relevant factors. During the follow-up, 1000 gout patients and 3214 controls experienced migraines. After adjusting for various factors, including demographics, health-related variables, and weight categories, the gout group had a 1.26-fold higher likelihood of developing migraines compared to the group without gout. This association was particularly strong for migraines without aura, while it was not significant for migraines with aura. In summary, our study reveals a significant link between gout and migraines in the Korean population, emphasizing the complex relationship among chronic disorders, with a specific focus on migraine subtypes.
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Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Kyung Chan Choi
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Younghee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea;
- Research Insititute for Complementary & Alternative Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Mi Jung Kwon
- Research Insititute for Complementary & Alternative Medicine, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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10
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van Rysewyk S, Blomkvist R, Chuter A, Crighton R, Hodson F, Roomes D, Smith BH, Toye F. Understanding the lived experience of chronic pain: A systematic review and synthesis of qualitative evidence syntheses. Br J Pain 2023; 17:592-605. [PMID: 37969135 PMCID: PMC10642495 DOI: 10.1177/20494637231196426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Although multiple measures of the causes and consequences of chronic non-cancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom. Methods Four bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives who co-created twenty survey statements. The survey was developed for testing the QES themes for validity in people living with pain. Results The research team identified and screened 1323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to myself; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a 2-week period in November 2021, and was completed by 1219 people, largely confirming the above themes. Conclusion/Implications This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic non-malignant musculoskeletal pain and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
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Affiliation(s)
- Simon van Rysewyk
- Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart, TAS, Australia
| | - Renée Blomkvist
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Rhea Crighton
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | | | - Blair H Smith
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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11
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Wilson N, Liu J, Adamjee Q, Di Giorgio S, Steer S, Hutton J, Lempp H. Exploring the emotional impact of axial Spondyloarthritis: a systematic review and thematic synthesis of qualitative studies and a review of social media. BMC Rheumatol 2023; 7:26. [PMID: 37608395 PMCID: PMC10464274 DOI: 10.1186/s41927-023-00351-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The psychological burden in people with inflammatory arthritis is substantial, yet little is known about the disease-related affect experienced by individuals with axial Spondyloarthritis (axial SpA). The aim of this study was to conduct a qualitative evidence synthesis and a review of social media to explore the emotional impact of living with axial SpA. METHODS We searched nine databases for studies reporting qualitative data about participants' emotional experience of living with axial SpA. In addition, we searched social media platforms for posts from people with axial SpA based in the UK that offered insights into emotional responses to living with the condition. We employed a thematic approach to synthesise the data. RESULTS We included 27 studies (1314 participants; 72% men) in our qualitative evidence synthesis and developed seven descriptive themes from the data: 1) delayed diagnosis: a barrier to emotional wellbeing; 2) disruptive symptoms: a source of mood swings; 3) work disability: a loss of self-esteem; 4) obstacles in interpersonal relationships: a trigger of distress; 5) taking up exercise: personal pride or unwelcomed reminders; 6) anti-TNF therapy: hope reignited despite concerns and 7) a journey of acceptance: worry mixed with hope. Posts extracted from social media fora (537; 48% from women) for the most part supported the seven themes. One additional theme-COVID-19, uncertainty and anxiety during the pandemic, was developed, reflecting common emotions expressed during the UK's first wave of the coronavirus pandemic. CONCLUSION This study highlights a preponderance of negative affect experienced by people living with axial SpA, conditioned through existing and anticipated symptoms, failed expectations, and lost sense of self. Given the bidirectional relationships between negative emotions and inflammation, negative emotions and perceptions of pain, and the influence of affect in self-care behaviours, this finding has important implications for treatment and management of people with axial SpA.
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Affiliation(s)
- Nicky Wilson
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
| | - Jia Liu
- Centre for Education, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Qainat Adamjee
- GKT School of Medical Education, King's College London, London, UK
| | - Sonya Di Giorgio
- King's College London Libraries & Collections, King's College London, London, UK
| | - Sophia Steer
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jane Hutton
- Department of Clinical Health Psychology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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12
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Wei J, Choi HK, Dalbeth N, Li X, Li C, Zeng C, Lei G, Zhang Y. Gout Flares and Mortality After Sodium-Glucose Cotransporter-2 Inhibitor Treatment for Gout and Type 2 Diabetes. JAMA Netw Open 2023; 6:e2330885. [PMID: 37624597 PMCID: PMC10457713 DOI: 10.1001/jamanetworkopen.2023.30885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023] Open
Abstract
Importance Recurrent flares are the hallmark of clinical manifestation of gout. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with a lower risk of incident gout; however, their association with recurrent flares is unknown. Objective To examine the association of SGLT2i vs active comparators (ie, glucagonlike peptide-1 receptor agonists [GLP-1 RA] or dipeptidyl peptidase-4 inhibitors [DPP-4i]) with the risk of recurrent gout flares and all-cause mortality among patients with gout and type 2 diabetes. Design, Setting, and Participants This population-based retrospective cohort study was performed from January 1, 2013, to March 31, 2022, using a UK primary care database. Participants included patients with gout and type 2 diabetes with visits to their general practitioners. Exposures Initiation of treatment with SGLT2i or active comparators. Main Outcomes and Measures The primary outcome was the number of recurrent gout flares ascertained using recorded codes and prescription records. Secondary outcomes were the first recurrent gout flare and all-cause mortality. The association of SGLT2i compared with active comparators for the risk of recurrent flares, the first recurrent flare, and all-cause mortality was assessed using Poisson regression or the Cox proportional hazards model with propensity score overlap weighting. Results Of a total of 5931 patients included in the analysis (mean [SD] age, 66.0 [11.6] years; 4604 [77.6%] men), 1548 initiated SGLT2i treatment and 4383 initiated treatment with active comparators during the study period. The relative rate of the recurrent flares with SGLT2i vs active comparators was 0.79 (95% CI, 0.65-0.97). Similar results were observed in the association of SGLT2i with the rate of recurrent flares when compared with DPP-4i or GLP-1 RA. For the first recurrent flare for SGLT2i vs active comparators, rate difference was -8.8 (95% CI, -17.2 to -0.4) per 1000 person-years and the hazard ratio was 0.81 (95% CI, 0.65-0.98). All-cause mortality per 1000 person-years was 18.8 for SGLT2i and 24.9 for active comparators, with rate difference of -6.1 (95% CI, -10.6 to -1.6) per 1000 person-years and hazard ratio of 0.71 (95% CI, 0.52-0.97). Conclusions and Relevance The findings of this cohort study suggest that SGLT2i were associated with a lower risk of recurrent gout flares and mortality than their active comparators in patients with gout and type 2 diabetes. These findings further suggest that SGLT2i could help reduce the burden of recurrent gout flares and could also narrow the mortality gap between patients with gout and the general population.
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Affiliation(s)
- Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
| | - Changjun Li
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
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13
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McCormick N, Yokose C, Wei J, Lu N, Wexler DJ, Aviña-Zubieta JA, De Vera MA, Zhang Y, Choi HK. Comparative Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for Recurrent Gout Flares and Gout-Primary Emergency Department Visits and Hospitalizations : A General Population Cohort Study. Ann Intern Med 2023; 176:1067-1080. [PMID: 37487215 DOI: 10.7326/m23-0724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT2is) decrease serum urate levels, but whether this translates into prevention of recurrent flares among patients with gout and gout-primary emergency department (ED) visits or hospitalizations is unknown. OBJECTIVE To compare gout flares and cardiovascular events among patients with gout initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is), another second-line glucose-lowering agent not associated with serum urate levels or cardiovascular risk. DESIGN Propensity score-matched, new-user cohort study. SETTING General population database from 1 January 2014 to 30 June 2022. PARTICIPANTS Patients with gout and type 2 diabetes. MEASUREMENTS The primary outcome was recurrent gout flare counts ascertained by ED, hospitalization, outpatient, and medication dispensing records. Secondary outcomes included myocardial infarction and stroke; genital infection (positive control) and osteoarthritis encounter (negative control) were also assessed. Poisson and Cox proportional hazards regressions were used with 1:1 propensity score matching (primary analysis) and overlap weighting (sensitivity analysis). RESULTS After propensity score matching, the flare rate was lower among SGLT2i initiators than DPP-4i initiators (52.4 and 79.7 events per 1000 person-years, respectively), with a rate ratio (RR) of 0.66 (95% CI, 0.57 to 0.75) and a rate difference (RD) of -27.4 (CI, -36.0 to -18.7) per 1000 person-years. The corresponding RR and RD for gout-primary ED visits and hospitalizations were 0.52 (CI, 0.32 to 0.84) and -3.4 (CI, -5.8 to -0.9) per 1000 person-years, respectively. The corresponding hazard ratio (HR) and RD for myocardial infarction were 0.69 (CI, 0.54 to 0.88) and -7.6 (CI, -12.4 to -2.8) per 1000 person-years; the HR for stroke was 0.81 (CI, 0.62 to 1.05). Those who initiated SGLT2is showed higher risk for genital infection (HR, 2.15 [CI, 1.39 to 3.30]) and no altered risk for osteoarthritis encounter (HR, 1.07 [CI, 0.95 to 1.20]). Results were similar when propensity score overlap weighting was applied. LIMITATION Participants had concurrent type 2 diabetes. CONCLUSION Among patients with gout, SGLT2is may reduce recurrent flares and gout-primary ED visits and hospitalizations and may provide cardiovascular benefits. PRIMARY FUNDING SOURCE National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; and Arthritis Research Canada, Vancouver, British Columbia, Canada (N.M., H.K.C.)
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital; The Mongan Institute, Department of Medicine, Massachusetts General Hospital; and Department of Medicine, Harvard Medical School, Boston, Massachusetts (C.Y., Y.Z.)
| | - Jie Wei
- Health Management Center, Department of Orthopaedics, National Clinical Research Center of Geriatric Disorders, and Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, and Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China (J.W.)
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada (N.L.)
| | - Deborah J Wexler
- Department of Medicine, Harvard Medical School, and Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts (D.J.W.)
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, and Division of Rheumatology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada (J.A.A.)
| | - Mary A De Vera
- Arthritis Research Canada, and Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada (M.A.D.V.)
| | - Yuqing Zhang
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital; The Mongan Institute, Department of Medicine, Massachusetts General Hospital; and Department of Medicine, Harvard Medical School, Boston, Massachusetts (C.Y., Y.Z.)
| | - Hyon K Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; and Arthritis Research Canada, Vancouver, British Columbia, Canada (N.M., H.K.C.)
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14
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Botson JK, Saag K, Peterson J, Obermeyer K, Xin Y, LaMoreaux B, Padnick‐Silver L, Verma S, Grewal S, Majjhoo A, Tesser JRP, Weinblatt ME. A Randomized, Double-Blind, Placebo-Controlled Multicenter Efficacy and Safety Study of Methotrexate to Increase Response Rates in Patients With Uncontrolled Gout Receiving Pegloticase: 12-Month Findings. ACR Open Rheumatol 2023; 5:407-418. [PMID: 37385296 PMCID: PMC10425585 DOI: 10.1002/acr2.11578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE To assess 12-month safety and efficacy of pegloticase + methotrexate (MTX) versus pegloticase + placebo (PBO) cotherapy in a PBO-controlled, double-blind trial (A randomized, double-blind, placebo-controlled, multicenter, efficacy and safety study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase [MIRROR RCT]). METHODS Patients with uncontrolled gout (serum urate level [SU] ≥7 mg/dl, oral urate-lowering therapy failure or intolerance, and presence of one or more gout symptoms [one or more tophi, two or more flares in 12 months, gouty arthropathy]) were randomized 2:1 to receive pegloticase (8-mg infusion every 2 weeks) with blinded MTX (oral 15 mg/week) or PBO for 52 weeks. Efficacy end points included proportion of responders (SU level <6 mg/dl for ≥80% of examined month) in the intent-to-treat population (ITT) (all randomized patients) during month 6 (primary end point), month 9, and month 12; proportion with resolution of one or more tophi (ITT); mean SU reduction (ITT); and time to SU-monitoring pegloticase discontinuation. Safety was evaluated via adverse event reporting and laboratory values. RESULTS Month 12 response rate was significantly higher in patients cotreated with MTX (60.0% [60 of 100] vs. 30.8% [16 of 52]; difference: 29.1% [95% confidence interval (CI): 13.2%-44.9%], P = 0.0003), with fewer SU discontinuations (22.9% [22 of 96] vs. 63.3% [31 of 49]). Complete resolution of one or more tophi occurred in 53.8% (28 of 52) versus 31.0% (9 of 29) of MTX versus PBO patients at week 52 (difference: 22.8% [95% CI: 1.2%-44.4%], P = 0.048), more than at week 24 (34.6% [18 of 52] vs. 13.8% [4 of 29]). Consistent with observations through month 6, pharmacokinetic and immunogenicity findings showed increased exposure and lower immunogenicity of pegloticase when administered with MTX, with an otherwise similar safety profile. No infusion reactions occurred after 24 weeks. CONCLUSION Twelve-month MIRROR RCT data further support MTX cotherapy with pegloticase. Tophi resolution continued to increase through week 52, suggesting continued therapeutic benefit beyond month 6 for a favorable treatment effect.
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Affiliation(s)
| | | | | | | | - Yan Xin
- Horizon Therapeutics plcDeerfieldIllinois
| | | | | | | | - Suneet Grewal
- East Bay Rheumatology Medical Group Inc.San LeandroCalifornia
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15
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Grubišić F, Jordan K. Are interventions for treatment of tophi in gout efficient? - A Cochrane Review summary with commentary. Int J Rheum Dis 2023. [PMID: 36891663 DOI: 10.1111/1756-185x.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/03/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Frane Grubišić
- Department of Rheumatology, Physical Medicine and Rehabilitation, School of Medicine University of Zagreb, Referral Center for Spondyloarthropathies, Ministry of Health of the Republic of Croatia, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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16
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Díaz-Torné C, Pou MA, Rodríguez-Díez B, Pujol-Ribera E. Living with gout. Experiences, impact and challenges of the disease. Qualitative study through focus groups. REUMATOLOGIA CLINICA 2023; 19:150-158. [PMID: 36058814 DOI: 10.1016/j.reumae.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To delve into the experiences of people living with gout regarding its causes and triggers, recommended treatments and therapeutic measures, and the impact of living with this problem. SUBJECTS AND METHODS Descriptive qualitative study. Opinion sampling, looking for discursive variability according to sex, age, socioeconomic position and treatments. Three focus groups were made with 11, 6 and 7 people, following a pre-established script of topics. Analysis following thematic content analysis procedures. RESULTS Participants were 19 men and 5 women, of different ages, socioeconomic status and treatments. Frequent comorbidities: hypertension and hypercholesterolemia. Genetics and the lack of renal elimination of urate were mentioned as causes of gout. They reported little knowledge of the causes and need more explanations about them. As triggers of the attack they identified: excess food and/or alcohol, trauma, stress or not following the treatment. Various drug treatment and expressed concern about their possible adverse effects were listed. Difficulties in adherence to the recommendations were also described. Non-pharmacological measures: rest, cold, proper footwear, walking, drinking water, and diet were also described. Chronic gout has an important impact on the daily life of patients and their families. Pain invalidates and leads to difficulties in performing daily activities. Irritations and mood swings were reported, which affect their family relationships. CONCLUSIONS These findings provide proposals to improve the care of people with gout. Information on its causes, the triggers of the crisis, dietary recommendations and exercise should be improved. The variability of treatments and recommendations on lifestyle should be analysed in depth.
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Affiliation(s)
- César Díaz-Torné
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain.
| | - Maria Antònia Pou
- Equipo de Atención Primaria Encants, Institut Català de la Salut, Barcelona, Spain
| | - Basilio Rodríguez-Díez
- Servicio de Reumatología, Althaia-Xarxa Assistencial i Universitaria de Manresa, Manresa, Barcelona, Spain
| | - Enriqueta Pujol-Ribera
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
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17
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Cipolletta E, Abhishek A, Di Battista J, Grassi W, Filippucci E. Ultrasonography in the prediction of gout flares: a 12-month prospective observational study. Rheumatology (Oxford) 2023; 62:1108-1116. [PMID: 35920773 DOI: 10.1093/rheumatology/keac367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate whether US findings indicating MSU deposits and US-detected inflammation (i.e. power Doppler signal) predict gout flares over 12 months. METHODS Gout patients on urate-lowering therapy for at least the preceding 6 months were enrolled consecutively in this 12-month prospective, observational, single-centre study. A nested case-control analysis was performed. Cases were participants with at least one flare in the follow-up period, while controls did not self-report any gout flare. The US assessment included elbows, wrists, second MCP joints, knees, ankles, and first MTP joints. The US findings indicating MSU deposits [i.e. aggregates, double contour (DC) sign and tophi] were identified as present/absent according to the Outcome Measure in Rheumatology definitions. Power Doppler signal was scored semiquantitatively. Summated scores were calculated for each US finding. RESULTS Eighty-one gout participants were enrolled, and 71 completed the study. Thirty (42.3%) of 71 participants experienced at least one flare over 12 months, with a median of 2.0 flares. Cases had a greater US burden of MSU deposits (6.7 ± 4.7 vs 2.9 ± 2.6, P = 0.01) and power Doppler signal (3.73 ± 3.53 vs 0.82 ± 1.44, P < 0.01) than controls, at baseline. The baseline US scores indicating MSU deposits and US-detected inflammation were significantly associated with the occurrence (total MSU score, adjusted odds ratio:1.75, 95% CI: 1.26, 2.43; power Doppler score, adjusted odds ratio: 1.63, 95% CI: 1.12, 2.40) and the number (total MSU score, adjusted incidence risk ratio: 1.17, 95% CI: 1.08, 1.26; power Doppler score, adjusted incidence risk ratio: 1.29, 95% CI: 1.19, 1.40) of flares over 12 months in multivariate analyses. CONCLUSIONS Baseline US findings indicating MSU deposits and US-detected inflammation are independent predictors of gout flares over 12 months.
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Affiliation(s)
- Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy.,Academic Rheumatology, University of Nottingham, Nottingham, UK
| | | | - Jacopo Di Battista
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
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18
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Howren A, Sayre EC, Choi HK, Avina-Zubieta JA, Shojania K, Park JY, De Vera MA. Onset of depression and anxiety among patients with gout after diagnosis: a population-based incident cohort study. BMC Rheumatol 2022; 6:56. [PMID: 36184626 PMCID: PMC9528093 DOI: 10.1186/s41927-022-00288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gout may be associated with an increased incidence of mental health disorders, however, published findings have been limited and inconsistent. Therefore, our objective was to conduct a population-based cohort study to evaluate the incidence of depression and anxiety after gout diagnosis. Methods We used linked population-based administrative health data in British Columbia, Canada that includes information on demographics, outpatient visits, and inpatient visits from the period of January 1, 1990 to March 31, 2018. We assessed depression and anxiety using validated International Classification of Diseases, 9th and 10th Revision coding algorithms. We applied multivariable Cox proportional hazard models to evaluate incident depression and anxiety among patients with gout in comparison to non-gout controls, adjusting for age, sex, neighbourhood income quintile, residence, comorbidities, and health care utilization. Results We included 157,426 incident cases of gout (60.2% male; mean age 57.1 years) and 157,426 non-gout controls (60.2% male; mean age 56.9 years). The incidence rate of depression among individuals with gout and non-gout controls was 12.9 (95% confidence interval [CI] 12.7–13.2) and 11.1 (95% CI 10.9–11.4) per 1000 person-years, respectively. The incidence rate of anxiety for those with gout was 5.4 (95% CI 5.3–5.5) per 1000 person-years and for non-gout controls was 4.6 (95% CI 4.4–4.7) per 1000 person-years. Individuals with gout had an increased onset of depression (adjusted hazard ratio [aHR], 1.08; 95% CI 1.05–1.11) and anxiety (aHR, 1.10; 95% CI 1.05–1.14) compared to non-gout controls. Conclusion Our population-based study shows an increased incidence of depression and anxiety following gout diagnosis in comparison to non-gout controls. Findings suggest the importance of considering psychiatric impacts in addition to the physical impacts of gout. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00288-6.
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Affiliation(s)
- Alyssa Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Hyon K Choi
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Kam Shojania
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Science, Vancouver, BC, Canada
| | - Jamie Y Park
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada. .,Arthritis Research Canada, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcome Science, Vancouver, BC, Canada.
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19
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When underlying biology threatens the randomization principle - initial gout flares of urate-lowering therapy. Nat Rev Rheumatol 2022; 18:543-549. [PMID: 35879610 PMCID: PMC9309993 DOI: 10.1038/s41584-022-00804-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Flare is the dominant feature of gout and occurs because of inflammatory response to monosodium urate crystals; prevention of gout flares should be the major goal of gout care. However, a paradoxical increase in the risk of flare following initiation of urate-lowering therapy presents considerable challenges for proving the expected long-term benefits of flare prevention in clinical trials. Nevertheless, excluding from enumeration flares that occur in the initial post-randomization period (which can last several months to 1 year) can threaten the core benefits of randomization: the characteristics of the remaining participants can differ from those who were randomized, introducing potential bias from confounding (both measured and unmeasured); participants who drop out or die are excluded from the analysis, introducing potential selection bias; and, finally, ignoring initial flares underestimates participants’ experience during the trial. This Perspective discusses these issues and recommends measures that will allow for high-level evidence that preserves the randomization principle, to satisfy methodological scrutiny and generate robust evidence-based guidelines for gout care. The paradoxical increase in gout flare risk upon initiation of urate-lowering therapy presents challenges for the measurement and analysis of gout flares in clinical trials of urate-lowering therapy. In this Perspective, the authors highlight these issues and discuss potential solutions.
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"My Pain Is Unbearable…I Cannot Recognize Myself!" Emotions, Cognitions, and Behaviors of People Living With Musculoskeletal Disorders: An Umbrella Review. J Orthop Sports Phys Ther 2022; 52:243-A102. [PMID: 35536247 DOI: 10.2519/jospt.2022.10707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize (1) the emotions, cognitions, and behaviors of people who are living with musculoskeletal disorders related to symptoms and (2) the interactions of emotions, cognitions, and behaviors with the person's environment (family, social, and work roles). DESIGN An umbrella review of qualitative research syntheses and meta-summaries (metasynthesis, meta-ethnographies, meta-aggregation, meta-summary). LITERATURE SEARCH We searched CINAHL, EMBASE, PsycARTICLES, PsycEXTRA, PsycINFO, PubMed, and PubPsych from database inception to January 2021. We also searched gray literature via Open Grey and Google Scholar. STUDY SELECTION CRITERIA We included qualitative evidence syntheses evaluating adults with musculoskeletal disorders, based on the multidimensional diagnostic criteria for acute and chronic pain. Emotions, cognitions, and behaviors were the phenomenon of interest. DATA SYNTHESIS We developed 3 categories of themes ([1] emotions, [2] cognitions, and [3] behaviors) for each objective. We selected the 3 most common emotions, cognitions, and behaviors that appear as themes in our narrative synthesis. RESULTS We included 20 qualitative evidence syntheses that retrieved 284 original qualitative studies. Despair, distress, and fear were the main emotions reported by people living with musculoskeletal disorders. The alterations of the self and how people described their symptoms, what caused them, and how the symptoms impacted their lives were the most common cognitions. Cognitive strategies (ie, acceptance) and perceptions about social support emerged. People often used passive behaviors (eg, social isolation or hiding symptoms) to cope with the challenges that arose related to musculoskeletal symptoms. However, some people actively faced their symptoms, planning their activities or practicing them despite their symptoms. CONCLUSION Clinicians who support people living with musculoskeletal disorders should consider (1) assessing other emotions than pain-related fear (eg, despair and distress), (2) observing their cognitive responses (ie, acceptance), and (3) evaluating what type of behaviors people use (eg, active or passive). J Orthop Sports Phys Ther 2022;52(5):243-261. doi:10.2519/jospt.2022.10707.
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Holyer J, Taylor WJ, Gaffo A, Hosie G, Horne A, Mihov B, Su I, Gamble GD, Dalbeth N, Stewart S. Which Attributes Are Most and Least Important to Patients When Considering Gout Flare Burden Over Time? A Best-worst Scaling Choice Study. J Rheumatol 2021; 49:213-218. [PMID: 34725178 DOI: 10.3899/jrheum.210605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Several factors contribute to the patient experience of gout flares, including pain intensity, duration, frequency, and disability. It is unknown which of these factors are most important to patients when considering flare burden over time, including those related to the cumulative experience of all flares, or the experience of a single worst flare. This study aimed to determine which flare attributes are the most and least important to the patient experience of flare burden over time. METHODS Participants with gout completed an anonymous online survey. Questions were aimed at identifying which attributes of gout flares, representing both individual and cumulative flare burden, were the most and least important over a hypothetical 6-month period. A best-worst scaling method was used to determine the importance hierarchy of the included attributes. RESULTS Fifty participants were included. Difficulty doing usual activities during the worst flare and pain of the worst flare were ranked as the most important, whereas average pain of all flares was considered the least important. Overall, attributes related to the single worst gout flare were considered more important than attributes related to the cumulative impact of all flares. CONCLUSION When thinking about the burden of gout flares over time, patients rank activity limitation and pain experienced during their worst gout flare as the most important contributing factors, whereas factors related to the cumulative impact of all flares over time are relatively less important.
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Affiliation(s)
- Jeremy Holyer
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - William J Taylor
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Angelo Gaffo
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Graham Hosie
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Anne Horne
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Borislav Mihov
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Isabel Su
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Gregory D Gamble
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Nicola Dalbeth
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
| | - Sarah Stewart
- JH was supported by a University of Auckland summer student scholarship. J. Holyer, medical student, G. Hosie, NZ Dip. in Policing, A. Horne, MBChB, B. Mihov, BPHty, I. Su, BSc, G.D. Gamble, MSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Deparment of Medicine, University of Auckland, Auckland, New Zealand; W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand; A. Gaffo, MD, MsPH, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ND reports grants and personal fees from AstraZeneca, personal fees from Horizon, AbbVie, AstraZeneca, Jansen, Hengrui, Dyve Biosciences, Selecta, and Arthrosi; and grants from Amgen and AstraZeneca outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Stewart, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. . Accepted for publication October 13, 2021
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Abstract
Gout flares are central to the patient experience of gout and are included in the Outcome Measures in Rheumatology (OMERACT) core outcome domain set for long-term gout studies. Although a valid definition for gout flare has been developed, there is no consensus around how flare outcomes are measured and reported in long-term clinical studies. Current methods of flare measurement, which are centered on measuring flares as a binary outcome (i.e., present vs absent), do not reflect the variable pattern of flares over time, nor the multidimensional patient experience of gout flares which include factors related to pain severity, functional disability, impact on family and social life, and psychological wellbeing. This review will discuss the importance and challenges of gout flare measurement.
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Affiliation(s)
- Sarah Stewart
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Angelo Gaffo
- Department of Medicine, University of Alabama and Birmingham, Alabama, United States.
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Holyer J, Garcia-Guillen A, Taylor WJ, Gaffo AL, Gott M, Slark J, Horne A, Su I, Dalbeth N, Stewart S. What Represents Treatment Efficacy in Long-term Studies of Gout Flare Prevention? An Interview Study of People With Gout. J Rheumatol 2021; 48:1871-1875. [PMID: 34470799 DOI: 10.3899/jrheum.210476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The patient experience of gout flares is multidimensional, with several contributing factors including pain intensity, duration, and frequency. There is currently no consistent method for reporting gout flare burden in long-term studies. This study aimed to determine which factors contribute to patient perceptions of treatment efficacy in long-term studies of gout flare prevention. METHODS This study involved face-to-face interviews with people with gout using visual representations of gout flare patterns. Participants were shown different flare scenarios over a hypothetical 6-month treatment period that portrayed varying flare frequency, pain intensity, and flare duration. The participants were asked to indicate and discuss which scenario they believed was most indicative of successful treatment over time. Quantitative data relating to the proportion of participants selecting each scenario were reported using descriptive statistics. A qualitative descriptive approach was used to code and categorize the data from the interview transcripts. RESULTS Twenty-two people with gout participated in the semistructured interviews. All 3 factors of pain intensity, flare duration, and flare frequency influenced participants' perception of treatment efficacy. However, a shorter flare duration was the most common indicator of successful treatment, with half of participants (n = 11, 50%) selecting the scenario with a shorter flare duration over those with less painful flares. CONCLUSION Flare duration, flare frequency, and pain severity are all taken into account by patients with gout when considering treatment efficacy over time. Long-term studies of gout should ideally capture all these factors to better represent patients' experience of treatment success.
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Affiliation(s)
- Jeremy Holyer
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrea Garcia-Guillen
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - William J Taylor
- W.J. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Angelo L Gaffo
- A.L. Gaffo, MD, MSPH, FACP, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Merryn Gott
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Julia Slark
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne Horne
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Isabel Su
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah Stewart
- J. Holyer, medical student, A. Garcia-Guillen, MD, M. Gott, PhD, J. Slark, PhD, A. Horne, MBChB, I. Su, BSc, N. Dalbeth, MBChB, MD, FRACP, S. Stewart, PhD, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand;
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Kumar M, Manley N, Mikuls TR. Gout Flare Burden, Diagnosis, and Management: Navigating Care in Older Patients with Comorbidity. Drugs Aging 2021; 38:545-557. [PMID: 34105100 DOI: 10.1007/s40266-021-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Gout is the most common form of inflammatory arthritis, and its incidence is highest in middle-aged and older patients. Adding to the diagnostic complexity, up to 50% of patients aged > 65 years present atypically, with subacute oligo- or polyarticular flares. Comorbidity and polypharmacy, common in older populations, affect real-world treatment decisions in gout management, and no specific guidelines are available to address these issues in these at-risk groups. Despite the growing public health burden posed by gout, suboptimal management has led to increased morbidity and substantial healthcare utilization and cost burden, as reflected by an increased incidence of emergency department visits and hospitalizations in recent years. Colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) should be considered as first-line agents for gout flare management. Urate-lowering therapy, with the goal of lowering and maintaining serum urate concentrations at < 6 mg/dL (< 360 μmol/L), is recommended to achieve optimal outcomes, including regression of tophi, reduction (or elimination) of flares, and reductions in total urate burden. In this review, we summarize the current burden posed by gout and discuss best practices in its diagnosis and management, focusing on best practices in the context of gout flare in older patients with comorbid conditions.
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Affiliation(s)
- Mukund Kumar
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE, 68198-6270, USA.,Medicine and Research, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Natalie Manley
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ted R Mikuls
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE, 68198-6270, USA. .,Medicine and Research, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA.
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Fuller A, Cai K, Filippou G, Pascart T, Diaz-Torne C, Hensey O, Grossberg D, Christensen R, Shea B, Singh JA, Tedeschi SK, Dalbeth N, Abhishek A. Experience and impact of crystal pyrophosphate deposition (CPPD) from a patient and caregiver perspective: A qualitative exploration from the OMERACT CPPD working group. Semin Arthritis Rheum 2021; 51:655-660. [PMID: 33941385 PMCID: PMC10061547 DOI: 10.1016/j.semarthrit.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore the lived experience of people with calcium pyrophosphate deposition (CPPD) disease and the impact of this condition on their daily lives. METHODS Patients with CPPD and their caregivers were invited to take part in a one-to-one (patient only) or paired (patient and caregiver) semi-structured interview. Interviews covered patients' diagnosis and treatment experiences, and the impact of CPPD on their daily lives. Transcribed interviews were analysed using inductive thematic analysis. RESULTS 28 patient interviews, six of which included a caregiver, were conducted across five countries. Acute CPP crystal arthritis flares resulted in temporary but profound disability for most patients, disrupting their ability to go about day-to-day activities, and they sought immediate medical attention. CPPD+OA and chronic CPP crystal inflammatory arthritis presented patients with longer term limitations in daily lives. Patients and their caregivers described these disruptions and limitations, which included a reduced ability or inability to complete household and self-care tasks, exercise, socialise, work and drive. They also described how arthritis pain and resulting limitations adversely impacted upon patients' psychological wellbeing. Delays in referral to specialists and diagnostic uncertainty were described by many. Lack of appropriate treatment or access to treatments only upon worsening of symptoms impacted upon the length of time some patients spent in pain and with functional limitations. CONCLUSION This study is the first to demonstrate the wide-ranging impact of CPPD, and highlights the need for improved diagnosis, physician training, as well as greater emphasis upon finding targeted therapies to specifically treat CPPD.
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Affiliation(s)
- Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
| | - Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Georgios Filippou
- Rheumatology Unit, ASST-Fatebenefratelli L, Sacco University Hospital, University of Milan, Italy
| | - Tristan Pascart
- Department of Rheumatology, Hopital Saint-Philibert, Lille Catholic University, Lille, France
| | - Cesar Diaz-Torne
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona, Spain
| | - Owen Hensey
- The Central Remedial Clinic, Dublin, Ireland
| | - David Grossberg
- Holy Cross Hospital, Silver Spring, MD, USA; Suburban Hospital, Bethesda, MD, USA
| | - Robin Christensen
- Department of Clinical Research, Copenhagen and Research Unit of Rheumatology, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Southern Denmark, Odense University Hospital, Denmark
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA; Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Epidemiology at the UAB School of Public Health, Birmingham, AL, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Garcia-Guillen A, Stewart S, Su I, Taylor WJ, Gaffo AL, Gott M, Slark J, Horne A, Dalbeth N. Gout flare severity from the patient perspective: a qualitative interview study. Arthritis Care Res (Hoboken) 2020; 74:317-323. [PMID: 33026692 DOI: 10.1002/acr.24475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The patient experience of a gout flare is multi-dimensional. To establish the most appropriate methods of flare measurement, there is a need to understand the complete experience of a flare. This qualitative study aimed to examine what factors contribute to the severity of a flare from the patient perspective. METHODS Face-to-face interviews were conducted with people with gout. Participants were asked to share their experience with their worst gout flare and contrast it to their experience of a less severe or mild flare. Interviews were audio-recorded and transcribed verbatim. Data was analysed using a reflexive thematic approach. RESULTS Twenty-two participants with gout (17 males, mean age 66.5 years) were interviewed at an academic centre in Auckland, New Zealand. Four key themes were identified as contributing to the severity of a flare: flare characteristics (pain intensity, joint swelling, redness and warmth, duration, and location), impact on function (including walking, activities of daily living, wearing footwear, and sleep), impact on family and social life (dependency on others, social connection, and work) and psychological impact (depression, anxiety, irritability, and sense of control). CONCLUSION A wide range of interconnecting factors contribute to the severity of a gout flare from the patient perspective. Capturing these domains in long-term gout studies would provide more meaningful and accurate representation of cumulative flare burden.
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Affiliation(s)
- Andrea Garcia-Guillen
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - Sarah Stewart
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - Isabel Su
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - William J Taylor
- University of Otago, Department of Medicine, Wellington, New Zealand
| | - Angelo L Gaffo
- UAB Health System, Rheumatology, Birmingham, United States
| | - Merryn Gott
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - Julia Slark
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - Anne Horne
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
| | - Nicola Dalbeth
- The University of Auckland Faculty of Medical and Health Sciences, Medicine, Auckland, New Zealand
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