1
|
McCormick N, Yokose C, Lu N, Wexler DJ, Aviña-Zubieta JA, De Vera MA, McCoy RG, Choi HK. Sodium-Glucose Cotransporter-2 Inhibitors vs Sulfonylureas for Gout Prevention Among Patients With Type 2 Diabetes Receiving Metformin. JAMA Intern Med 2024; 184:650-660. [PMID: 38619822 PMCID: PMC11019449 DOI: 10.1001/jamainternmed.2024.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/27/2024] [Indexed: 04/16/2024]
Abstract
Importance Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are a revolutionary treatment for type 2 diabetes (T2D) with cardiovascular, kidney, and serum urate-lowering benefits. Objective To compare risk of incident gout and rate of recurrent flares between patients with T2D initiating SGLT2i vs sulfonylurea, most common second-line glucose-lowering therapy, when added to metformin monotherapy. Design, Setting, and Participants This sequential, propensity score-matched, new-user comparative effectiveness study using target trial emulation framework included adults with T2D receiving metformin monotherapy in a Canadian general population database from January 1, 2014, to June 30, 2022. Exposures Initiation of SGLT2i vs sulfonylurea. Main Outcomes and Measures The primary outcome was incident gout diagnosis, ascertained by emergency department (ED), hospital, outpatient, and medication dispensing records. Secondary outcomes were gout-primary hospitalizations and ED visits and major adverse cardiovascular events (MACE), as well as recurrent flare rates among prevalent gout patients. Heart failure (HF) hospitalization was assessed as positive control outcome and osteoarthritis encounters as negative control. For target trial emulations, we used Cox proportional hazards and Poisson regressions with 1:1 propensity score matching (primary analysis) and overlap weighting (sensitivity analysis). The analysis was conducted from September to December, 2023. Results Among 34 604 propensity score matched adults with T2D initiating SGLT2i or sulfonylurea (20 816 [60%] male, mean [SD] age, 60 [12.4] years), incidence of gout was lower among SGLT2i initiators (4.27 events per 1000 person-years) than sulfonylurea initiators (6.91 events per 1000 person-years), with a hazard ratio (HR) of 0.62 (95% CI, 0.48-0.80) and a rate difference (RD) of -2.64 (95% CI, -3.99 to -1.29) per 1000 person-years. Associations persisted regardless of sex, age, or baseline diuretic use. SGLT2i use was also associated with fewer recurrent flares among gout patients (rate ratio, 0.67; 95% CI, 0.55-0.82; and RD, -20.9; 95% CI, -31.9 to -10.0 per 1000 person-years). HR and RD for MACE associated with SGLT2i use were 0.87 (95% CI, 0.77-0.98) and -3.58 (95% CI, -6.19 to -0.96) per 1000 person-years. For control outcomes, SGLT2i users had lower risk of HF (HR, 0.53; 95% CI, 0.38-0.76), as expected, with no difference in osteoarthritis (HR, 1.11; 95% CI, 0.94-1.34). Results were similar when applying propensity score overlap weighting. Conclusions In this population-based cohort study, the gout and cardiovascular benefits associated with SGLT2i in these target trial emulations may guide selection of glucose-lowering therapy in patients with T2D, at risk for or already with gout.
Collapse
Affiliation(s)
- Natalie McCormick
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Chio Yokose
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Deborah J. Wexler
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Diabetes Center, Massachusetts General Hospital, Boston
| | - J. Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A. De Vera
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore
- University of Maryland Institute for Health Computing, Bethesda
- Division of Gerontology, Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Hyon K. Choi
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Wang R, Liu T, Li X, Lu E, Chen Y, Luo K, Wang T, Huang X, Zhang Z, Du S, Sha X. Biomimetic Integrated Nanozyme for Flare and Recurrence of Gouty Arthritis. Asian J Pharm Sci 2024; 19:100913. [PMID: 38903129 PMCID: PMC11186967 DOI: 10.1016/j.ajps.2024.100913] [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: 06/17/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 06/22/2024] Open
Abstract
Flare and multiple recurrences pose significant challenges in gouty arthritis. Traditional treatments provide temporary relief from inflammation but fail to promptly alleviate patient pain or effectively prevent subsequent recurrences. It should also be noted that both anti-inflammation and metabolism of uric acid are necessary for gouty arthritis, calling for therapeutic systems to achieve these two goals simultaneously. In this study, we propose a biomimetic integrated nanozyme, HMPB-Pt@MM, comprising platinum nanozyme and hollow Prussian blue. It demonstrates anti-inflammatory properties by eliminating reactive oxygen species and reducing infiltration of inflammatory macrophages. Additionally, it rapidly targets inflamed ankles through the camouflage of macrophage membranes. Furthermore, HMPB-Pt@MM exhibits urate oxidase-like capabilities, continuously metabolizing locally elevated uric acid concentrations, ultimately inhibiting multiple recurrences of gouty arthritis. In summary, HMPB-Pt@MM integrates ROS clearance with uric acid metabolism, offering a promising platform for the treatment of gouty arthritis.
Collapse
Affiliation(s)
- Rui Wang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Tongyao Liu
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Xinhong Li
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Enhao Lu
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yiting Chen
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Kuankuan Luo
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Tao Wang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Xueli Huang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Zhiwen Zhang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Shilin Du
- Department of Emergency Medicine, Shanghai Geriatric Medical Center, Shanghai 201104, China
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xianyi Sha
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Institutes of Integrative Medicine, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| |
Collapse
|
3
|
Liu S, Sun H, Yang S, Liang N, Gao Y, Qu S, Chen H. Clustering of gout-related comorbidities and their relationship with gout flares: a data-driven cluster analysis of eight comorbidities. J Endocrinol Invest 2024; 47:1119-1128. [PMID: 37906371 DOI: 10.1007/s40618-023-02224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To study the aggregation of multiple comorbidities in people with gout and explore differences in prognosis of gout flares among different subgroups. METHODS Hierarchical clustering was performed to identify homogeneous subgroups among 2639 people with gout using eight comorbidities. A one-year follow-up of acute gout flares in 463 of these people was conducted; the incidence and the timing of gout flares in each cluster were assessed to explore prognosis of gout flares. Binary logistic regression was applied to assess factors associated with gout flares. RESULTS In baseline study, we identified five subgroups (C1-C5). C1 (n = 671, 25%) was characterized by isolated gout with few comorbidities. C2 (n = 258, 10%) were all obese. Almost all people in C3 (n = 335, 13%) had diabetes (99.7%). All people in C4 (n = 938, 36%) had dyslipidemia. C5 (n = 437, 17%) had the highest proportion of cardiovascular disease (CVD, 53%), chronic kidney disease (CKD, 56%), and cancer (7%). In follow-up study, C5 had the highest incidence (71.9%) and earliest onset (median 3 months) of gout flares. C2 had the lowest incidence (52.1%) and the latest onset (median 10 months) of gout flares. The highest relative risk for gout recurrent was seen for C5 (OR = 2.09). Other factors associated with the risk of gout flares were age at diagnosis of gout, duration of gout, presence of tophi, and smoking ≥ 20 cigarettes/day. CONCLUSIONS We clustered people with gout into five groups with varying comorbidities. People with CVD, CKD, and cancer had the highest risk of gout flares and should receive comprehensive care.
Collapse
Affiliation(s)
- S Liu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - H Sun
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - S Yang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - N Liang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Y Gao
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - S Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China.
| | - H Chen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, China.
| |
Collapse
|
4
|
Li Y, Merriman TR, Chen H, Lv Q, Yan Y, Xu X, Ji A, Cheng Z, Wang X, Lu D, Han L, Cui L, Wang C, Sun W, Li C, Lu J. Clinical characteristics of adolescent-onset gout in Chinese: A hospital-based cross-sectional study. Semin Arthritis Rheum 2024; 65:152405. [PMID: 38335695 DOI: 10.1016/j.semarthrit.2024.152405] [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: 09/24/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Adolescent-onset gout has a greater impact on the lives and health of patients than adult-onset gout. However, there is a relative lack of clinical information on adolescent-onset gout. Hence, we analyzed a Chinese cohort. METHODS We studied clinical features of 9,003 Chinese patients. Gout onset age of 12 - 19 years is defined as adolescent-onset group (AG), 20 - 40 years as early-onset group (EG), and 41 - 64 years as late-onset group (LG). Multivariable regression analysis evaluated factors associated with recurrent flares, serum urate (SU) levels, and underexcretion type in AG. RESULTS Compared with EG and LG, the AG had higher SU levels [AG: 9.5 (2.2) mg/dL, EG: 8.6 (2.1) mg/dL, LG: 7.73 (2.0) mg/dL, P < 0.001], higher percentage of positive family history of gout (AG: 41.8 %, EG: 29.6 %, LG: 24.6 %, P < 0.001), underexcretion type (AG: 62.4 %, EG: 62.5 %, LG: 58.8 %, P = 0.04), recurrent flares (AG: 78.1 %, EG: 70.3 %, LG: 68.9 %, P = 0.01). Urate-lowering therapy (ULT) initiated [OR 6.58 (95 % CI 1.35 - 32.00)] and hypercholesterolemia [OR 4.16 (95 % CI 1.28 - 13.53)] were associated with recurrent flares. eGFR was identified to be a significant variable of increasing SU levels [beta -0.24 (95 % CI -0.04 to -0.01)]. Hypertriglyceridemia [OR 0.35 (95 % CI 0.17 - 0.71)] was related to underexcretion type. CONCLUSION Adolescent-onset gout patients had clinically distinctive features with higher SU levels, BMI, positive gout family history, underexcretion type and recurrent flares. These specific populations were less likely to achieve ULT target, requiring more clinical attention.
Collapse
Affiliation(s)
- Yushuang Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China
| | - Tony R Merriman
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, 200072 Shanghai, PR China
| | - Qingguo Lv
- Department of Endocrinology and Metabolism, Center for diabetes and metabolism research, West China Hospital of Sichuan University, 610041 Chengdu, PR China
| | - Yinkun Yan
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045 Beijing, PR China
| | - Xinmiao Xu
- Department of Endocrinology and Metabolism, Yantai Yeda Hospital, 265599 Yantai, PR China
| | - Aichang Ji
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Zan Cheng
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Xiaxia Wang
- Department of Cardiology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Di Lu
- Department of the Third Chest, Qingdao Chest Hospital, 266043 Qingdao, PR China
| | - Lin Han
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Lingling Cui
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Can Wang
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Wenyan Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Changgui Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China
| | - Jie Lu
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China.
| |
Collapse
|
5
|
McCormick N, Yokose C, Challener GJ, Joshi AD, Tanikella S, Choi HK. Serum Urate and Recurrent Gout. JAMA 2024; 331:417-424. [PMID: 38319333 PMCID: PMC10848075 DOI: 10.1001/jama.2023.26640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
Importance Approximately 12 million adults in the US have a history of gout, but whether serum urate levels can help predict recurrence is unclear. Objective To assess associations of a single serum urate measurement with subsequent risk of acute gout flares and subsequent risk of hospitalizations for gout among patients in the UK with a history of gout. Design, Setting, and Participants This retrospective study included patients with a history of gout identified from the UK between 2006 and 2010 who were followed up through Primary Care Linked Data medical record linkage until 2017 and through the Hospital Episode Statistics database until 2020. Exposures Serum urate levels at enrollment. Main Outcome and Measure Rate of recurrent acute gout, ascertained by hospitalization, outpatient, and prescription/procedure records, and adjusted rate ratios using negative binomial regressions. Results Among 3613 patients with gout (mean age, 60 years; 3104 [86%] men), 1773 gout flares occurred over a mean follow-up of 8.3 years. Of these, 1679 acute gout flares (95%) occurred in people with baseline serum urate greater than or equal to 6 mg/dL and 1731 (98%) occurred in people with baseline serum urate greater than or equal to 5 mg/dL. Rates of acute gout flares per 1000 person-years were 10.6 for participants with baseline urate levels less than 6 mg/dL, 40.1 for levels of 6.0 to 6.9 mg/dL, 82.0 for levels of 7.0 to 7.9 mg/dL, 101.3 for levels of 8.0 to 8.9 mg/dL, 125.3 for urate levels of 9.0 to 9.9 mg/dL, and 132.8 for levels greater than or equal to 10 mg/dL. Rate ratio of flares were 1.0, 3.37, 6.93, 8.67, 10.81, and 11.42, respectively, over 10 years (1.61 [1.54-1.68] per mg/dL). Rates of hospitalization per 1000 person-years during follow-up were 0.18 for those with baseline serum urate less than 6 mg/dL, 0.97 for serum urate of 6.0 to 6.9 mg/dL, 1.8 for serum urate of 7.0 to 7.9 mg/dL, 2.2 for serum urate of 8.0 to 8.9 mg/dL, 6.7 for serum urate of 9.0 to 9.9 mg/dL, and 9.7 for serum urate greater than or equal to 10 mg/dL. Rate ratios of hospitalization for gout, adjusting for age, sex, and race were 1.0, 4.70, 8.94, 10.37, 33.92, and 45.29, respectively (1.87 [1.57-2.23] per mg/dL). Conclusions and Relevance In this retrospective study of patients with a history of gout, serum urate levels at baseline were associated with the risk of subsequent gout flares and rates of hospitalization for recurrent gout. These findings support using a baseline serum urate level to assess risk of recurrent gout over nearly 10 years of follow-up.
Collapse
Affiliation(s)
- Natalie McCormick
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Chio Yokose
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gregory J. Challener
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Amit D. Joshi
- Channing Division of Network Medicine, Boston, Massachusetts
| | - Sruthi Tanikella
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Hyon K. Choi
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Wang M, Li R, Qi H, Pang L, Cui L, Liu Z, Lu J, Wang R, Hu S, Liang N, Tao Y, Dalbeth N, Merriman TR, Terkeltaub R, Yin H, Li C. Metabolomics and Machine Learning Identify Metabolic Differences and Potential Biomarkers for Frequent Versus Infrequent Gout Flares. Arthritis Rheumatol 2023; 75:2252-2264. [PMID: 37390372 DOI: 10.1002/art.42635] [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: 12/04/2022] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The objective of this study was to discover differential metabolites and pathways underlying infrequent gout flares (InGF) and frequent gout flares (FrGF) using metabolomics and to establish a predictive model by machine learning (ML) algorithms. METHODS Serum samples from a discovery cohort of 163 patients with InGF and 239 patients with FrGF were analyzed by mass spectrometry-based untargeted metabolomics to profile differential metabolites and explore dysregulated metabolic pathways using pathway enrichment analysis and network propagation-based algorithms. ML algorithms were performed to establish a predictive model based on selected metabolites, which was further optimized by a quantitative targeted metabolomics method and validated in an independent validation cohort with 97 participants with InGF and 139 participants with FrGF. RESULTS A total of 439 differential metabolites between InGF and FrGF groups were identified. Top dysregulated pathways included carbohydrates, amino acids, bile acids, and nucleotide metabolism. Subnetworks with maximum disturbances in the global metabolic networks featured cross-talk between purine metabolism and caffeine metabolism, as well as interactions among pathways involving primary bile acid biosynthesis, taurine and hypotaurine metabolism, alanine, aspartate, and glutamate metabolism, suggesting epigenetic modifications and gut microbiome in metabolic alterations underlying InGF and FrGF. Potential metabolite biomarkers were identified using ML-based multivariable selection and further validated by targeted metabolomics. Area under receiver operating characteristics curve for differentiating InGF and FrGF achieved 0.88 and 0.67 for the discovery and validation cohorts, respectively. CONCLUSION Systematic metabolic alterations underlie InGF and FrGF, and distinct profiles are associated with differences in gout flare frequencies. Predictive modeling based on selected metabolites from metabolomics can differentiate InGF and FrGF.
Collapse
Affiliation(s)
- Ming Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Rui Li
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China and Chinese Academy of Sciences (CAS) Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, CAS, Shanghai, China and Innovation Center for Intervention of Chronic Disease and Promotion of Health, Shanghai, China
| | - Han Qi
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Lei Pang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Lingling Cui
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Key Laboratory of Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen Liu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Key Laboratory of Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Lu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Key Laboratory of Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rong Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Shuhui Hu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Ningning Liang
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, CAS, Shanghai, China and Innovation Center for Intervention of Chronic Disease and Promotion of Health, Shanghai, China and University of Chinese Academy of Sciences, CAS, Beijing, China
| | - Yongzhen Tao
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, CAS, Shanghai, China and Innovation Center for Intervention of Chronic Disease and Promotion of Health, Shanghai, China
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Robert Terkeltaub
- VA San Diego Healthcare System, San Diego, California and University of California San Diego, La Jolla, California
| | - Huiyong Yin
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China and CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, CAS, Shanghai, China and Innovation Center for Intervention of Chronic Disease and Promotion of Health, Shanghai, China and Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Changgui Li
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China and Shandong Provincial Key Laboratory of Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
7
|
Finnikin S, Mallen CD, Roddy E. Cohort study investigating gout flares and management in UK general practice. BMC PRIMARY CARE 2023; 24:246. [PMID: 37993770 PMCID: PMC10664696 DOI: 10.1186/s12875-023-02201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Gout is the most common inflammatory arthritis and is almost exclusively managed in primary care, however the course and severity of the condition is variable and poorly characterised. This research aims improve understanding about the frequency of, and factors associated with, gout flares in the UK and characterise the factors associated with the initiation of ULT. METHODS Using the Clinical Practice Research Database, patients with a coded incident gout diagnosis without a prior prescription for urate-lowering therapy (ULT) were identified. Gout flares post diagnosis and ULT initiation were identified through prescribing and coded data. Patient characteristics, co-morbidities and co-prescribing were co-variants. Factors associated with gout flares and ULT initiation were analysed using cox-proportional hazard model and logistic regression. RESULTS Fifty-one thousand seven hundred eighty-four patients were identified: 18,605 (35.9%, 95%CI 35.5-36.3%) had experienced ≥ 1 recurrent flare, 17.4% (95%CI 17.1-17.8%) within 12 months of diagnosis. Male sex, black ethnicity, higher BMI, heart failure, CKD, CVD and diuretic use were associated with flares, with the highest HR seen with high serum urate levels (≥ 540 µmol/L HR 4.63, 95%CI 4.03-5.31). ULT initiation was associated with similar variables, although higher alcohol intake and older age were associated with lower odds of ULT initiation but were not associated with flares. ULT was initiated in 27.7% (95%CI 27.3-28.0%): 5.7% (95%CI 5.5-5.9%) within 12 months of diagnosis. ULT initiation rates were higher in patients with recurrent flares. CONCLUSION Approximately one in six people with incident gout had a second flare within 12 months. Factors associated with flare recurrence and ULT initiation were similar, but ULT initiation occurred later after diagnosis than previously thought.
Collapse
Affiliation(s)
- Samuel Finnikin
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| |
Collapse
|
8
|
Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Risk of Venous Thromboembolism With Gout Flares. Arthritis Rheumatol 2023; 75:1638-1647. [PMID: 36808284 DOI: 10.1002/art.42480] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Previous studies demonstrated that the risk of venous thromboembolism (VTE) is increased in patients with gout, but not whether there was a temporal association between gout flare and VTE. This study was undertaken to evaluate potential temporal associations between gout flare and VTE. METHODS Data were obtained from electronic primary-care records from the UK's Clinical Practice Research Datalink, which links data from hospitalization and mortality registers. Using self-controlled case series analysis adjusted for season and age, we evaluated the temporal association between gout flare and VTE. The 90 days after primary-care consultation or hospitalization for gout flare was designated the exposed period. This was divided into three 30-day intervals. The baseline period was up to 2 years before the start of and up to 2 years after the end of the exposed period. The association between gout flare and VTE was measured using adjusted incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). RESULTS In total, 314 patients met the inclusion criteria (age ≥18 years, incident gout, no presence of VTE or use of a primary-care anticoagulant prescription before the start of the pre-exposure period). Among the 314 patients, VTE incidence was significantly higher in the exposed period than in the baseline period (adjusted IRR 1.83, 95% CI 1.30-2.59). The adjusted IRR of VTE during the first 30 days after gout flare was 2.31 (95% CI 1.39-3.82) relative to the baseline period. No increase in the adjusted IRRs was observed in days 31-60 (adjusted IRR 1.49, 95% CI 0.79-2.81) and days 61-90 (adjusted IRR 1.67, 95% CI 0.91-3.06) relative to baseline. Results were consistent across sensitivity analyses. CONCLUSION Among patients with gout, there was a transient increase in the rate of VTE within 30 days after primary-care consultation or hospitalization for gout flare.
Collapse
Affiliation(s)
- Edoardo Cipolletta
- Academic Rheumatology, University of Nottingham, Nottingham, UK, and Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | - Anthony J Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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.)
| |
Collapse
|
11
|
Hu S, Sun M, Li M, Xue X, Terkeltaub R, Wang C, Wang M, Lu J, Ran Z, Li H, Ji A, Sun W, Li X, He Y, Liu Z, Zhang H, Wang X, Ji X, Dalbeth N, Li C. Elevated serum CA72-4 predicts gout flares during urate lowering therapy initiation: a prospective cohort study. Rheumatology (Oxford) 2023; 62:2435-2443. [PMID: 36409036 PMCID: PMC10321093 DOI: 10.1093/rheumatology/keac656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/10/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Gout flares during urate-lowering therapy (ULT) initiation are common, but predictors of these flares are poorly understood. The aim of this study was to determine whether serum CA72-4 is an independent predictor for gout flares during ULT initiation. METHODS A prospective cohort study was conducted between March 2021 and January 2022. Men with gout, at least one gout flare in the past year, and at least three serum CA72-4 measurements in the previous six months were enrolled. Participants were grouped according to their highest recorded serum CA72-4 levels (above or within the normal range). All participants took oral febuxostat 20 mg daily without flare prophylaxis therapy, and attended face-to-face visits every four weeks until 24 weeks. The incidence of gout flare was compared between the two groups. Backward stepwise logistic regression analyses were used to identify risk factors associated with flares. Receiver operating characteristic curve analysis was used to evaluate prediction efficacy. RESULTS A total of 193 completed the study (79 with high CA72-4; 114 with normal CA72-4). The cumulative incidence of at least one gout flare was 48.1% (62.1% in the high CA72-4 group, 38.4% in the normal CA72-4 group, P = 0.001), and recurrent (≥2) flares was 33.0% (47.1% in the high CA72-4 group, 23.2% in the normal CA72-4, P < 0.001). High CA72-4, disease duration, intra-articular tophus size, glucose, high-density lipoprotein-cholesterol and ESR were independent risk factors for gout flares. Serum CA72-4 alone predicted recurrent flares with an area under the curve of 0.63 (95% CI = 0.54, 0.71), and 0.78 (95% CI = 0.71, 0.85) when combined with other independent variables. CONCLUSION High serum CA72-4 predicts the risk of gout flares during ULT initiation. TRIAL REGISTRATION ChiCTR; https://www.chictr.org.cn/; ChiCTR2100043573.
Collapse
Affiliation(s)
| | | | | | | | | | - Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ming Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Zijing Ran
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hailong Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Aichang Ji
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Wenyan Sun
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinde Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Xuefeng Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Changgui Li
- Correspondence to: Changgui Li, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China. E-mail:
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Wang H, Yan C, Wu Q, Zeng H, Zhang Z, Wang W, Sun X. Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients. J Orthop Surg Res 2023; 18:61. [PMID: 36683056 PMCID: PMC9869566 DOI: 10.1186/s13018-023-03536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference. METHODS This hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared. RESULT The uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P < 0.05). Patients in the hyperuricemia group with diabetes and tophi and those administered diuretics were more prone to acute gout attacks than those in the normal uric acid level group (P < 0.05). In the normal uric acid level group, 22 patients (84.6%) exhibited single joint involvement, whereas only 18 patients (47.4%) in the hyperuricemia group demonstrated single joint involvement (P < 0.05). After 1 year of follow-up, the gout recurrence rate in the hyperuricemia group was 44.7%, which was significantly higher that the recurrence rate in the normoglycemic group (11.5%; P < 0.05). Presenting tophi in perioperative orthopedic surgery patients was found to be an independent risk factor for gout recurrence within 1 year (RR = 4.80; P = 0.029). CONCLUSION The recurrence rate of gout in patients with hyperuricemia during perioperative period increased 1 year after operation. Therefore, it is crucial to monitor the uric acid level to prevent acute gout attacks during the perioperative period and recurrence during the 1-year follow-up period. Moreover, the risk of an acute gout recurrence 1 year after operation increased in patients who presented tophi; therefore, it is necessary to maintain appropriate blood uric acid level during perioperative period among patients undergoing orthopedic surgery.
Collapse
Affiliation(s)
- Hui Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China ,grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Chao Yan
- School of Health Care, MinJiang Teachers College, Fuzhou, 350108 Fujian Province People’s Republic of China
| | - Qiping Wu
- grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Hao Zeng
- grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Zhihong Zhang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Wanming Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Xiaotang Sun
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
| |
Collapse
|
14
|
Xie D, Choi HK, Dalbeth N, Wallace ZS, Sparks JA, Lu N, Zeng C, Li X, Wei J, Lei G, Zhang Y. Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study. Arthritis Rheumatol 2023; 75:122-132. [PMID: 36082457 PMCID: PMC9537980 DOI: 10.1002/art.42339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/19/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gout patients often have multiple comorbidities, making them susceptible to SARS-CoV-2 infection and poor outcomes. This study was undertaken to examine the association between gout and the risk of SARS-CoV-2 infection and severe outcomes, especially in patients who have received a SARS-CoV-2 vaccine. METHODS We conducted 2 cohort studies using The Health Improvement Network in the UK. Individuals with gout and those without gout from the general population were followed up from December 8, 2020 to October 31, 2021. We estimated the rate difference (RD) and hazard ratio (HR) of SARS-CoV-2 infection and severe outcomes (i.e., hospitalization and death within 30 days after SARS-CoV-2 infection) for individuals with gout versus those without gout using a Cox proportional hazards model according to SARS-CoV-2 vaccination status. We adjusted for potential confounders by using overlap weighting of exposure scores. RESULTS Among the vaccinated cohort, 1,955 cases of breakthrough COVID-19 infection occurred in 54,576 individuals with gout (4.68 cases per 1,000 person-months), and 52,468 cases occurred in 1,336,377 individuals without gout (3.76 cases per 1,000 person-months). The partially adjusted RD of breakthrough infection was 0.91 cases per 1,000 person-months (95% confidence interval [95% CI] 0.62-1.20 cases per 1,000 person-months), and the partially adjusted HR was 1.24 (95% CI 1.19-1.30). Gout was also associated with an increased risk of hospitalization (adjusted HR 1.30 [95% CI 1.10-1.53]) and death (adjusted HR 1.36 [95% CI 0.87-2.13]). Women with gout had an increased risk of hospitalization (adjusted HR 1.55 [95% CI 1.15-2.10]) and death (adjusted HR 2.46 [95% CI 1.12-5.41]). Similar associations with gout were observed in the unvaccinated cohort. CONCLUSION These general population data suggest that individuals with gout, especially women, have higher risks of SARS-CoV-2 infection and severe outcomes, even when vaccinated.
Collapse
Affiliation(s)
- Dongxing Xie
- Department of Orthopaedics, 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, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| | - Jeffrey A. Sparks
- Harvard Medical School, Boston, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, USA
| | - Na Lu
- Arthritis Research Canada, Richmond, Canada
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, 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, 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, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
15
|
Lee J, Kim J, Ghang B, Jeong W. A retrospective observational study of the appropriate starting dose of febuxostat in patients with gout. Korean J Intern Med 2022; 38:427-433. [PMID: 36325753 PMCID: PMC10175865 DOI: 10.3904/kjim.2022.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND/AIMS The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period. METHODS We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020. RESULTS Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly during the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack. CONCLUSIONS Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.
Collapse
Affiliation(s)
- Joondon Lee
- Jeju National University Hospital, Jeju, Korea
| | - Jinseok Kim
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Byeongzu Ghang
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Wooseong Jeong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| |
Collapse
|
16
|
Li H, Dalbeth N, Wallace ZS, Sparks JA, Li X, Zeng C, Wang Y, Xie D, Lei G, Wei J, Zhang Y. Risk of gout flares after COVID-19 vaccination: A case-crossover study. Semin Arthritis Rheum 2022; 56:152059. [PMID: 35797765 PMCID: PMC9239705 DOI: 10.1016/j.semarthrit.2022.152059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Routine vaccinations are associated with an increased risk of gout flares. We examined the association between COVID-19 vaccination, an immunization program implemented to a large proportion of population, and the risk of gout flares. METHODS We conducted a time-stratified case-crossover study among patients with gout who experienced gout flares between December 2020 and September 2021, using data from The Health Improvement Network. We compared the risk of gout flares on each of the seven days on and after the day of COVID-19 vaccination vs. no vaccination during that period using conditional logistic regression. In addition, we performed subgroup analyses stratified by different COVID-19 vaccines (i.e., BNT162b2, hereafter referred to as BNT, and ChAdOx1 nCov-19, hereafter referred to as ChAd). RESULTS Among 5,904 patients with gout (mean age: 63·1 years; 85·5% male) who experienced gout flares within one month, the risk of gout flares slightly increased on the second day after COVID-19 vaccination (odds ratio: 1·44; 95% CI: 1·02 to 2·07). The risk of gout flares also slightly increased after receiving COVID-19 vaccine on other remaining days (ORs ranged from 1·03 to 1·22); however, none of them was statistically significant. An increased risk of gout flares on the second day after vaccination was mainly observed for the ChAd vaccine (odds ratio: 1·44; 95% CI: 1·00 to 2·05), but not for BNT vaccine (odds ratio: 1·18; 95% CI: 0·67 to 2·02). CONCLUSION COVID-19 vaccination, mainly ChAd vaccination, slightly increases the risk of gout flares on the second day after vaccination. This finding reassures the safety of COVID-19 vaccination for patients with gout.
Collapse
Affiliation(s)
- Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, 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, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dongxing Xie
- Department of Orthopaedics, 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, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China,Department of Epidemiology and Health statistics, Xiangya School of Public Health, Central South University, Changsha, China,Corresponding authors
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Corresponding authors
| |
Collapse
|
17
|
Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout. JAMA 2022; 328:440-450. [PMID: 35916846 PMCID: PMC9346550 DOI: 10.1001/jama.2022.11390] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Gout is associated with cardiovascular diseases. The temporal association between gout flares and cardiovascular events has not been investigated. OBJECTIVE To investigate whether there is a transient increase in risk of cardiovascular events after a recent gout flare. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational study was conducted using electronic health records from the Clinical Practice Research Datalink in England between January 1, 1997, and December 31, 2020. A multivariable nested case-control study was performed among 62 574 patients with gout, and a self-controlled case series, adjusted for season and age, was performed among 1421 patients with gout flare and cardiovascular event. EXPOSURES Gout flares were ascertained using hospitalization, primary care outpatient, and prescription records. MAIN OUTCOMES AND MEASURES The primary outcome was a cardiovascular event, defined as an acute myocardial infarction or stroke. Association with recent prior gout flares was measured using adjusted odds ratios (ORs) with 95% CIs in a nested case-control study and adjusted incidence rate ratios (IRRs) with 95% CIs in a self-controlled case series. RESULTS Among patients with a new diagnosis of gout (mean age, 76.5 years; 69.3% men, 30.7% women), 10 475 patients with subsequent cardiovascular events were matched with 52 099 patients without cardiovascular events. Patients with cardiovascular events, compared with those who did not have cardiovascular events, had significantly higher odds of gout flare within the prior 0 to 60 days (204/10 475 [2.0%] vs 743/52 099 [1.4%]; adjusted OR, 1.93 [95% CI, 1.57-2.38]) and within the prior 61 to 120 days (170/10 475 [1.6%] vs 628/52 099 [1.2%]; adjusted OR, 1.57 [95% CI, 1.26-1.96]). There was no significant difference in the odds of gout flare within the prior 121 to 180 days (148/10 475 [1.4%] vs 662/52 099 [1.3%]; adjusted OR, 1.06 [95% CI, 0.84-1.34]). In the self-controlled case series (N = 1421), cardiovascular event rates per 1000 person-days were 2.49 (95% CI, 2.16-2.82) within days 0 to 60; 2.16 (95% CI, 1.85-2.47) within days 61 to 120; and 1.70 (95% CI, 1.42-1.98) within days 121 to 180 after a gout flare, compared with cardiovascular event rates of 1.32 (95% CI, 1.23-1.41) per 1000 person-days within the 150 days before or the 181 to 540 days after the gout flare. Compared with 150 days before or the 181 to 540 days after a gout flare, incidence rate differences for cardiovascular events were 1.17 (95% CI, 0.83-1.52) per 1000 person-days, and adjusted IRRs were 1.89 (95% CI, 1.54-2.30) within days 0 to 60; 0.84 (95% CI, 0.52-1.17) per 1000 person-days and 1.64 (95% CI, 1.45-1.86) within days 61 to 120; and 0.38 (95% CI, 0.09-0.67) per 1000 person-days and 1.29 (95% CI, 1.02-1.64) within days 121 to 180 after a gout flare. CONCLUSIONS AND RELEVANCE Among individuals with gout, those who experienced a cardiovascular event, compared with those who did not experience such an event, had significantly higher odds of a recent gout flare in the preceding days. These findings suggest gout flares are associated with a transient increase in cardiovascular events following the flare.
Collapse
Affiliation(s)
- Edoardo Cipolletta
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Laila J. Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Georgina Nakafero
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Anthony J. Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
18
|
Huddleston EM, Gaffo AL. Emerging strategies for treating gout. Curr Opin Pharmacol 2022; 65:102241. [DOI: 10.1016/j.coph.2022.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
|
19
|
Dasgupta E, Chong ZP, Ting MN, Mohd Tajuddin AA, Voon KX, Sasitharan T, Tai KS, Yeap SS. Relationship of medication adherence, serum uric acid level and diet to recurrent attacks of gout. THE EGYPTIAN RHEUMATOLOGIST 2022. [DOI: 10.1016/j.ejr.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
20
|
Basilio-Razon PIE, Wong E. A Pain in the Foot: Delayed Diagnosis of Primary Septic Arthritis of Naviculocuneiform and Second/Third Tarsometatarsal Joints. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933233. [PMID: 34711795 PMCID: PMC8564783 DOI: 10.12659/ajcr.933233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 65-year-old
Final Diagnosis: Septic arthritis of midfoot
Symptoms: Foot pain
Medication: —
Clinical Procedure: Debridement • drainage
Specialty: Family Medicine • General and Internal Medicine • Orthopedics • Emergency Medicine
Collapse
Affiliation(s)
| | - Evelyn Wong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW We aim to provide a comprehensive review of the available literature to inform dietary recommendations for patients with gout and hyperuricemia that have the potential to simultaneously lower serum urate and reduce gout morbidity while addressing gout's cardiometabolic comorbidities holistically. RECENT FINDINGS The global burden of gout is rising worldwide, particularly in developed nations as well as in women. Patients with gout are often recommended to follow a low-purine (i.e., low-protein) diet to avoid purine-loading. However, such an approach may lead to increased consumption of unhealthy carbohydrates and fats, which in turn contributes to metabolic syndrome and subsequently raises serum urate levels and leads to adverse cardiovascular outcomes. On the other hand, several well-established diets for cardiometabolic health, such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, in combination with weight loss for those who are overweight or obese, also have beneficial effects on relevant gout endpoints. It is important to recognize not only the direct effect of diet on hyperuricemia and gout, but its mediated effect through obesity and insulin resistance. Thus, several preeminent healthy dietary patterns that have proven benefits in cardiometabolic health have the power to holistically address not only gout morbidity but also its associated comorbidities that lead to premature mortality among patients with gout.
Collapse
|
22
|
Abdellatif W, Ding J, Khorshed D, Shojania K, Nicolaou S. Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum 2021; 50:S17-S23. [PMID: 32620197 DOI: 10.1016/j.semarthrit.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gout is a common inflammatory arthritis that manifests as an aggregate of variably symptomatic monosodium urate crystals (MSU) in the joints and surrounding tissues in addition to multisystem involvement such as genitourinary and cardiovascular systems. In recent decades, there has been a documented increase in the prevalence and incidence of gout. Risk factors for gout include obesity, dietary influences, hypertension, renal impairment, and diuretic use. A prompt diagnosis followed by uric acid lowering treatment prior to the onset of bone destruction is the goal in any suspected case of gout. Advanced imaging modalities, such as dual energy computed tomography (DECT) and ultrasonography (US), employed for the diagnosis of gout are each accompanied by advantages and disadvantages. Conventional radiography (CR), although useful in visualizing joint erosions and mineralization, is limited in its ability to diagnose gout flare. Although synovial fluid aspiration remains the gold standard for MSU crystal visualization, less-invasive imaging modalities are preferred to avoid potential complications. DECT and US in particular are useful in the diagnosis of gout. In this review, we will discuss the current state and role of imaging in the detection of gout.
Collapse
Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Kam Shojania
- Department of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
| |
Collapse
|
23
|
Koto R, Nakajima A, Horiuchi H, Yamanaka H. Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan. Ann Rheum Dis 2021; 80:1483-1490. [PMID: 34158371 PMCID: PMC8522452 DOI: 10.1136/annrheumdis-2021-220439] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
Objectives In patients with gout, treating to target serum uric acid levels (sUA) of ≤6.0 mg/dL is universally recommended to prevent gout flare. However, there is no consensus on asymptomatic hyperuricaemia. Using Japanese health insurance claims data, we explored potential benefits of sUA control for preventing gout flare in subjects with asymptomatic hyperuricaemia. Methods This retrospective cohort study analysed the JMDC Claims Database from April 2012 through June 2019. Subjects with sUA ≥8.0 mg/dL were identified, and disease status (prescriptions for urate-lowering therapy (ULT), occurrence of gout flare, sUA) was investigated for 1 year. Time to first onset and incidence rate of gout flare were determined by disease status subgroups for 2 years or more. The relationship between gout flare and sUA control was assessed using multivariable analysis. Results The analysis population was 19 261 subjects who met eligibility criteria. We found fewer occurrences of gout flare, for both gout and asymptomatic hyperuricaemia, in patients who achieved sUA ≤6.0 mg/dL with ULT than in patients whose sUA remained >6.0 mg/dL or who were not receiving ULT. In particular, analysis by a Cox proportional-hazard model for time to first gout flare indicated that the HR was lowest, at 0.45 (95% CI 0.27 to 0.76), in subjects with asymptomatic hyperuricaemia on ULT (5.0<sUA ≤ 6.0 mg/dL), compared with untreated subjects (sUA ≥8.0 mg/dL). Conclusions Occurrences of gout flare were reduced by controlling sUA at ≤6.0 mg/dL in subjects with asymptomatic hyperuricaemia as well as in those with gout. Trial registration number UMIN000039985.
Collapse
Affiliation(s)
- Ruriko Koto
- Medical Science Department, Teijin Pharma Limited, Chiyoda-ku, Tokyo, Japan
| | - Akihiro Nakajima
- Pharmaceutical Development Administration Department, Teijin Pharma Limited, Chiyoda-ku, Tokyo, Japan
| | - Hideki Horiuchi
- Medical Science Department, Teijin Pharma Limited, Chiyoda-ku, Tokyo, Japan
| | - Hisashi Yamanaka
- Rheumatology, Sanno Medical Center, Tokyo, Japan.,Department of Rheumatology, International University of Health and Welfare, Chiba, Japan.,Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
24
|
Te Kampe R, Jansen TL, van Durme C, Janssen M, Petersen G, Boonen A. Outcomes of Care Among Patients With Gout in Europe: A Cross-sectional Survey. J Rheumatol 2021; 49:312-319. [PMID: 34329184 DOI: 10.3899/jrheum.210009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess health- and patient-centered outcomes in gout across Europe, and explore patient-, care-, and country-level characteristics associated with these outcomes. METHODS Patients with self-reported physician-diagnosed gout from 14 European countries completed an online survey. Multivariable mixed-effect logistic and linear regressions were computed for health outcomes (gout flare recurrence) and patient-centered outcomes (patient satisfaction with current medication, and unaddressed goals), accounting for clustering within countries. The role of patient-, care-, and country-level factors was explored. RESULTS Participants included 1029 patients, predominantly diagnosed by a general practitioner (GP). One or more gout flares were reported by 70% of patients and ≥ 3 flares by 32%. Gout patients reported 1.1 ± 1.2 unaddressed goals, and 80% were satisfied with current medication. Patients with ≥ 3 and ≥ 1 flares were less likely to be treated with urate-lowering therapy (ULT) (OR 0.52, 95% CI 0.39-0.70 and OR 0.38, 95% CI 0.28-0.53, respectively), but more likely to have regular physician visits (OR 2.40, 95% CI 1.79-3.22 and OR 1.77, 95% CI 1.30-2.41). Three or more gout flares were also associated with lower satisfaction (OR 0.39, 95% CI 0.28-0.56) and more unaddressed goals (β 0.36, 95% CI 0.19-0.53). Notwithstanding, the predicted probability of being satisfied was still between 57% and 75% among patients with ≥ 3 flares but who were not receiving ULT. Finally, patients from wealthier and Northern European countries more frequently had ≥ 3 gout flares. CONCLUSION Across Europe, many patients with gout remain untreated despite frequent reported flares. Remarkably, a substantial proportion of them were still satisfied with gout management. A better understanding of patients' satisfaction and its role in physicians' gout management decisions is warranted to improve quality of care and gout outcomes across Europe.
Collapse
Affiliation(s)
- Ritch Te Kampe
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| | - Tim L Jansen
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| | - Caroline van Durme
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| | - Matthijs Janssen
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| | - Gudula Petersen
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| | - Annelies Boonen
- The data collection for this study was funded by Grünenthal GmbH. R. te Kampe, MSc, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, and Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; T.L. Jansen, MD, PhD, M. Janssen, MD, PhD, Department of Rheumatology, VieCuri Medical Center, Venlo, the Netherlands; C. van Durme, MD, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands, and Centre Hospitalier Chrétien, Liège, Belgium; G. Petersen, PhD, Grünenthal GmbH, Aachen, Germany; A. Boonen, Professor, MD, PhD, Department of Internal Medicine, Maastricht University Medical Center, and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. GP is a full-time employee in the department of Governmental Affairs & Patient Centricity at Grünenthal GmbH. Address correspondence to R. te Kampe, Department of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. . Accepted for publication May 28, 2021
| |
Collapse
|
25
|
Abstract
Gout is a common and treatable disease caused by the deposition of monosodium urate crystals in articular and non-articular structures. Increased concentration of serum urate (hyperuricaemia) is the most important risk factor for the development of gout. Serum urate is regulated by urate transporters in the kidney and gut, particularly GLUT9 (SLC2A9), URAT1 (SLC22A12), and ABCG2. Activation of the NLRP3 inflammasome by monosodium urate crystals with release of IL-1β plays a major role in the initiation of the gout flare; aggregated neutrophil extracellular traps are important in the resolution phase. Although presenting as an intermittent flaring condition, gout is a chronic disease. Long-term urate lowering therapy (eg, allopurinol) leads to the dissolution of monosodium urate crystals, ultimately resulting in the prevention of gout flares and tophi and in improved quality of life. Strategies such as nurse-led care are effective in delivering high-quality gout care and lead to major improvements in patient outcomes.
Collapse
Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Anna L Gosling
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Angelo Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham National Institute for Health Research Biomedical Research Centre, Nottingham, UK
| |
Collapse
|
26
|
Khanna PP, Khanna D, Cutter G, Foster J, Melnick J, Jaafar S, Biggers S, Rahman AKMF, Kuo HC, Feese M, Kivitz A, King C, Shergy W, Kent J, Peloso PM, Danila MI, Saag KG. Reducing Immunogenicity of Pegloticase With Concomitant Use of Mycophenolate Mofetil in Patients With Refractory Gout: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2021; 73:1523-1532. [PMID: 33750034 DOI: 10.1002/art.41731] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pegloticase is used for the treatment of severe gout, but its use is limited by immunogenicity. This study was undertaken to evaluate whether mycophenolate mofetil (MMF) prolongs the efficacy of pegloticase. METHODS Participants were randomized 3:1 to receive 1,000 mg MMF twice daily or placebo for 14 weeks, starting 2 weeks before receiving pegloticase and continuing while receiving intravenous pegloticase 8 mg biweekly for 12 weeks. Participants then received pegloticase alone from week 12 to week 24. The primary end points were the proportion of patients who sustained a serum urate level of ≤6 mg/dl at 12 weeks and the rate of adverse events (AEs). Secondary end points included 24-week durability of serum urate level ≤6 mg/dl. Fisher's exact test and Wilcoxon's 2-sample test were used for analyses, along with Kaplan-Meier estimates and log rank tests. RESULTS A total of 32 participants received ≥1 dose of pegloticase. Participants were predominantly men (88%), with a mean age of 55.2 years, mean gout duration of 13.4 years, and mean baseline serum urate level of 9.2 mg/dl. At 12 weeks, a serum urate level of ≤6 mg/dl was achieved in 19 (86%) of 22 participants in the MMF arm compared to 4 (40%) of 10 in the placebo arm (P = 0.01). At week 24, the serum urate level was ≤6 mg/dl in 68% of MMF-treated patients versus 30% of placebo-treated patients (P = 0.06), and rates of AEs were similar between groups, with more infusion reactions occurring in the placebo arm (30% versus 0%). CONCLUSION Our findings indicate that MMF therapy with pegloticase is well tolerated and shows a clinically meaningful improvement in targeted serum urate level of ≤6 mg/dl at 12 and 24 weeks. This study suggests an innovative approach to pegloticase therapy in gout.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | | | - Jeff Kent
- Horizon Therapeutics, Lake Forest, Illinois, USA
| | | | | | | |
Collapse
|
27
|
Bajpai R, Muller S, Mallen C, Watson L, Richette P, Hider SL, Roddy E. Onset of comorbidities and flare patterns within pre-existing morbidity clusters in people with gout: 5-year primary care cohort study. Rheumatology (Oxford) 2021; 61:407-412. [DOI: 10.1093/rheumatology/keab283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Objective
To investigate the onset of comorbidities and pattern of flares over 5 years according to baseline comorbidity clusters in people with gout.
Methods
In a prospective primary care-based cohort study, adults aged ≥18 years with gout were identified from primary care medical records in 20 general practices across the West Midlands, UK and followed up over 5 years. Four clusters of participants have been defined previously according to baseline comorbidity status. The associations of (i) incident comorbidities and (ii) gout flares with baseline cluster membership were estimated using age and sex-adjusted Poisson regression and mixed effects ordinal logistic regression, respectively.
Results
The comorbidity with the highest incidence was coronary artery disease (39.2%), followed by hypertension (36.7%), chronic kidney disease stage ≥3 (18.1%), obesity (16.0%), hyperlipidaemia (11.7%), diabetes (8.8%) and cancer (8.4%). There were statistically significant associations observed between cluster membership and incidence of coronary artery disease, hyperlipidaemia, heart failure and hypertension. In each cluster, nearly one-third of participants reported two or more gout flares at each time-point. History of oligo/polyarticular flares (odds ratio [OR]= 2.16, 95% confidence interval [CI]: 1.73, 2.70) and obesity (1.66, 95% CI: 1.21, 2.25) were associated with increasing flares whereas current use of allopurinol was associated with lower risk (0.42, 95% CI: 0.34–0.53). Cluster membership was not associated with flares.
Conclusion
Substantial numbers of people in each cluster developed new comorbidities that varies by cluster membership. People also experienced multiple flares over time, but these did not differ between clusters. Clinicians should be vigilant for the development of new comorbidities in people with gout.
Collapse
Affiliation(s)
- Ram Bajpai
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Lorraine Watson
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Pascal Richette
- Service de Rhumatologie, APHP, Hôpital Lariboisière
- Inserm, UMR-S 1132, Université de Paris, Paris, France
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| |
Collapse
|
28
|
Liang J, Jiang Y, Huang Y, Huang Y, Liu F, Zhang Y, Yang M, Wu J, Xiao M, Cao S, Gu J. Comorbidities and factors influencing frequent gout attacks in patients with gout: a cross-sectional study. Clin Rheumatol 2021; 40:2873-2880. [PMID: 33538925 DOI: 10.1007/s10067-021-05595-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/06/2020] [Accepted: 01/17/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective was to identify the comorbidities of gout, to compare gender difference and independent factors of frequent gout attacks (> 20 times). METHOD Demographic, clinical variables, self-reported comorbidities, and biochemical variables (i.e., initial serum uric acid (UA) and UA at visit) were collected in this cross-sectional study. Gout attack times were recorded as ≤ 5, 6-10, 11-20, and > 20. Adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to explore the association between selected risk factors and frequent gout attacks. RESULTS Six hundred fifty-three gout patients with a mean age of 48.3 ± 15.8 years were included, 84.7% of whom were males. The median gout duration was 6.0 (3.0-12.0) years. The most common comorbidities involved hypertension (166, 25.4%), coronary artery disease (CAD) (67, 10.3%), chronic kidney disease (66, 10.1%), and hyperlipidemia (57, 8.7%). Abnormalities including nephrolithiasis (29.4%), hydronephrosis (3.2%), and gallstones (11.9%) were also found. Although female patients had a longer disease duration and more CAD, they had a lower level of UA, creatine, and C-reactive protein (CRP) but higher high-density lipoprotein cholesterol (HDL-C) (p < 0.05). A positive correlation between UA and triglycerides was found in females (p = 0.039). Patients with renal insufficiency or nephrolithiasis had longer disease duration and more gout attacks (p < 0.001). In multivariable regression analysis, only gout duration (OR = 7.89, p < 0.001) and UA (OR = 1.48, p < 0.001) was independent factors of frequent gout attacks. CONCLUSIONS Comorbidity screening involving dyslipidemia is often neglected in gout patients. Gout duration and UA are the risk factors of frequent gout attacks. Key Points • Comorbidities can be overlooked if the screening for lipid levels, cardiovascular disease, and kidney disease is not completed. • There are differences in comorbidities and biochemical findings between male and female patients with gout. • Gout duration and serum uric acid level are independent risk factors of frequent gout attacks.
Collapse
Affiliation(s)
- Jing Liang
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Yutong Jiang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yefei Huang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yulan Huang
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Feng Liu
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Yanli Zhang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jialing Wu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Min Xiao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.
| |
Collapse
|
29
|
Association of urate deposition shown by ultrasound and frequent gout attacks. Z Rheumatol 2020; 80:565-569. [PMID: 33034681 DOI: 10.1007/s00393-020-00913-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are few data demonstrating the association between urate burden assessed by ultrasound (US) and gout flares. The aim of this study was to determine the association of urate deposition shown by US and frequent gout attacks. MATERIALS AND METHODS Patients with gout were divided into two groups according to the frequency of gout attacks in the previous 12 months: frequent (>2 attacks) and infrequent (0-2 attacks). Urate deposition in the hands, knees, and feet was assessed by US. RESULTS Overall, 106 patients were enrolled in this study, of whom 32 (30.1%) had had frequent gout attacks (>2 attacks) in the previous 12 months (the average number of gout attacks was 4.7, range 3-12). Those with frequent gout attacks had significantly longer gout duration, a higher serum urate level, and more urate deposition shown by US than those with infrequent gout attacks (P < 0.05). In both univariate and logistic regression analyses, frequent gout attacks were correlated with gout duration, serum urate level, and urate deposition as shown by US (P < 0.05). CONCLUSION These findings indicate that urate deposition shown by US is independently associated with frequent gout attacks. Special attention should be given to the prevention of flares in patients with an initially high urate burden as assessed by US.
Collapse
|
30
|
Latent Class Growth Analysis of Gout Flare Trajectories: A Three‐Year Prospective Cohort Study in Primary Care. Arthritis Rheumatol 2020; 72:1928-1935. [DOI: 10.1002/art.41476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/30/2020] [Indexed: 01/22/2023]
|
31
|
Koto R, Nakajima A, Horiuchi H, Yamanaka H. Real-world treatment of gout and asymptomatic hyperuricemia: A cross-sectional study of Japanese health insurance claims data. Mod Rheumatol 2020; 31:261-269. [PMID: 32552370 DOI: 10.1080/14397595.2020.1784556] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess gout and asymptomatic hyperuricemia in Japan and review treatment conditions. METHODS This retrospective cross-sectional study analyzed the prevalence of hyperuricemia and gout, and characteristics and treatment of patients with those conditions, using Japanese health insurance claims and medical check-up data collected from April 2016 through March 2017. RESULTS Among 2,531,383 persons registered in the database, 1.1% (men 1.9%, women <0.1%) were diagnosed with gout and 2.6% (4.1%, 0.4%) with asymptomatic hyperuricemia. Medical check-ups showed 13.4% (19.6%, 1.0%) of patients with hyperuricemia (serum uric acid [sUA] > 7.0 mg/dL). Urate-lowering therapy (ULT) was prescribed for 80.7% of patients identified with gout and 72.4% identified with asymptomatic hyperuricemia. ULT adherence was satisfactory, but most patients were treated with low-dose ULT. Less than half of patients receiving ULT achieved the sUA target (≤6.0 mg/dL). In gout patients, the incidence of gout flare was 47.8% (0.74 flares/person-year). CONCLUSIONS Although hyperuricemia prevalence is similar in Japan and worldwide, gout is comparatively rare in Japan. Gout and asymptomatic hyperuricemia are often treated with low-dose ULT, and many patients fail to reach target sUA, suggesting that gout management is suboptimal in Japan. Patients would benefit from stricter focus on a treat-to-target approach for gout management.
Collapse
Affiliation(s)
- Ruriko Koto
- Medical Science Department, Teijin Pharma Limited, Tokyo, Japan
| | - Akihiro Nakajima
- Pharmaceutical Development Administration Department, Teijin Pharma Limited, Tokyo, Japan
| | - Hideki Horiuchi
- Medical Science Department, Teijin Pharma Limited, Tokyo, Japan
| | | |
Collapse
|
32
|
Chernoff DJ, Barker JP, Wingerter SA, Shriwise TL. Gout After Total Knee Arthroplasty. Arthroplast Today 2020; 6:278-282. [PMID: 32577478 PMCID: PMC7303497 DOI: 10.1016/j.artd.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Crystalline arthropathies are well-known pathologies in a native knee; however, the literature is scarce with regards to crystalline arthropathies in a total knee arthroplasty (TKA). The presentation of crystalline arthropathy in a TKA can be similar to a periprosthetic joint infection (PJI), making it difficult to distinguish between the 2 diagnoses. We present 1 case highlighting the similarity between crystalline arthropathy and PJI. A 71-year-old man with a history of bilateral TKAs presented with bilateral painful knee effusions and was initially presumed to have PJIs; however, he was later diagnosed with gout and successfully treated medically. A complete review of the literature demonstrates that crystalline arthropathies after TKA are infrequently reported and can be difficult to decipher from PJIs, and there is a lack of standardized treatment.
Collapse
Affiliation(s)
- Daniel J Chernoff
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Jordan P Barker
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Scott A Wingerter
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Thomas L Shriwise
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| |
Collapse
|
33
|
Towiwat P, Phungoen P, Tantrawiwat K, Laohakul P, Aiewruengsurat D, Thanadetsuntorn C, Ruchakorn N, Sangsawangchot P, Buttham B. Quality of gout care in the emergency departments: a multicentre study. BMC Emerg Med 2020; 20:27. [PMID: 32312248 PMCID: PMC7171834 DOI: 10.1186/s12873-020-00319-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. METHODS A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. RESULTS Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). CONCLUSIONS Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.
Collapse
Affiliation(s)
- Patapong Towiwat
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kitti Tantrawiwat
- Department of Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Pavita Laohakul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Duangkamol Aiewruengsurat
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Chokchai Thanadetsuntorn
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopparat Ruchakorn
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Passagorn Sangsawangchot
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Bodin Buttham
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
| |
Collapse
|
34
|
Abstract
INTRODUCTION Gout is a painful form of inflammatory arthritis associated with several comorbidities, particularly cardiovascular disease. Cherries, which are rich in anti-inflammatory and antioxidative bioactive compounds, are proposed to be efficacious in preventing and treating gout, but recommendations to patients are conflicting. Cherry consumption has been demonstrated to lower serum urate levels and inflammation in several small studies. One observational case cross-over study reported that cherry consumption was associated with reduced risk of recurrent gout attacks. This preliminary evidence requires substantiation. The proposed randomised clinical trial aims to test the effect of consumption of tart cherry juice on risk of gout attacks. METHODS AND ANALYSIS This 12-month, parallel, double-blind, randomised, placebo-controlled trial will recruit 120 individuals (aged 18-80 years) with a clinical diagnosis of gout who have self-reported a gout flare in the previous year. Participants will be randomly assigned to an intervention group, which will receive Montmorency tart cherry juice daily for a 12-month period, or a corresponding placebo group, which will receive a cherry-flavoured placebo drink. The primary study outcome is change in frequency of self-reported gout attacks. Secondary outcome measures include attack intensity, serum urate concentration, fractional excretion of uric acid, biomarkers of inflammation, blood lipids and other markers of cardiovascular risk. Other secondary outcome measures will be changes in physical activity and functional status. Statistical analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION This study has been granted ethical approval by the National Research Ethics Service, Yorkshire and The Humber-Leeds West Research Ethics Committee (ref: 18/SW/0262). Results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03621215.
Collapse
Affiliation(s)
- Kirstie Louise Lamb
- Food and Nutrition Group, Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| | - Anthony Lynn
- Food and Nutrition Group, Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| | - Jean Russell
- Corporate Information and Computing Services, The University of Sheffield, Sheffield, UK
| | - Margo E Barker
- Food and Nutrition Group, Sheffield Business School, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
35
|
Lee JS, Kwon OC, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Clinical features and recurrent attack in gout patients according to serum urate levels during an acute attack. Korean J Intern Med 2020; 35:240-248. [PMID: 30685959 PMCID: PMC6960048 DOI: 10.3904/kjim.2018.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS A substantial portion of gout patients have normal serum urate levels during an acute attack but data on the clinical characteristics and risk of recurrence compared with hyperuricemic patients are limited. METHODS In this retrospective cohort study, clinical features of normouricemic and hyperuricemic patients were compared. Multivariate analysis was performed to determine whether normouricemic patients were less likely to have a recurrent attack. RESULTS Among a total of 221 gout patients, 88 (39.8%) had normouricemia during an acute attack. Postsurgical gout (22.7% vs. 6.0%, p < 0.001), hemodialysis initiation (9.1% vs. 2.3%, p = 0.029) and inflammatory activity were higher in normouricemic patients than in hyperuricemic patients. The frequency of renal insufficiency was lower in normouricemic patients (25.0% vs. 53.4%, p < 0.001). However, the recurrence rate of gout attack was not different between the two groups (24.7% vs. 33.0%, p = 0.220). In multivariate analysis, female sex, history of urinary stone, presence of tophi, and use of thiazide were associated with increase of recurrent gout attack, but not with serum urate status during an acute attack (hazard ratio, 1.075; 95% confidence interval, 0.972 to 1.190; p = 0.159). CONCLUSION Normouricemia during an acute gout attack was more frequently observed in postsurgical episodes, hemodialysis initiation and patients with preserved renal function. While higher inflammatory activity was observed in normouricemic patients, recurrent attack was not associated with serum urate levels during an acute attack. Thus, careful follow-up should be considered in gout patients regardless of serum urate levels during an acute attack.
Collapse
Affiliation(s)
- Jung Sun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Seokchan Hong, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-1410 Fax: +82-2-3010-6969 E-mail:
| |
Collapse
|
36
|
Fomin VV, Morosova TE, Tsurko VV. [Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice]. TERAPEVT ARKH 2019; 91:75-83. [PMID: 32598593 DOI: 10.26442/00403660.2019.12.000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 02/07/2023]
Abstract
In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.
Collapse
Affiliation(s)
- V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T E Morosova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Tsurko
- Sechenov First Moscow State Medical University (Sechenov University).,Pirogov Russian National Research Medical University
| |
Collapse
|
37
|
Interaction of the p.Q141K Variant of the ABCG2 Gene with Clinical Data and Cytokine Levels in Primary Hyperuricemia and Gout. J Clin Med 2019; 8:jcm8111965. [PMID: 31739430 PMCID: PMC6912417 DOI: 10.3390/jcm8111965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Gout is an inflammatory arthritis influenced by environmental risk factors and genetic variants. The common dysfunctional p.Q141K allele of the ABCG2 gene affects gout development. We sought after the possible association between the p.Q141K variant and gout risk factors, biochemical, and clinical determinants in hyperuricemic, gouty, and acute gouty arthritis cohorts. Further, we studied the correlation of p.Q141K allele and levels of pro-/anti-inflammatory cytokines. Coding regions of the ABCG2 gene were analyzed in 70 primary hyperuricemic, 182 gout patients, and 132 normouricemic individuals. Their genotypes were compared with demographic and clinical parameters. Plasma levels of 27 cytokines were determined using a human multiplex cytokine assay. The p.Q141K variant was observed in younger hyperuricemic/gout individuals (p = 0.0003), which was associated with earlier disease onset (p = 0.004), trend toward lower BMI (p = 0.056), and C-reactive protein (CRP, p = 0.007) but a higher glomerular filtration rate (GFR, p = 0.035). Levels of 19 cytokines were higher, mainly in patients with acute gouty arthritis (p < 0.001), irrespective of the presence of the p.Q141K variant. The p.Q141K variant influences the age of onset of primary hyperuricemia or gout and other disease-linked risk factors and symptoms. There was no association with cytokine levels in the circulation.
Collapse
|
38
|
Yates KA, Yoshida K, Xu C, Lyu H, Norvang V, Solomon DH, Tedeschi SK. Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence. J Rheumatol 2019; 47:1261-1266. [PMID: 31676701 DOI: 10.3899/jrheum.190778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Little is known about acute calcium pyrophosphate (CPP) crystal arthritis flare rates and risk factors for recurrence. We characterized flares and determined the rate and predictors of acute CPP crystal arthritis flares in an academic medical center cohort. METHODS We performed a retrospective cohort study among a random sample of patients with acute CPP crystal arthritis identified in the Partners HealthCare electronic medical record, 1991-2017. Flare was defined as self-limited, acute-onset synovitis with synovial fluid CPP crystals and/or chondrocalcinosis, not better explained by another cause. We calculated incidence rates (IR) for acute CPP crystal arthritis flare among all subjects and by sex. We estimated HR for recurrent flare using univariate Cox models that accounted for within-person correlated data. RESULTS We identified 70 patients with acute CPP crystal arthritis with a total of 111 flares. Recurrent flares occurred in 24% of patients; half of flares occurred in a previously unaffected joint. The acute CPP crystal arthritis flare rate was 11.4 per 100 person-years overall (95% CI 8.2-15.4), 14.2 in women (95% CI 9.6-0.1), and 7.1 in men (95% CI 3.4-13.0). Cancer (HR 2.98, 95% CI 1.33-6.68) and chronic kidney disease (HR 2.92, 95% CI 1.10-7.76) were associated with a higher rate for recurrent flare. CONCLUSION Recurrent flares occurred in about one-fourth of patients with acute CPP crystal arthritis and often occurred in previously unaffected joints. The acute CPP crystal arthritis flare rate was twice as high in women as in men.
Collapse
Affiliation(s)
- Katherine A Yates
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Kazuki Yoshida
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Chang Xu
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Houchen Lyu
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Vibeke Norvang
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Daniel H Solomon
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Sara K Tedeschi
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. .,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School.
| |
Collapse
|
39
|
Variation in methods, results and reporting in electronic health record-based studies evaluating routine care in gout: A systematic review. PLoS One 2019; 14:e0224272. [PMID: 31648282 PMCID: PMC6812805 DOI: 10.1371/journal.pone.0224272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To perform a systematic review examining the variation in methods, results, reporting and risk of bias in electronic health record (EHR)-based studies evaluating management of a common musculoskeletal disease, gout. METHODS Two reviewers systematically searched MEDLINE, Scopus, Web of Science, CINAHL, PubMed, EMBASE and Google Scholar for all EHR-based studies published by February 2019 investigating gout pharmacological treatment. Information was extracted on study design, eligibility criteria, definitions, medication usage, effectiveness and safety data, comprehensiveness of reporting (RECORD), and Cochrane risk of bias (registered PROSPERO CRD42017065195). RESULTS We screened 5,603 titles/abstracts, 613 full-texts and selected 75 studies including 1.9M gout patients. Gout diagnosis was defined in 26 ways across the studies, most commonly using a single diagnostic code (n = 31, 41.3%). 48.4% did not specify a disease-free period before 'incident' diagnosis. Medication use was suboptimal and varied with disease definition while results regarding effectiveness and safety were broadly similar across studies despite variability in inclusion criteria. Comprehensiveness of reporting was variable, ranging from 73% (55/75) appropriately discussing the limitations of EHR data use, to 5% (4/75) reporting on key data cleaning steps. Risk of bias was generally low. CONCLUSION The wide variation in case definitions and medication-related analysis among EHR-based studies has implications for reported medication use. This is amplified by variable reporting comprehensiveness and the limited consideration of EHR-relevant biases (e.g. data adequacy) in study assessment tools. We recommend accounting for these biases and performing a sensitivity analysis on case definitions, and suggest changes to assessment tools to foster this.
Collapse
|
40
|
Abstract
Gout is a chronic disease caused by monosodium urate (MSU) crystal deposition. Gout typically presents as an acute, self-limiting inflammatory monoarthritis that affects the joints of the lower limb. Elevated serum urate level (hyperuricaemia) is the major risk factor for MSU crystal deposition and development of gout. Although traditionally considered a disorder of purine metabolism, altered urate transport, both in the gut and the kidneys, has a key role in the pathogenesis of hyperuricaemia. Anti-inflammatory agents, such corticosteroids, NSAIDs and colchicine, are widely used for the treatment of gout flare; recognition of the importance of NLRP3 inflammasome activation and bioactive IL-1β release in initiation of the gout flare has led to the development of anti-IL-1β biological therapy for gout flares. Sustained reduction in serum urate levels using urate-lowering therapy is vital in the long-term management of gout, which aims to dissolve MSU crystals, suppress gout flares and resolve tophi. Allopurinol is the first-line urate-lowering therapy and should be started at a low dose, with gradual dose escalation. Low-dose anti-inflammatory therapies can reduce gout flares during initiation of urate-lowering therapy. Models of care, such as nurse-led strategies that focus on patient engagement and education, substantially improve clinical outcomes and now represent best practice for gout management.
Collapse
|
41
|
Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ, Crowson CS, Matteson EL, Bongartz T. Changes in the Presentation of Incident Gout and the Risk of Subsequent Flares: A Population-based Study over 20 Years. J Rheumatol 2019; 47:613-618. [PMID: 31308206 DOI: 10.3899/jrheum.190346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine whether a change in the presentation of incident gout happened over the last 20 years and to determine the risk of subsequent gout flares after an initial gout attack. METHODS All incident cases of gout were identified among residents of Olmsted County, Minnesota, diagnosed in 1989-1992 and 2009-2010 according to the earliest date fulfilling the 1977 American Rheumatism Association preliminary criteria, or the New York or Rome criteria for gout. Patients in both cohorts were then followed for up to 5 years. Cumulative incidence and person-year methods were used to compare flare rates, and conditional frailty models were used to examine predictors. RESULTS A total of 429 patients with incident gout (158 patients in 1989-1992 and 271 patients in 2009-2010) were identified and followed for a mean of 4.2 years. The majority of patients were male (73%) and the mean age (SD) at gout onset was 59.7 (17.3) years. Classic podagra decreased significantly from 74% to 59% (p < 0.001). Cumulative incidence of first flare was similar in both cohorts (62% vs 60% by 5 yrs in 1989-1992 and 2009-2010, respectively; p = 0.70), but overall flare rate was marginally higher in 2009-2010 compared to 1989-1992 (rate ratio: 1.24). Hyperuricemia (HR 1.59) and kidney disease (HR 1.34) were significant predictors of future flares. CONCLUSION Gout flares were common in both time periods. Hyperuricemia and kidney disease were predictors of future flares in patients with gout. Podagra as a presentation of gout has become relatively less frequent in recent years.
Collapse
Affiliation(s)
- Mohanad M Elfishawi
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA. .,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University.
| | - Nour Zleik
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| | - Zoran Kvrgic
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| | - Clement J Michet
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| | - Cynthia S Crowson
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| | - Eric L Matteson
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| | - Tim Bongartz
- From the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals, Jamaica, New York; Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MBBCh, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens, and Division of Rheumatology, Mayo Clinic College of Medicine; N. Zleik, MD, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Queens; C.J. Michet Jr., MD, Division of Rheumatology, Mayo Clinic College of Medicine; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine; T. Bongartz, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine, and Department of Emergency Medicine, Vanderbilt University
| |
Collapse
|
42
|
Abstract
OBJECTIVE/METHODS The Longitudinal Health Insurance Database (LHID) 2010 was used to identify gout cases and their number of gout flares. RESULTS Out of 21,376 gout patients, a total of 3561 (16.7%) had frequent gout flares (≥3 gout flares/year). Average all-cause healthcare utilization (35.9 visits vs. 30.7 visits; p < .001) and gout-related utilization (22.7 visits vs. 15.6 visits; p < .001) were higher in frequent gout flare patients than in those with infrequent gout flares. The median gout-related cost (USD $369 vs. $285; p < .001), but not all-cause costs (p = .25), were higher in frequent gout flare patients compared to the infrequent group. Over 55.8% of the flares were treated with colchicine + NSAIDs. CONCLUSIONS In conclusion, patients with frequent gout flares had higher healthcare utilization and gout-related healthcare costs. Colchicine + NSAIDs are commonly used therapy for gout flare.
Collapse
Affiliation(s)
- Yi-Yun Lee
- a Department of Pharmacy , College of Pharmacy, Taipei Medical University , Taipei , Taiwan
- b Department of Pharmacy , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan
| | - Li-Na Kuo
- a Department of Pharmacy , College of Pharmacy, Taipei Medical University , Taipei , Taiwan
- b Department of Pharmacy , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan
| | - Jin-Hua Chen
- c Biostatistics Center and Masters Program in Big Data Technology and Management, College of Management, Taipei Medical University , Taipei , Taiwan
| | - Yi-Chun Lin
- c Biostatistics Center and Masters Program in Big Data Technology and Management, College of Management, Taipei Medical University , Taipei , Taiwan
| | - Lung-Fang Chen
- d Department of Rheumatology , Wan Fang Hospital, Taipei Medical University , Taipei City , Taiwan
| | - Yu Ko
- a Department of Pharmacy , College of Pharmacy, Taipei Medical University , Taipei , Taiwan
- e Research Center of Pharmacoeconomics, College of Pharmacy, Taipei Medical University , Taipei , Taiwan
| |
Collapse
|
43
|
Proudman C, Lester SE, Gonzalez-Chica DA, Gill TK, Dalbeth N, Hill CL. Gout, flares, and allopurinol use: a population-based study. Arthritis Res Ther 2019; 21:132. [PMID: 31151457 PMCID: PMC6544947 DOI: 10.1186/s13075-019-1918-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a paucity of community-based data regarding the prevalence and impact of gout flares as these may often be self-managed. The aim of this study was to determine the prevalence of self-reported gout and gout flares, the use of urate-lowering therapy (ULT), and the association of gout flares with health-related quality of life (HRQoL) in a large community sample. Covariate associations with flare frequency and allopurinol use were also examined. METHODS The South Australian Health Omnibus Survey is an annual, face-to-face population-based survey. Data collected in the 2017 survey included self-reported medically diagnosed gout, allopurinol use (first-line ULT in Australia), and gout attacks (flares) in the last 12 months, in addition to sociodemographic variables and health-related quality of life (HRQoL, SF-12). Data were weighted to the Australian Bureau of Statistics 2016 census data to reflect the South Australian population. Participants 25 years and over (n = 2778) were included in the analysis. RESULTS The prevalence of gout was 6.5% (95%CI 5.5, 7.5). Amongst participants with gout, 37.1% (95%CI 29.6, 45.3) reported currently using allopurinol, while 23.2% (95%CI 16.9, 21.0) reported prior use (38% discontinuation rate). Frequent flares (≥ 2 in the last year) were reported by 25% of participants with gout and were more likely with younger age, higher body mass index, and current allopurinol use (p < 0.05). The frequency of gout flares was associated with a lower physical HRQoL (p = 0.012). Current allopurinol use was reported by 51% of participants with frequent gout flares. CONCLUSION Flares were frequently reported by people with gout in the community. Gout flares were associated with reduced physical HRQoL. Almost one half of people with frequent gout flares were not receiving allopurinol, and current allopurinol use was associated with frequent gout flares, suggesting undertreated disease and suboptimal use of ULT. Determining covariate associations with flares and ineffective allopurinol use may identify means of improving treatment and reducing flares.
Collapse
Affiliation(s)
- Charlotte Proudman
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Susan E. Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville South, 5011 South Australia
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - David A. Gonzalez-Chica
- Discipline of General Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Tiffany K. Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Catherine L. Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville South, 5011 South Australia
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| |
Collapse
|
44
|
Jaffe DH, Klein AB, Benis A, Flores NM, Gabay H, Morlock R, Teltsch DY, Chapnick J, Molad Y, Giveon SM, Feldman B, Leventer-Roberts M. Incident gout and chronic Kidney Disease: healthcare utilization and survival. BMC Rheumatol 2019; 3:11. [PMID: 30937425 PMCID: PMC6425669 DOI: 10.1186/s41927-019-0060-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background Uncontrolled gout can cause significant joint and organ damage and has been associated with impairments in quality of life and high economic cost. Gout has also been associated with other comorbid diseases, such as chronic kidney disease. The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD). Methods Clalit Health Services (CHS) data were used to conduct a retrospective population-based cohort study of incident gout between 1/1/2006–31/12/2009. Incident cases of gout were identified and stratified by CKD status and by age group (< 55 and 55+ years). CKD status was defined as a pre-existing diagnosis of chronic kidney disease, chronic renal failure, kidney transplantation, or dialysis at index date. Demographic and clinical characteristics, as well as healthcare resource use, were reported. Results A total of 12,940 incident adult gout patients, with (n = 8286) and without (n = 4654) CKD, were followed for 55,206 person-years. Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01–2.71; HR55+ years = 1.50; 95% CI 1.37–1.65). Conclusions The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age. Future work should explore factors associated with these outcomes and barriers to gout control in order to enhance patient management among this high-risk subgroup.
Collapse
Affiliation(s)
- Dena H Jaffe
- Kantar Health, Ariel Sharon St 4, 52511 Ramat-Gan, Israel
| | - Alyssa B Klein
- 2AstraZeneca, Medical Evidence and Observational Research Centre, 200 Orchard Ridge Drive, Gaithersburg, MD USA
| | - Arriel Benis
- Clalit Research Institute, Zamenhoff 42, Floor - 1, 6435331 Tel Aviv, Israel
| | | | - Hagit Gabay
- Clalit Research Institute, Zamenhoff 42, Floor - 1, 6435331 Tel Aviv, Israel
| | | | | | | | - Yair Molad
- 8Beilinson Hospital, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Shmuel M Giveon
- Clalit Research Institute, Zamenhoff 42, Floor - 1, 6435331 Tel Aviv, Israel
| | - Becca Feldman
- Clalit Research Institute, Zamenhoff 42, Floor - 1, 6435331 Tel Aviv, Israel
| | | |
Collapse
|
45
|
Chinchilla SP, Doherty M, Abhishek A. Gout Activity Score has predictive validity and is sensitive to change: results from the Nottingham Gout Treatment Trial (Phase II). Rheumatology (Oxford) 2019; 58:5306645. [PMID: 30726962 PMCID: PMC6649838 DOI: 10.1093/rheumatology/key446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/13/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine the predictive validity of the Gout Activity Score (GAS), its correlation with the Gout Impact Scale (GIS) and their sensitivity to change. METHODS Data from a clinical trial in which participants with one or more gout flares in the previous year were recruited from primary care and randomized to nurse-led or continuing usual care were used in this study. GAS and GIS were calculated as described, with higher scores indicating worse disease activity and quality of life, respectively. The correlation between GAS and GIS was examined using Spearman's correlation. Standardized response means (SRMs) were calculated to assess sensitivity to change. The association between GAS at baseline and the number of flares in the next 12 months was evaluated using Poisson regression. Data analyses were performed using STATA version 14, with P-values <0.05 being statistically significant. RESULTS There was low positive correlation between GAS and gout concern overall and unmet treatment need subscales of GIS (r = 0.34-0.45). Female sex associated independently with fewer gout flares, while increasing GAS, BMI and age associated independently with frequent flares. Of all the outcome measures examined, GAS was the most responsive to change (SRM 0.89 to -0.53). Of the GIS domains, the gout concern overall domain had the best sensitivity to change (SRM 1.06-0.01). CONCLUSION GAS is sensitive to change, has predictive validity and correlates with relevant domains of GIS such as gout concern overall. Additional independent validation of GAS is required before it can be adopted in clinical practice.
Collapse
Affiliation(s)
- Sandra P Chinchilla
- University of the Basque Country (UPV/EHU), Bilbao-Biscay, Spain
- Academic Rheumatology
| | - Michael Doherty
- Academic Rheumatology
- NIHR-BRC, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Academic Rheumatology
- NIHR-BRC, University of Nottingham, Nottingham, UK
| |
Collapse
|
46
|
Chan CW, Yap YN. Pharmacotherapeutic management of gout in patients with cardiac disease. Expert Opin Pharmacother 2018; 19:2011-2018. [DOI: 10.1080/14656566.2018.1536747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Chun Wai Chan
- Department of Family Medicine, School of Medicine, International Medical University , Seremban, Negeri Sembilan Darul Khusus, Malaysia
| | - Ying Nee Yap
- School of Medicine, International Medical University , Kuala Lumpur, Malaysia
| |
Collapse
|
47
|
Pascart T, Grandjean A, Capon B, Legrand J, Namane N, Ducoulombier V, Motte M, Vandecandelaere M, Luraschi H, Godart C, Houvenagel E, Norberciak L, Budzik JF. Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study : MSU burden and risk of gout flare. Arthritis Res Ther 2018; 20:210. [PMID: 30223875 PMCID: PMC6142357 DOI: 10.1186/s13075-018-1714-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background Predicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares. Methods This prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated. Results Overall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm3 increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15–4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm3 (specificity 61%, sensitivity 77%). Conclusions This is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares. Electronic supplementary material The online version of this article (10.1186/s13075-018-1714-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France. .,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, 59000, Lille, France. .,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France.
| | - Agathe Grandjean
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Benoist Capon
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Julie Legrand
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Nasser Namane
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Marguerite Motte
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Marie Vandecandelaere
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Catherine Godart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Jean-François Budzik
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, 59000, Lille, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| |
Collapse
|
48
|
Scheepers LE, van Onna M, Stehouwer CD, Singh JA, Arts IC, Boonen A. Medication adherence among patients with gout: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 47:689-702. [DOI: 10.1016/j.semarthrit.2017.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/29/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
|
49
|
Abstract
Gout is common in the elderly, affecting an estimated 4.7 million people aged > 60 years in the USA alone. The incidence and prevalence of gout increases, and male predisposition to gout reduces, with increasing age. The elderly have more comorbidities, and gout manifests differently, with more frequent involvement of knees, ankles, and wrists at disease onset, systemic upset, and tophi. Comorbidities and polypharmacy make the management of gout flares challenging in this population. Intra-articular corticosteroid injection remains the treatment of choice for accessible joints, oral prednisolone is preferred over low-dose colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided. Xanthine oxidase inhibitors (XOI) remain the first-line treatment for hyperuricemia in the elderly. Arhalofenate, an emerging uricosuric anti-inflammatory drug, prevents gout flares while reducing serum urate. It may be particularly relevant in the treatment of gout in the elderly as they are unable to tolerate long-term colchicine for flare prophylaxis and frequently have contraindications to corticosteroids and NSAIDs. However, given its modest urate-lowering effect, it can only be used in combination with an XOI, and the safety and efficacy of this drug has not been examined in the elderly or in those with chronic kidney disease. Diuretics and beta-blockers should be discontinued where feasible, whereas low-dose aspirin can be continued if otherwise indicated.
Collapse
Affiliation(s)
- Abhishek Abhishek
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.
- Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, Nottingham, NG5 1PB, UK.
| |
Collapse
|
50
|
Stiburkova B, Pavelcova K, Zavada J, Petru L, Simek P, Cepek P, Pavlikova M, Matsuo H, Merriman TR, Pavelka K. Functional non-synonymous variants of ABCG2 and gout risk. Rheumatology (Oxford) 2017; 56:1982-1992. [PMID: 28968913 DOI: 10.1093/rheumatology/kex295] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Common dysfunctional variants of ATP binding cassette subfamily G member 2 (Junior blood group) (ABCG2), a high-capacity urate transporter gene, that result in decreased urate excretion are major causes of hyperuricemia and gout. In the present study, our objective was to determine the frequency and effect on gout of common and rare non-synonymous and other functional allelic variants in the ABCG2 gene. Methods The main cohort recruited from the Czech Republic consisted of 145 gout patients; 115 normouricaemic controls were used for comparison. We amplified, directly sequenced and analysed 15 ABCG2 exons. The associations between genetic variants and clinical phenotype were analysed using the t-test, Fisher's exact test and a logistic and linear regression approach. Data from a New Zealand Polynesian sample set and the UK Biobank were included for the p.V12M analysis. Results In the ABCG2 gene, 18 intronic (one dysfunctional splicing) and 11 exonic variants were detected: 9 were non-synonymous (2 common, 7 rare including 1 novel), namely p.V12M, p.Q141K, p.R147W, p.T153M, p.F373C, p.T434M, p.S476P, p.D620N and p.K360del. The p.Q141K (rs2231142) variant had a significantly higher minor allele frequency (0.23) in the gout patients compared with the European-origin population (0.09) and was significantly more common among gout patients than among normouricaemic controls (odds ratio = 3.26, P < 0.0001). Patients with non-synonymous allelic variants had an earlier onset of gout (42 vs 48 years, P = 0.0143) and a greater likelihood of a familial history of gout (41% vs 27%, odds ratio = 1.96, P = 0.053). In a meta-analysis p.V12M exerted a protective effect from gout (P < 0.0001). Conclusion Genetic variants of ABCG2, common and rare, increased the risk of gout. Non-synonymous allelic variants of ABCG2 had a significant effect on earlier onset of gout and the presence of a familial gout history. ABCG2 should thus be considered a common and significant risk factor for gout.
Collapse
Affiliation(s)
- Blanka Stiburkova
- Institute of Rheumatology.,Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University, General University Hospital in Prague
| | - Katerina Pavelcova
- Institute of Rheumatology.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Lenka Petru
- Institute of Rheumatology.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | | | | | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | |
Collapse
|