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Abstract Although updated consensus guidelines, and effective therapies, are available for management of gout, suboptimal management remains an issue. Barriers were identified and addressed as part of a dedicated, structured gout ...
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Abstract Although updated consensus guidelines, and effective therapies, are available for management of gout, suboptimal management remains an issue. Barriers were identified and addressed as part of a dedicated, structured gout clinic. More frequent appointments resulted in a faster rate of serum urate reduction, and the clinic provided the opportunity for the education of both patients and general practitioners in the management of gout.
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The treatment of acute gout can present problems in some cases (such as in patients with renal failure or peptic ulceration or taking warfarin), but the major obstacle is usually maintaining long term control. Converting correct m...
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The treatment of acute gout can present problems in some cases (such as in patients with renal failure or peptic ulceration or taking warfarin), but the major obstacle is usually maintaining long term control. Converting correct management decisions to long term success will depend on good compliance - providing the patient with a clear, simple explanation of the pathogenesis of the disease and the rationale behind therapy is the key first step.
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IntroductionGout is a common, progressive, systemic inflammatory arthritis caused by hyperuricemia. Current guidelines recommend that serum uric acid (sUA) levels be maintained below 6.0?mg/dl to minimize acute gout attacks, tophi...
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IntroductionGout is a common, progressive, systemic inflammatory arthritis caused by hyperuricemia. Current guidelines recommend that serum uric acid (sUA) levels be maintained below 6.0?mg/dl to minimize acute gout attacks, tophi development, and long-term joint and organ damage. This study examined the influence of uncontrolled gout on post-diagnosis comorbidities and medication use.MethodsThe Humana Research Database (2007–2016, commercial insurance and Medicare) was searched (PearlDiver tool) for patients who had a gout diagnosis code, claims data for at least 6?months before and after diagnosis, and at least 90?days of continuous urate-lowering therapy within 1?year of diagnosis. Patients with controlled (all sUA measurements?<?6.0?mg/dl) and uncontrolled (all sUA measurements?≥?8.0?mg/dl) gout were further examined and compared to better understand the influence of uncontrolled gout on post-diagnosis comorbidities, medication use, and reasons for seeking medical care.ResultsA total of 5473 and 1358 patients met inclusion and classification criteria for the controlled and uncontrolled groups, respectively. Identified comorbidities in both groups included hypertension, hyperlipidemia, diabetes, cardiovascular disease, and chronic kidney disease (CKD). However, the uncontrolled group was more likely to have diabetes, CKD, and cardiovascular disease (including heart failure and atrial fibrillation). Additionally, CKD tended to be more advanced in the uncontrolled gout population (Stage 4–5: 34.6 vs. 22.2%). Overall opioid use was higher in uncontrolled patients.ConclusionsThe current study identified differences between controlled and uncontrolled gout patients, including usage of medication, severity of CKD, and prevalence of CKD, diabetes, and heart disease.
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Objective: Streamlining the initiation of allopurinol could result in a cost benefit for a common medical problem and obviate the perception that no treatment is required once acute attacks have resolved. Our objective was to test...
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Objective: Streamlining the initiation of allopurinol could result in a cost benefit for a common medical problem and obviate the perception that no treatment is required once acute attacks have resolved. Our objective was to test the hypothesis that there is no difference in patient daily pain or subsequent attacks with early versus delayed initiation of allopurinol for an acute gout attack. Methods: A total of 57 men with crystal-proven gout were randomized to allopurinol 300 mg daily or matching placebo for 10 days. All subjects received indomethacin 50 mg 3 times per day for 10 days, a prophylactic dose of colchicine 0.6 mg 2 times per day for 90 days, and open-label allopurinol starting at day 11. Primary outcome measures were pain on visual analogue scale (VAS) for the primary joint on days 1 to 10 and self-reported flares in any joint through day 30. Results: On the basis of 51 evaluable subjects (allopurinol in 26, placebo in 25), mean daily VAS pain scores did not differ significantly between study groups at any point between days 1 and 10. Initial VAS pain scores for allopurinol and placebo arms were 6.72 versus 6.28 (P =.37), declining to 0.18 versus 0.27 (P =.54) at day 10, with neither group consistently having more daily pain. Subsequent flares occurred in 2 subjects taking allopurinol and 3 subjects taking placebo (P =.60). Although urate levels decreased rapidly in the allopurinol group (from 7.8 mg/dL at baseline to 5.9 mg/dL at day 3), sedimentation rates and C-reactive protein levels did not differ between groups at any point. Conclusions: Allopurinol initiation during an acute gout attack caused no significant difference in daily pain, recurrent flares, or inflammatory markers.
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Introduction. Gout is a disease that may be associated with different comorbidities, which causes difficulties in their management and appreciation of clinical manifestations. The objective of the study was to analyse the clinical...
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Introduction. Gout is a disease that may be associated with different comorbidities, which causes difficulties in their management and appreciation of clinical manifestations. The objective of the study was to analyse the clinical and evolution peculiarities in patients with gout, from different age groups. Material and methods. A descriptive, selective study of 237 patients with gout (mean age of men 60±8.0 years and 63±9.0 years in women) was conducted. The diagnosis of gout was carried out according to the American College of Rheumatology and European League Against Rheumatism 2015 criteria. The patients were separated into two groups, depending on the age at the gout onset: 60 years (group II, 146 patients). The raw data were processed in SPSS version 26.0. Results. The mean duration of the disease was comparable in both groups: 11 [7.6; 18.6] years (from 1 month to 23.7 years (p = 0.7) in group I and 11.3 [8.3; 14] years (from 1.6 years to 21.8 years) in group II. The equivalent duration of arthritis allowed comparing the characteristics of evolution in the groups. The chronic form of gout arthritis was slightly more common in group II than in group I, with significant differences (24% and 34%, p<0.01). Conclusions. With the increase of age, the frequency of risk factors for gout increases: taking small doses of acetylsalicylic acid increases from 6 to 40%, diuretics from 18 to 44%, alcohol intake from 14 to 28%, hypertension from 44 to 78%, consumption of saturated foods with purine from 51 to 68%, overweight and obesity from 58 to 76% in the groups of patients with gout onset at the age less then 60 years and 60 years and more. Copyright ? 2022 Balkan Medical Union.
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A 25-year-old male presented with pain, swelling and decreased range of motion in multiple joints. He had mild left flank pain, fevers, night sweats and poor appetite for 1 week duration. Past medical history included an elevated ...
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A 25-year-old male presented with pain, swelling and decreased range of motion in multiple joints. He had mild left flank pain, fevers, night sweats and poor appetite for 1 week duration. Past medical history included an elevated creatinine two years ago which was lost to follow-up. The patient was originally from South America and worked on a dairy farm.The patient was afebrile and vitals were stable. Other than redness and swelling in multiple joints, the physical examination was unremarkable. Initial investigations showed: creatinine 700 |xmol/L, urate 462 (xmol/L and WBC 13.5 x 109/L. HLA-B27 was negative. Right knee joint aspiration revealed monosodium urate crystals. Serology for infectious causes, TB skin test, blood, urine and synovial fluid cultures were negative. Kidney ultrasound was consistent with chronic renal disease.
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Epidemiologic data from recent decades show a significant increase in the prevalence and incidence of gout worldwide, in addition to changes in its clinical expression. Our objective was to compare the frequency of the severity of...
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Epidemiologic data from recent decades show a significant increase in the prevalence and incidence of gout worldwide, in addition to changes in its clinical expression. Our objective was to compare the frequency of the severity of gout and disability in two patient groups at our clinic during different periods. We included and compared data of two groups: group A (1995-2000), patients from previous report, and group B (2010-2014), the baseline data of current patients participating in a cohort (GRESGO). This evaluation included data of socioeconomic and educational levels, demographics, associated diseases, previous treatment, clinical and biochemical data, and disability evaluated using the Health Assessment Questionnaire (HAQ). We included data of 564 gout patients. Participants were 35.7 +/- 12.7 years old at onset and had 12.0 +/- 9.2-years disease duration at their first evaluation in our department. Group B patients were younger, had higher educational and socioeconomic levels, and had more severe disease. However, this group had less frequency of some associated diseases and significantly higher HAQ scores. With increased HAQ score, a higher number of acute flares and tender, limited-to-motion, and swollen joints were seen. The spectrum of gout has changed over the past decade. A higher percentage of our patients had a severe form of disease, were younger, had earlier disease onset, and had more disability reflected in higher HAQ scores. In our current patient group, the variable most associated with disability was limited-to-motion joints; however, the number of acute flares and tender and swollen joints was also higher in patients with greater disability.
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Objective Gout treatment is largely suboptimal in clinical practice. We aimed to assess the predictors of disease-activity at 12 months in a real-life setting. Methods Consecutive patients referred to Rheumatology Units for suspec...
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Objective Gout treatment is largely suboptimal in clinical practice. We aimed to assess the predictors of disease-activity at 12 months in a real-life setting. Methods Consecutive patients referred to Rheumatology Units for suspected acute crystal-induced arthritis were enrolled in a multicentre-cohort study. Only patients with clinical diagnosis of gout were eligible. Disease-activity was evaluated by the Patient Acceptable Symptom State (PASS) on a visual analogue scale (VAS, 0=unsatisfactory, 100=satisfactory) at 0 (T0) and 12 months (T12), and the composite score called Gout Activity Score (GAS) calculated on the number of arthritic attacks (flare count), serum uric acid (sUA), cumulative number of tophi, VAS (T12), PtGA (T12). Multivariate linear regression model was performed to assess predictors of gout disease-activity at T12 with PASS and GAS as outcomes. Results 201 patients had gout (diagnosis on synovial fluid in 45%, tophi in 26%, mean sUA 7.4±1.9 mg/L, 85% with urate-lowering therapy (ULT) in progress/initiated at T0); mean age 63±13 years, 88% men, median (interquartile range) disease duration 2.9 years (0.7-9.4). Follow-up visits were performed in 113 (56%) patients at T12. Mean PASS observed at T0 and at T12 were 38±27 and 74±23, respectively, whereas GAS at T12 was 10±8. A significant association was observed between the presence of tophi and PASS at T12 (-15.3, 95% CI -25.5, -5.2; p=0.003) and GAS at T12 (+4.0, 95% CI 0.6,7.4; p=0.02), adjusted for age, sex, disease duration, sUA <6 mg/dL, tender joint count, PASS at T0, ULT). Conclusion The baseline presence of tophi may predict high disease-activity at T12, thus worsening GAS and patients’pain perception. ? Copyright CliniCal and ExpErimEntal rhEumatology 2023.
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Urate-lowering therapies for the management of gout lead to a reduction in serum urate levels, monosodium urate crystal deposition, and the clinical features of gout, including painful and disabling gout flares, chronic gouty arth...
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Urate-lowering therapies for the management of gout lead to a reduction in serum urate levels, monosodium urate crystal deposition, and the clinical features of gout, including painful and disabling gout flares, chronic gouty arthritis, and tophi. Thus, disease remission is a potential goal of urate-lowering therapy. In 2016, preliminary gout remission criteria were developed by a large group of rheumatologists and researchers with expertise in gout. The preliminary gout remission criteria were defined as: serum urate < 0.36 mmol/L (6 mg/dL); an absence of gout flares; an absence of tophi; pain due to gout < 2 on a 0-10 scale; and a patient global assessment < 2 on a 0-10 scale over a 12-month period. In this critical review, we describe the development of the preliminary gout remission criteria, the properties of the preliminary gout remission criteria, and clinical studies of gout remission in people taking urate-lowering therapy. We also describe a future research agenda for gout remission.
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Objective Determine the real-world incidence of acute gout prophylaxis (AGP) prescribing when a xanthine oxidase inhibitor (XOI) is initiated and describe characteristics of AGP prescribing.
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