Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Gout: HELP
Articles by Abhishek Abhishek
Based on 22 articles published since 2010
(Why 22 articles?)
||||

Between 2010 and 2020, A. Abhishek wrote the following 22 articles about Gout.
 
+ Citations + Abstracts
1 Editorial Incident gout and erectile dysfunction: is hyperuricaemia the elephant in the room? 2017

Abhishek, Abhishek / Doherty, Michael. ·Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. Abhishek.abhishek@nottingham.ac.uk. · Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Arthritis Res Ther · Pubmed #28797283.

ABSTRACT: The first prospective population-based study to examine risk of erectile dysfunction in men with gout in the western world has been published. It reports that following their first diagnosis of gout, men have a 31% higher risk of erectile dysfunction than matched controls, although the absolute increase in risk is small. Of interest, the incidence of erectile dysfunction reported in this study is tenfold higher than those reported in nation-wide cohort studies from Taiwan. There is a need for further prospective cohort studies to examine the possible mechanistic association between gout, hyperuricaemia and erectile dysfunction.

2 Review Review: Unmet Needs and the Path Forward in Joint Disease Associated With Calcium Pyrophosphate Crystal Deposition. 2018

Abhishek, Abhishek / Neogi, Tuhina / Choi, Hyon / Doherty, Michael / Rosenthal, Ann K / Terkeltaub, Robert. ·University of Nottingham, UK City Hospital, Nottingham, UK. · Boston University School of Medicine, Boston, Massachusetts. · Massachusetts General Hospital, Boston, Massachusetts. · Medical College of Wisconsin, Milwaukee. · Veterans Affairs, University of California at San Diego, San Diego, California. ·Arthritis Rheumatol · Pubmed #29609209.

ABSTRACT: Calcium pyrophosphate (CPP) crystal deposition (CPPD) is prevalent and can be associated with synovitis and joint damage. The population of elderly persons predominantly affected by CPPD is growing rapidly. Since shortfalls exist in many aspects of CPPD, we conducted an anonymous survey of CPPD unmet needs, prioritized by experts from the Gout, Hyperuricemia and Crystal-Associated Disease Network. We provide our perspectives on the survey results, and we propose several CPPD basic and clinical translational research pathways. Chondrocyte and cartilage culture systems for generating CPP crystals in vitro and transgenic small animal CPPD models are needed to better define CPPD mechanism paradigms and help guide new therapies. CPPD recognition, clinical research, and care would be improved by international consensus on CPPD nomenclature and disease phenotype classification, better exploitation of advanced imaging, and pragmatic new point-of-care crystal analytic approaches for detecting CPP crystals. Clinical impacts of CPP crystals in osteoarthritis and in asymptomatic joints in elderly persons remain major unanswered questions that are rendered more difficult by current inability to therapeutically limit or dissolve the crystal deposits and assess the consequent clinical outcome. Going forward, CPPD clinical research studies should define clinical settings in which articular CPPD does substantial harm and should include analyses of diverse clinical phenotypes and populations. Clinical trials should identify the best therapeutic targets to limit CPP crystal deposition and associated inflammation and should include assessment of intraarticular agents. Our perspective is that such advances in basic and clinical science in CPPD are now within reach and can lead to better treatments for this disorder.

3 Review Are Doctors the Best People to Manage Gout? Is There a Role for Nurses and Pharmacists? 2018

Latif, Zahira / Abhishek, Abhishek. ·Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB, UK. · Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Nottingham, NG5 1PB, UK. Abhishek.abhishek@nottingham.ac.uk. ·Curr Rheumatol Rep · Pubmed #29516289.

ABSTRACT: PURPOSE OF REVIEW: To discuss alternate models of long-term gout management RECENT FINDINGS: Nurse-led care of gout appears to improve the uptake of and adherence to urate-lowering treatment in a research setting. Less impressive improvements were achieved with pharmacist-led remote management of gout; however, both strategies were more effective than usual primary care provider management of gout. Individualised education about gout, patient involvement in decision-making, and access to trained support in managing side-effects and gout flares can improve the uptake of fine and adherence to urate-lowering treatment. This may be best achieved with nurse-led care of gout. However, further research is required to evaluate if the model of nurse-led care of gout can be implemented in routine clinical practice and in different healthcare systems.

4 Review Education and non-pharmacological approaches for gout. 2018

Abhishek, Abhishek / Doherty, Michael. ·Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #29272507.

ABSTRACT: The objectives of this review are as follows: to highlight the gaps in patient and physician knowledge of gout and how this might impede optimal disease management; to provide recommended core knowledge points that should be conveyed to people with gout; and to review non-pharmacological interventions that can be used in gout management. MeSH terms were used to identify eligible studies examining patients' and health-care professionals' knowledge about gout and its management. A narrative review of non-pharmacological management of gout is provided. Many health-care professionals have significant gaps in their knowledge about gout that have the potential to impede optimal management. Likewise, people with gout and the general population lack knowledge about causes, consequences and treatment of this condition. Full explanation about gout, including the potential benefits of urate-lowering treatment (ULT), motivates people with gout to want to start such treatment, and there is evidence, albeit limited, that educational interventions can improve uptake and adherence to ULT. Additionally, several non-pharmacological approaches, such as rest and topical ice application for acute attacks, avoidance of risk factors that can trigger acute attacks, and dietary interventions that may reduce gout attack frequency (e.g. cherry or cherry juice extract, skimmed milk powder or omega-3 fatty acid intake) or lower serum uric acid (e.g. vitamin C), can be used as adjuncts to ULT. There is a pressing need to educate health-care professionals, people with gout and society at large to remove the negative stereotypes associated with gout, which serve as barriers to optimal gout management, and to perceive gout as a significant medical condition. Moreover, there is a paucity of high-quality trial evidence on whether certain simple individual dietary and lifestyle factors can reduce the risk of recurrent gout attacks, and further studies are required in this field.

5 Review New urate-lowing therapies. 2018

Abhishek, Abhishek. ·Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Curr Opin Rheumatol · Pubmed #29251661.

ABSTRACT: PURPOSE OF REVIEW: To discuss recent studies of lesinurad and arhalofenate. RECENT FINDINGS: Lesinurad acts by blocking urate reabsorption channels URAT-1 and OAT-4. It has urate-lowering effect when used alone and in combination with xanthine oxidase inhibitors (XOIs). Its uricosuric activity depends on glomerular filtration, and its' efficacy is impaired at eGFR less than 30 ml/min. Lesinurad monotherapy (400 mg/day) associates with serum creatinine elevations. However, this risk is substantially attenuated with coprescription of a XOI and when prescribed at a dose of 200 mg/day. Given its' modest urate-lowering effect, and the risk of serum creatinine elevation when used alone, it is licenced for use in combination with XOI for people unable to achieve target serum uric acid with XOI alone. Lesinurad does not have the drug interactions associated with probenecid, however, it is metabolized by CYP2C9, and should be used with caution if CYP2C9 inhibitors are coprescribed. Arhalofenate also acts by blocking URAT-1; however, it also blocks the NALP-3 inflammasome providing gout-specific anti-inflammatory effect. Arhalofenate has a weaker urate-lowering effect than lesinurad and further phase III evaluation is planned. SUMMARY: Lesinurad provides an additional option for people with gout unable to achieve target serum uric acid with XOI alone.

6 Review Gout - a guide for the general and acute physicians. 2017

Abhishek, Abhishek / Roddy, Edward / Doherty, Michael. ·University of Nottingham, Nottingham, UK Abhishek.abhishek@nottingham.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK. · University of Nottingham, Nottingham, UK. ·Clin Med (Lond) · Pubmed #28148582.

ABSTRACT: Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients. Gout can be diagnosed on clinical grounds in those with typical podagra. However, in those with involvement of other joints, joint aspiration is recommended to demonstrate monosodium urate crystals and exclude other causes of acute arthritis, such as septic arthritis. However, a clinical diagnosis of gout can be made if joint aspiration is not feasible. This review summarises the current understanding of the pathophysiology, clinical presentation, investigations and treatment of gout.

7 Review Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review. 2016

Eminaga, Fatma / La-Crette, Jonathan / Jones, Adrian / Abhishek, A. ·Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK. · Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK. Abhishek.abhishek@nottingham.ac.uk. · Academic Rheumatology, Clinical Sciences Building, University of Nottingham, Nottingham, NG5 1PB, UK. Abhishek.abhishek@nottingham.ac.uk. ·Rheumatol Int · Pubmed #27761603.

ABSTRACT: The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Medline), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identified. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 10-15 [SMD

8 Article Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. 2019

Bursill, David / Taylor, William J / Terkeltaub, Robert / Abhishek, Abhishek / So, Alexander K / Vargas-Santos, Ana Beatriz / Gaffo, Angelo Lino / Rosenthal, Ann / Tausche, Anne-Kathrin / Reginato, Anthony / Manger, Bernhard / Sciré, Carlo / Pineda, Carlos / van Durme, Caroline / Lin, Ching-Tsai / Yin, Congcong / Albert, Daniel Arthur / Biernat-Kaluza, Edyta / Roddy, Edward / Pascual, Eliseo / Becce, Fabio / Perez-Ruiz, Fernando / Sivera, Francisca / Lioté, Frédéric / Schett, Georg / Nuki, George / Filippou, Georgios / McCarthy, Geraldine / da Rocha Castelar Pinheiro, Geraldo / Ea, Hang-Korng / Tupinambá, Helena De Almeida / Yamanaka, Hisashi / Choi, Hyon K / Mackay, James / ODell, James R / Vázquez Mellado, Janitzia / Singh, Jasvinder A / Fitzgerald, John D / Jacobsson, Lennart T H / Joosten, Leo / Harrold, Leslie R / Stamp, Lisa / Andrés, Mariano / Gutierrez, Marwin / Kuwabara, Masanari / Dehlin, Mats / Janssen, Matthijs / Doherty, Michael / Hershfield, Michael S / Pillinger, Michael / Edwards, N Lawrence / Schlesinger, Naomi / Kumar, Nitin / Slot, Ole / Ottaviani, Sebastien / Richette, Pascal / MacMullan, Paul A / Chapman, Peter T / Lipsky, Peter E / Robinson, Philip / Khanna, Puja P / Gancheva, Rada N / Grainger, Rebecca / Johnson, Richard J / Te Kampe, Ritch / Keenan, Robert T / Tedeschi, Sara K / Kim, Seoyoung / Choi, Sung Jae / Fields, Theodore R / Bardin, Thomas / Uhlig, Till / Jansen, Tim / Merriman, Tony / Pascart, Tristan / Neogi, Tuhina / Klück, Viola / Louthrenoo, Worawit / Dalbeth, Nicola. ·Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia davebursill@bigpond.com. · Department of Medicine, University of Otago, Wellington, New Zealand. · Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand. · Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA. · Department of Academic Rheumatology, University of Nottingham, Nottingham, UK. · Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland. · Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. · Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA. · Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany. · Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA. · Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany. · Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy. · Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy. · Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico. · Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands. · Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. · Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA. · Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA. · Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK. · Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. · Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. · Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland. · Rheumatology Division, Cruces University Hospital, Baracaldo, Spain. · Department of Medicine, University of the Basque Country, Biscay, Spain. · Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain. · Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain. · Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France. · Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France. · Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany. · Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. · Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland. · School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. · Department of Rheumatology, Hôpital Lariboisière, Paris, France. · Rheumatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. · Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan. · School of Medicine, Tokyo Women's Medical University, Tokyo, Japan. · Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. · President and CEO, Aristea Therapeutics, San Diego, California, USA. · Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA. · Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA. · Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA. · Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. · Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. · Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA. · Department of Medicine, Otago University, Christchurch, New Zealand. · Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain. · Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México. · Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. · Department of Cardiology, Toranomon Hospital, Minato-ku, Japan. · Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden. · Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands. · Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA. · Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA. · College of Medicine, University of Florida, Gainesville, Florida, USA. · Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. · Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA. · Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark. · Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France. · Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France. · Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada. · Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand. · CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA. · School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. · Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA. · Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria. · Department of Medicine, University of Otago, Wellington, Wellington, New Zealand. · Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA. · Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA. · Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA. · Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea. · Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA. · Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Biochemistry, University of Otago, Dunedin, New Zealand. · Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France. · Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ·Ann Rheum Dis · Pubmed #31501138.

ABSTRACT: OBJECTIVE: There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS: A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS: The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION: Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.

9 Article Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. 2019

Fuller, Amy / Jenkins, Wendy / Doherty, Michael / Abhishek, Abhishek. ·Academic Rheumatology. · NIHR-BRC, University of Nottingham, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #31410473.

ABSTRACT: OBJECTIVES: To explore patient satisfaction, gout knowledge, medication adherence and flares among participants receiving nurse-led or general practitioner (GP)-led care of gout in the Nottingham Gout Treatment Trial phase-II (NGTT-II). METHODS: A total of 438 participants of NGTT-II were sent a questionnaire enquiring about gout knowledge, satisfaction with health-care practitioner, urate-lowering treatment being undertaken, and gout flares ⩾1 year after their final visit. Nurse-led care participants were asked about their preference for receiving gout treatment from either a GP or a nurse. RESULTS: Completed questionnaires were returned by 82% of participants. Participants previously receiving nurse-led care reported greater satisfaction with health-care practitioner (P < 0.001), had better gout knowledge (P = 0.02), were more likely to be taking urate-lowering treatment [adjusted relative risk (95% CI) 1.19 (1.09, 1.30)], and self-reported fewer flares in the previous 12 months [median (inter-quartile range) 0 (0-0) vs 1 (0-3), P < 0.001] than those receiving GP-led care. Of participants receiving nurse-led care, 41-63% indicated preference for receiving gout treatment from a nurse, while only 5-20% indicated preference for receiving treatment from GPs. CONCLUSION: The results of this study favour nurse-led care, involving individualized patient education and engagement and a treat-to-target strategy, in terms of patient acceptability, long-term adherence, and flares. Further research is required to evaluate the feasibility of implementing such a model of care in clinical practice.

10 Article Implication of nurse intervention on engagement with urate-lowering drugs: A qualitative study of participants in a RCT of nurse led care. 2019

Latif, Zahira P / Nakafero, Georgina / Jenkins, Wendy / Doherty, Michael / Abhishek, Abhishek. ·Academic rheumatology, faculty of medicine & health sciences, school of medicine, university of Nottingham, Nottingham, UK; Rheumatology research group, institute of inflammation and ageing, university of Birmingham, Birmingham, UK. · Academic rheumatology, faculty of medicine & health sciences, school of medicine, university of Nottingham, Nottingham, UK; Nottingham NIHR biomedical research centre, Nottingham, UK. · Academic rheumatology, faculty of medicine & health sciences, school of medicine, university of Nottingham, Nottingham, UK; Nottingham NIHR biomedical research centre, Nottingham, UK. Electronic address: Abhishek.abhishek@nottingham.ac.uk. ·Joint Bone Spine · Pubmed #30394337.

ABSTRACT: OBJECTIVES: To explore patient perception of the role of a nurse-led complex package of care in facilitating engagement with urate-lowering therapies (ULTs) in the management of gout. METHODS: Thirty people who had participated in a randomised controlled trial investigating the effect of a nurse-led complex package of care for gout, were purposively sampled and interviewed between 18-26 months after the end of the trial. Interviews were recorded, transcribed and analysed using a modified grounded-theory approach. Data were managed using Nvivo. STATA v15 was used to describe summary statistics. RESULTS: Participants described their views and experiences of engaging with a nurse-led intervention designed to provide holistic assessment, individualised patient education, and involvement in shared decision-making for the long-term management of gout. The analysis revealed key themes in how nurse-led intervention facilitated engagement with ULT, namely by proving improved knowledge and understanding of gout and its treatment, involvement of patients in decision-making about treatment, and increased confidence about benefits from treatment. However, some treatment uncertainty and concern remained and one participant free of gout flares discontinued ULT, while another halved the dose after the end of the trial. CONCLUSIONS: This study reports data on patient experience of engaging with ULT to manage gout after receiving nurse-led care. It demonstrates that shared decision-making and the joint efforts of fully informed practitioners and patients persuades patients to engage with ULTs, and that experiencing the benefits of curative treatment motivates them to maintain adherence.

11 Article Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. 2018

Doherty, Michael / Jenkins, Wendy / Richardson, Helen / Sarmanova, Aliya / Abhishek, Abhishek / Ashton, Deborah / Barclay, Christine / Doherty, Sally / Duley, Lelia / Hatton, Rachael / Rees, Frances / Stevenson, Matthew / Zhang, Weiya. ·Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. Electronic address: michael.doherty@nottingham.ac.uk. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. · Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK. · Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. ·Lancet · Pubmed #30343856.

ABSTRACT: BACKGROUND: In the UK, gout management is suboptimum, with only 40% of patients receiving urate-lowering therapy, usually without titration to achieve a target serum urate concentration. Nurses successfully manage many diseases in primary care. We compared nurse-led gout care to usual care led by general practitioners (GPs) for people in the community. METHODS: Research nurses were trained in best practice management of gout, including providing individualised information and engaging patients in shared decision making. Adults who had experienced a gout flare in the previous 12 months were randomly assigned 1:1 to receive nurse-led care or continue with GP-led usual care. We assessed patients at baseline and after 1 and 2 years. The primary outcome was the percentage of participants who achieved serum urate concentrations less than 360 μmol/L (6 mg/dL) at 2 years. Secondary outcomes were flare frequency in year 2, presence of tophi, quality of life, and cost per quality-adjusted life-year (QALY) gained. Risk ratios (RRs) and 95% CIs were calculated based on intention to treat with multiple imputation. This study is registered with www.ClinicalTrials.gov, number NCT01477346. FINDINGS: 517 patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. Nurse-led care was associated with high uptake of and adherence to urate-lowering therapy. More patients receiving nurse-led care had serum urate concentrations less than 360 μmol/L at 2 years than those receiving usual care (95% vs 30%, RR 3·18, 95% CI 2·42-4·18, p<0·0001). At 2 years all secondary outcomes favoured the nurse-led group. The cost per QALY gained for the nurse-led intervention was £5066 at 2 years. INTERPRETATION: Nurse-led gout care is efficacious and cost-effective compared with usual care. Our findings illustrate the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes. FUNDING: Arthritis Research UK.

12 Article Brief Report: Monosodium Urate Monohydrate Crystal Deposits Are Common in Asymptomatic Sons of Patients With Gout: The Sons of Gout Study. 2018

Abhishek, Abhishek / Courtney, Philip / Jenkins, Wendy / Sandoval-Plata, Gabriela / Jones, Adrian C / Zhang, Weiya / Doherty, Michael. ·University of Nottingham, Nottingham, UK. · Nottingham University Hospitals NHS Trust, Nottingham, UK. ·Arthritis Rheumatol · Pubmed #29806203.

ABSTRACT: OBJECTIVE: To estimate the prevalence and distribution of asymptomatic monosodium urate monohydrate (MSU) crystal deposition in sons of patients with gout. METHODS: Patients with gout were mailed an explanatory letter with an enclosed postage-paid study packet to mail to their son(s) age ≥20 years old. Sons interested in participating returned a reply form and underwent telephone screening. Subsequently, they attended a study visit at which blood and urine samples were obtained and musculoskeletal ultrasonography was performed, with the sonographer blinded with regard to the subject's serum urate level. Images were assessed for double contour sign, intraarticular or intratendinous aggregates/tophi, effusion, and power Doppler signal. Logistic regression was used to examine associations. Adjusted odds ratios (OR RESULTS: One hundred thirty-one sons (mean age 43.8 years, mean body mass index 27.1 kg/m CONCLUSION: Asymptomatic sons of patients with gout frequently have hyperuricemia and MSU crystal deposits. In this study MSU crystal deposits were present in participants with serum urate levels of ≥5 mg/dl. Evaluation of subjects without a family history of gout is needed to determine whether the threshold for MSU crystal deposition is also lower in the general population.

13 Article First validation of the gout activity score against gout impact scale in a primary care based gout cohort. 2018

La-Crette, Jonathan / Jenkins, Wendy / Fernandes, Gwen / Valdes, Ana M / Doherty, Michael / Abhishek, Abhishek. ·Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB Nottingham, United Kingdom. · Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB Nottingham, United Kingdom; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, NG5 1PB Nottingham, United Kingdom. · Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB Nottingham, United Kingdom. Electronic address: abhishek.abhishek@nottingham.ac.uk. ·Joint Bone Spine · Pubmed #28528279.

ABSTRACT: OBJECTIVES: To validate the gout activity score (GAS) against the gout impact scale in a primary care based gout cohort. METHODS: This was a single-centre cross-sectional study. People with gout who participated in previous research at academic rheumatology, University of Nottingham, UK, and consented for participation in future studies were mailed a questionnaire in September 2015. Those returning completed questionnaires were invited to attend for a study visit at which blood was collected and musculoskeletal examination was performed. The Gout Assessment Questionnaire, which contains the gout impact scale (GIS), and short form (SF) 36v2 questionnaires were completed. The GAS RESULTS: One hundred and two (93% men) of the 150 participants who were mailed a questionnaire attended the study visit. Their mean (SD) age, body mass index, serum uric acid and GAS were 67.94 (9.93) years, 29.96 (4.57) kg/m CONCLUSION: This first study to validate GAS against the GIS found moderate correlation. However, this study did not examine the predictive validity of GAS, and prospective studies are needed before GAS can be used widely.

14 Article Managing Gout Flares in the Elderly: Practical Considerations. 2017

Abhishek, Abhishek. ·Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. Abhishek.abhishek@nottingham.ac.uk. · Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, Nottingham, NG5 1PB, UK. Abhishek.abhishek@nottingham.ac.uk. ·Drugs Aging · Pubmed #29214511.

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.

15 Article Triggers of acute attacks of gout, does age of gout onset matter? A primary care based cross-sectional study. 2017

Abhishek, Abhishek / Valdes, Ana M / Jenkins, Wendy / Zhang, Weiya / Doherty, Michael. ·Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, United Kingdom. ·PLoS One · Pubmed #29023487.

ABSTRACT: OBJECTIVES: To determine the proportion of people with gout who self-report triggers of acute attacks; identify the commonly reported triggers, and examine the disease and demographic features associated with self-reporting any trigger(s) of acute attacks of gout. METHODS: Individuals with gout were asked to fill a questionnaire enquiring about triggers that precipitated their acute gout attacks. Binary logistic regression was used to compute odds ratio (OR) and 95% confidence intervals (CI) to examine the association between having ≥1 self-reported trigger of acute gout and disease and demographic risk factors and to adjust for covariates. All statistical analyses were performed using STATA. RESULTS: 550 participants returned completed questionnaires. 206 (37.5%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45%). Patients who had onset of gout before the age of 50 years were significantly more likely to identify a trigger for precipitating their acute gout attacks (aOR (95%CI) 1.73 (1.12-2.68) after adjusting for covariates. CONCLUSION: Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout. Less than 20% people self-reported acute gout attacks from conventionally accepted triggers of gout e.g. alcohol, red-meat intake, while c.5% reported novel triggers such as dehydration, injury or physical activity, and weather extremes.

16 Article Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study. 2017

Abhishek, Abhishek / Jenkins, Wendy / La-Crette, Jonathan / Fernandes, Gwen / Doherty, Michael. ·Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital. · Department of Medicine, Nottingham University Hospitals NHS Trust. · Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #28082620.

ABSTRACT: Objectives: To evaluate the persistence and adherence on urate-lowering treatment (ULT) in primary care 5 years after an initial nurse-led treatment of gout. Methods: One hundred gout patients initiated on up-titrated ULT between March and July 2010 were sent a questionnaire that elicited information on current ULT, reasons for discontinuation of ULT if applicable, medication adherence and generic and disease-specific quality-of-life measures in 2015. They were invited for one visit at which height and weight were measured and blood was collected for serum uric acid measurement. Results: Seventy-five patients, mean age 68.13 years ( s . d . 10.07) and disease duration 19.44 years ( s . d . 13), returned completed questionnaires. The 5-year persistence on ULT was 90.7% (95% CI 81.4, 91.6) and 85.3% of responders self-reported taking ULT ⩾6 days/week. Of the 65 patients who attended the study visit, the mean serum uric acid was 292.8 μmol/l ( s . d . 97.2). Conclusion: An initial treatment that includes individualized patient education and involvement in treatment decisions results in excellent adherence and persistence on ULT >4 years after the responsibility of treatment is taken over by the patient's general practitioner, suggesting that this model of gout management should be widely adopted.

17 Article Adequacy of Online Patient Information Resources on Gout and Potentially Curative Urate-Lowering Treatment. 2017

Jimenez-Liñan, L M / Edwards, L / Abhishek, A / Doherty, Michael. ·University of Nottingham and Nottingham City Hospital, Nottingham, UK. · University of Nottingham and Nottingham City Hospital, Nottingham, and Royal Derby Hospital, Derby, UK. ·Arthritis Care Res (Hoboken) · Pubmed #27390083.

ABSTRACT: OBJECTIVE: To assess the content and readability of online patient information resources against the current understanding of gout. METHODS: An online survey was undertaken using Google UK, USA, Australia, and Canada. Information was assessed for content and accuracy on 19 key points regarding core content for gout patient information resources. Readability was assessed using the Flesch-Kincaid Reading Ease score. Fifteen randomly selected websites were reviewed by a blinded second observer. RESULTS: A total of 85 websites were selected. More than 50% of the websites provided no information or had inaccuracies regarding the pathogenesis of gout. Most websites contained information on dietary and lifestyle modifications for treating gout and did not emphasize urate-lowering therapy (ULT) and its potential for cure. Over 75% of the websites had no/inaccurate information on the role of ULT or prophylaxis for preventing gout attacks on starting ULT. The majority of websites were difficult to read, with information in 68% of the websites rated at least fairly difficult. CONCLUSION: Only a few web-based patient information resources provide accurate and easy-to-read information on gout. This study will help physicians direct patients to currently reliable resources, but there is a need to improve many web-based patient information resources, which at present act as barriers to care.

18 Article Intercritical circulating levels of neo-epitopes reflecting matrixmetalloprotease-driven degradation as markers of gout and frequent gout attacks. 2016

Valdes, Ana M / Manon-Jensen, Tina / Abhishek, Abhishek / Jenkins, Wendy / Siebuhr, Anne Sofie / Karsdal, Morten A / Doherty, Sally / Zhang, Weiya / Richardson, Helen / Doherty, Michael / Bay-Jensen, Anne-Christine. ·Academic Rheumatology, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Nottingham, UK Ana.Valdes@nottingham.ac.uk. · Rheumatology, Nordic Bioscience Biomarkers and Research, Herlev, Denmark. · Academic Rheumatology, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #27256715.

ABSTRACT: OBJECTIVE: Recurrent flares constitute the main clinical burden of gout. Our aim was to assess whether biomarkers measuring MMP tissue degradation could be used as markers of frequent gout flares. METHODS: Fasting plasma samples from 112 men with gout and 170 controls, along with serum samples from 447 men with gout collected at baseline from an ongoing clinical trial, were analysed by ELISA for neo-epitopes from MMP degradation of collagens type I (C1M) and type III (C3M). The log10 levels of both markers were compared between cases and controls and between gout patients with three or more gout attacks in the past year and those with two or less attacks. RESULTS: The circulating levels of C1M and C3M correlated with gout status in the case-control study. Levels of both markers were associated with frequent gout flares (⩾3 attacks in the past year) in both cohorts (odds ratio, OR = 3.1; 95% CI: 1.4, 6.8; P = 0.0056 for log10C1M, and OR = 6.7; 95% CI: 2.3, 19.3; P = 0.0005 for log10C3M). The area under the curve in a receiver operating characteristic analysis of frequent flares increased from 0.68 to 0.74 in one cohort and from 0.60 to 0.66 in the other when log10C1M and log10C3M were added to clinical variables of the model. CONCLUSION: C1M and C3M, reflective of interstitial matrix destruction, are associated with gout status and with frequent gout flares in men, suggesting that increased MMP activity may contribute to gout flares. Further research is needed to find out whether this is independent of dietary and lifestyle risk factors for acute gout.

19 Article Association of Serum Uric Acid and Disease Duration With Frequent Gout Attacks: A Case-Control Study. 2016

Abhishek, Abhishek / Valdes, Ana M / Zhang, Weiya / Doherty, Michael. ·University of Nottingham, Nottingham, UK. Abhishek.abhishek@nottingham.ac.uk. · University of Nottingham, Nottingham, UK. ·Arthritis Care Res (Hoboken) · Pubmed #26866719.

ABSTRACT: OBJECTIVE: To ascertain whether readily available disease and demographic factors associate with frequent acute attacks of gout, and to find out whether they can identify patients especially at risk of recurrent gout attacks. METHODS: Data from 3 previous studies at Academic Rheumatology, University of Nottingham, UK, were used. Patients taking urate lowering treatment (ULT) were excluded, as it influences gout flare frequency. Logistic regression was used to examine the association between age, sex, body mass index (BMI), disease duration, cardiovascular comorbidities, tophi, serum uric acid (SUA), and >2 acute attacks of gout in the previous 12 months. Receiver operating curves were plotted to examine their ability in identifying patients with recurrent gout attacks. RESULTS: A total of 468 gout patients (88.5% men, mean ± SD age 62.2 ± 11.3 years, BMI 29.8 ± 5.0 kg/m(2) ) were included. Disease duration and SUA associated independently with >2 acute attacks of gout in the previous 12 months (adjusted odds ratio 1.36 [95% confidence interval (95% CI) 1.08-1.72] and 1.27 [95% CI 1.10-1.46], respectively). However, these factors performed poorly in identifying patients with frequent gout attacks, with an area under the curve (AUC) of 0.61, and there was an insignificant increase in AUC on adding other variables (AUC 0.64). CONCLUSION: Higher SUA and longer disease duration associate independently with frequent gout attacks, presumably because of greater crystal load. This association supports early consideration of ULT for gout patients with higher SUA. However, as readily available disease and demographic factors perform poorly in identifying patients with frequent gout attacks, further research is required to ascertain the reasons underlying interpersonal variations in frequency of gout attacks.

20 Minor Inpatient rheumatology consultation for gout flares and advice to initiate urate lowering treatment (ULT) in hospital discharge summary increases ULT prescription in primary care. 2019

Kapadia, Aneesa / Abhishek, Abhishek. ·Department of Rheumatology, Queens Medical Centre, Nottingham University Hospital NHS Trust, NG72UH Nottingham, United Kingdom. · Department of Rheumatology, Queens Medical Centre, Nottingham University Hospital NHS Trust, NG72UH Nottingham, United Kingdom; Academic Rheumatology, Clinical Sciences Building, City Hospital Nottingham, NG51PB Nottingham, United Kingdom. Electronic address: Abhishek.abhishek@nottingham.ac.uk. ·Joint Bone Spine · Pubmed #29966768.

ABSTRACT: -- No abstract --

21 Minor Low omega-3 fatty acid levels associate with frequent gout attacks: a case control study. 2016

Abhishek, A / Valdes, Ana M / Doherty, Michael. ·Academic Rheumatology, University of Nottingham, Nottingham, UK. ·Ann Rheum Dis · Pubmed #26715654.

ABSTRACT: -- No abstract --

22 Minor In vivo detection of monosodium urate crystal deposits by Raman spectroscopy-a pilot study. 2016

Abhishek, Abhishek / Curran, Declan J / Bilwani, Faizan / Jones, Adrian C / Towler, Mark R / Doherty, Michael. ·Academic Rheumatology, University of Nottingham, Nottingham, UK, abhishek.abhishek@nottingham.ac.uk. · Department of Mechanical & Industrial Engineering, Ryerson University, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. · Department of Mechanical & Industrial Engineering, Ryerson University. · Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK and. · Department of Mechanical & Industrial Engineering, Ryerson University, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada, Department of Biomedical Engineering, University Malaya, Kuala Lumpur, Malaysia. · Academic Rheumatology, University of Nottingham, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #26342227.

ABSTRACT: -- No abstract --