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Gout: HELP
Articles by Mariano Andres
Based on 20 articles published since 2008
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Between 2008 and 2019, Mariano Andrés wrote the following 20 articles about Gout.
 
+ Citations + Abstracts
1 Editorial Criteria for gout diagnosis? 2013

Pascual, Eliseo / Andrés, Mariano / Vela, Paloma. · ·J Rheumatol · Pubmed #23547255.

ABSTRACT: -- No abstract --

2 Review Managing Gout in the Patient with Renal Impairment. 2018

Pascual, Eliseo / Sivera, Francisca / Andrés, Mariano. ·Hospital General Universitario de Alicante, calle del Roble 6, 03015, Alicante, Spain. pascual_eli@gva.es. · Universidad Miguel Hernández de Elche, Alicante, Spain. pascual_eli@gva.es. · Hospital General Universitario Elda, Alicante, Spain. · Hospital General Universitario de Alicante, calle del Roble 6, 03015, Alicante, Spain. · Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain. ·Drugs Aging · Pubmed #29435850.

ABSTRACT: Hyperuricaemia is an independent risk factor for renal function decline. Evidence is emerging that urate-lowering therapy might be beneficial in subjects with renal impairment. We  review the association between renal impairment and gout, some of the related pathogenic processes and the possible impact of gout treatment on the progression of renal impairment. Nevertheless, the management of gout is more complex in the presence of chronic kidney disease. The main aim of gout therapy is to fully dissolve the urate crystals, thus curing the disease. Avoidance of attacks-prophylaxis-and their prompt treatment if they occur, along with accurate information to patients, completes the treatment strategy. This article provides a practical guide to managing gout in older patients and in those with renal impairment. We highlight the shortcomings in our current treatment options and strategies.

3 Review Severe gout: Strategies and innovations for effective management. 2017

Pascual, Eliseo / Andrés, Mariano / Vázquez-Mellado, Janitzia / Dalbeth, Nicola. ·Sección de Reumatología, Hospital General Universitario de Alicante, Av. Pintor Baeza 12, 03010 Alicante, Spain; Departamento de Medicina Clínica (Reumatología), Universidad Miguel Hernández, Carretera Nacional 332 S/N, 03550, San Juan de Alicante, 03010 Alicante, Spain. Electronic address: pascual_eli@gva.es. · Sección de Reumatología, Hospital General Universitario de Alicante, Av. Pintor Baeza 12, 03010 Alicante, Spain; Departamento de Medicina Clínica (Reumatología), Universidad Miguel Hernández, Carretera Nacional 332 S/N, 03550, San Juan de Alicante, 03010 Alicante, Spain. · Servicio de Reumatología, Hospital General de México, Dr. Balmis 148, Cuauhtémoc, Doctores, 06726 Ciudad de México, D.F., Mexico. · Department of Rheumatology, Auckland District Health Board and Department of Medicine, University of Auckland, Auckland 1010, New Zealand. ·Joint Bone Spine · Pubmed #27932279.

ABSTRACT: Severe gout is characterised by frequent polyarticular flares, numerous tophi, joint damage, and musculoskeletal disability. This is a preventable condition and in many cases, represents a disease that has been insufficiently managed for years. Standard management recommendations may be insufficient for patients with severe gout; these patients frequently require intensive individualised pharmacological management with combinations of urate-lowering therapy and anti-inflammatory agents. In this article, we aim to integrate recent therapeutic advances to provide a practical framework for optimal management of severe gout.

4 Review Gout: Diagnosis and treatment. 2017

Sivera, Francisca / Andrés, Mariano / Quilis, Neus. ·Sección de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España. Electronic address: fransimas@yahoo.es. · Sección de Reumatología, Hospital General Universitario de Alicante, Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España. · Sección de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España. ·Med Clin (Barc) · Pubmed #27931865.

ABSTRACT: -- No abstract --

5 Review Mechanisms of crystal formation in gout-a structural approach. 2015

Pascual, Eliseo / Addadi, Lia / Andrés, Mariano / Sivera, Francisca. ·Department of Medicine, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Pintor Baeza 12, Alicante 03010, Spain. · Department of Structural Biology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 7610001, Israel. · Rheumatology Unit, Hospital General Universitario de Elda, Carretera Elda-Sax SN, Elda 03600, Spain. ·Nat Rev Rheumatol · Pubmed #26369610.

ABSTRACT: The mechanisms and sites of monosodium urate monohydrate (MSU) crystal deposition in gout have received little attention from the scientific community to date. Formalin fixation of tissues leads to the dissolution of MSU crystals, resulting in their absence from routinely processed pathological samples and hence neglect. However, modern imaging techniques-especially ultrasonography but also conventional CT and dual-energy CT-reveal that MSU crystals form at the cartilage surface as well as inside tendons and ligaments, often at insertion sites. Tophi comprise round white formations of different sizes surrounded by inflammatory tissue. Studies of fibres recovered from gouty synovial fluid indicate that these fibres are likely to be a primary site of crystal formation by templated nucleation, with crystals deposited parallel to the fibres forming transverse bands. In tophi, two areas can be distinguished: one where crystals are formed on cellular tissues and another consisting predominantly of crystals, where secondary nucleation seems to take place; this organization could explain how tophi can grow rapidly. From these observations based on a crystallographic approach, it seems that initial templated nucleation on structural fibres-probably collagen-followed at some sites by secondary nucleation could explain MSU crystal deposition in gout.

6 Review Dietary supplements for chronic gout. 2014

Andrés, Mariano / Sivera, Francisca / Falzon, Louise / Buchbinder, Rachelle / Carmona, Loreto. ·Sección de Reumatología, Hospital General Universitario de Alicante, C/ Pintor Baeza, 12, Alicante, Spain, 03010. ·Cochrane Database Syst Rev · Pubmed #25287939.

ABSTRACT: BACKGROUND: Dietary supplements are frequently used for the treatment of several medical conditions, both prescribed by physicians or self administered. However, evidence of benefit and safety of these supplements is usually limited or absent. OBJECTIVES: To assess the efficacy and safety of dietary supplementation for people with chronic gout. SEARCH METHODS: We performed a search in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL on 6 June 2013. We applied no date or language restrictions. In addition, we performed a handsearch of the abstracts from the 2010 to 2013 American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) conferences, checked the references of all included studies and trial registries. SELECTION CRITERIA: We considered all published randomised controlled trials (RCTs) or quasi-RCTs that compared dietary supplements with no supplements, placebo, another supplement or pharmacological agents for adults with chronic gout for inclusion. Dietary supplements included, but were not limited to, amino acids, antioxidants, essential minerals, polyunsaturated fatty acids, prebiotic agents, probiotic agents and vitamins. The main outcomes were reduction in frequency of gouty attacks and trial participant withdrawal due to adverse events. We also considered pain reduction, health-related quality of life, serum uric acid (sUA) normalisation, function (i.e. activity limitation), tophus regression and the rate of serious adverse events. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified two RCTs (160 participants) that fulfilled our inclusion criteria. As these two trials evaluated different diet supplements (enriched skim milk powder (SMP) and vitamin C) with different outcomes (gout flare prevention for enriched SMP and sUA reduction for vitamin C), we reported the results separately.One trial including 120 participants, at moderate risk of bias, compared SMP enriched with glycomacropeptides (GMP) with unenriched SMP and with lactose over three months. Participants were predominantly men aged in their 50's who had severe gout. The frequency of acute gout attacks, measured as the number of flares per month, decreased in all three groups over the study period.The effects of enriched SMP (SMP/GMP/G600) compared with the combined control groups (SMP and lactose powder) at three months in terms of mean number of gout flares per month were uncertain (mean ± standard deviation (SD) flares per month: 0.49 ± 1.52 in SMP/GMP/G60 group versus 0.70 ± 1.28 in control groups; mean difference (MD) -0.21, 95% confidence interval (CI) -0.76 to 0.34; low-quality evidence). The number of withdrawals due to adverse effects was similar in both groups although again the results were imprecise (7/40 in SMP/GMP/G600 group versus 11/80 in control groups; risk ratio (RR) 1.27, 95% CI 0.53 to 3.03; low-quality evidence). The findings for adverse events were also uncertain (2/40 in SMP/GMP/G600 group versus 3/80 in control groups; RR 1.33, 95% CI 0.23 to 7.66; low-quality evidence). Gastrointestinal events were the most commonly reported adverse effects. Pain from self reported gout flares (measured on a 10-point Likert scale) improved slightly more in the SMP/GMP/G600 group compared with controls (mean ± SD reduction -1.97 ± 2.28 points in SMP/GMP/G600 group versus -0.94 ± 2.25 in control groups; MD -1.03, 95% CI -1.96 to -0.10; low-quality evidence). This was an absolute reduction of 10% (95% CI 20% to 1% reduction), which may not be of clinical relevance. Results were imprecise for the outcome improvement in physical function (mean ± SD Health Assessment Questionnaire (HAQ)-II (scale 0 to 3, 0 = no disability): 0.08 ± 0.23 in SMP/GMP/G60 group versus 0.11 ± 0.31 in control groups; MD -0.03, 95% CI -0.14 to 0.08; low-quality evidence). Similarly, results for sUA reduction were imprecise (mean ± SD reduction: -0.025 ± 0.067 mmol/L in SMP/GMP/G60 group versus -0.010 ± 0.069 in control groups; MD -0.01, 95% CI -0.04 to 0.01; low-quality evidence). The study did not report tophus regression and health-related quality of life impact.One trial including 40 participants, at moderate to high risk of bias, compared vitamin C alone with allopurinol and with allopurinol plus vitamin C in a three-arm trial. We only compared vitamin C with allopurinol in this review. Participants were predominantly middle-aged men, and their severity of gout was representative of gout in general. The effect of vitamin C on the rate of gout attacks was not assessed. Vitamin C did not lower sUA as much as allopurinol (-0.014 mmol/L in vitamin C group versus -0.118 mmol/L in allopurinol group; MD 0.10, 95% CI 0.06 to 0.15; low-quality evidence). The study did not assess tophus regression, pain reduction or disability or health-related quality of life impact. The study reported no adverse events and no participant withdrawal due to adverse events. AUTHORS' CONCLUSIONS: While dietary supplements may be widely used for gout, this review has shown a paucity of high-quality evidence assessing dietary supplementation.

7 Review Treatment target and followup measures for patients with gout: a systematic literature review. 2014

Andrés, Mariano / Sivera, Francisca / Falzon, Louise / van der Heijde, Désirée M / Carmona, Loreto. ·From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética. ·J Rheumatol Suppl · Pubmed #25180129.

ABSTRACT: OBJECTIVE: To systematically review the validity of serum uric acid (SUA) as a treatment target for patients with gout, and the clinimetric properties of the potential tools for monitoring these patients. METHODS: A search was performed in Medline, Embase and the Cochrane Library from inception to October 2011, and the 2010-2011 American College of Rheumatology and European League Against Rheumatism meeting abstracts. Studies evaluating different SUA levels or SUA reduction with the achievement of outcomes, and studies assessing clinimetric properties of instruments used to follow patients with gout were selected. Intervention studies were also included in order to estimate responsiveness. Titles and abstracts of the identified references were screened, and included articles were reviewed in detail and data collected using ad hoc standard forms. RESULTS: In total, 4575 articles were retrieved, 120 articles reviewed in detail, and 54 articles were included in the systematic literature review. SUA reduction was significantly associated with a reduction in acute attacks (6 studies), tophi regression (2 studies), and crystal clearance (3 studies). SUA 6.0 mg/dl was used as cutoff point in most of studies, but this level was found to be arbitrary. For followup of patients with gout, tophus measurement by caliper and ultrasound, the physical component of the Medical Outcomes Study Short Form-36 Survey, and Health Assessment Questionnaire have shown excellent clinimetric properties for this purpose. CONCLUSION: Reducing SUA is a valid treatment target for patients with gout, but the target level of reduction (cutoff point) is not clear. Some tools were found suitable for following patients with gout.

8 Review Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review. 2014

Sivera, Francisca / Andrès, Mariano / Falzon, Louise / van der Heijde, Désirée M F M / Carmona, Loreto. ·From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela. ·J Rheumatol Suppl · Pubmed #25180122.

ABSTRACT: OBJECTIVE: To analyze the diagnostic utility of clinical, laboratory, and imaging items for gout. METHODS: A systematic literature search was performed in MEDLINE, EMBASE, and The Cochrane Library; and a manual search of abstracts from the 2010/2011 meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism, as well as the reference lists of retrieved papers. Studies were included if they evaluated the diagnostic utility of clinical, laboratory, or imaging features or criteria for the diagnosis or classification of gout in adult patients. Two independent reviewers selected papers, extracted the data, and assessed the risk of bias. RESULTS: Nineteen studies were included in the review; 4 used the identification of monosodium urate (MSU) crystals as the reference standard (RS) and the rest used expert opinion or the ACR preliminary criteria. Most features were evaluated in a single study. Evidence for diagnostic utility, using MSU crystals as RS, of over 50 individual clinical, laboratory, and radiographic features was retrieved. Most items showed a positive likelihood ratio (LR+) < 3, except for the following: response of arthritis to colchicine (LR+ 4.3); presence of tophi on physical examination (LR+ 15.6-30.9); identification of the double-contour sign in ultrasound (US) (LR+ 13.6); and detection of urate deposits by dual-energy computed tomography (DECT) (LR+ 9.5). CONCLUSION: Individual clinical features show low diagnostic utility, with the exception of tophi and response to colchicine. Some US and DECT findings show better performance than most clinical features.

9 Review Interleukin-1 inhibitors for acute gout. 2014

Sivera, Francisca / Wechalekar, Mihir D / Andrés, Mariano / Buchbinder, Rachelle / Carmona, Loreto. ·Servicio de Reumatologia, Hospital de Elda, Ctra. Elda-Sax, PTDA. La Torreta, S/N, Elda (Alicante), Spain, 03600. ·Cochrane Database Syst Rev · Pubmed #25177840.

ABSTRACT: BACKGROUND: Acute gout flares cause significant pain and disability and it is important to provide quick and effective pain relief. Traditional options for managing acute flares include colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. OBJECTIVES: To assess the benefits and harms of interleukin-1 inhibitors (anakinra, canakinumab, rilonacept) in acute gout. SEARCH METHODS: We searched The Cochrane Library, MEDLINE and EMBASE on 19 June 2013. We applied no date or language restrictions. We performed a handsearch of the abstracts from the European League Against Rheumatism (EULAR) (2009 to 2012) and American College of Rheumatology (ACR) (2009 to 2011) conferences and of the references of all included trials. We also screened the Clinical Trials Registry Platform of the World Health Organization and Clinical Trials Registry Platform of the US National Institutes of Health. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-randomised clinical trials (controlled clinical trials (CCTs)) assessing an interleukin-1 inhibitor (anakinra, canakinumab or rilonacept) against placebo or another active treatment (colchicine, paracetamol, NSAIDs, glucocorticoids (systemic or intra-articular), adrenocorticotropin hormone, a different interleukin-1 blocking agent or a combination of any of the above) in adults with acute gout. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed the risk of bias and extracted the data. If appropriate, we pooled data in a meta-analysis. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included four studies (806 participants) in the review. The studies had an unclear risk of selection bias and low risk of performance and attrition biases. One study each had an unclear risk of detection and selection bias.Three studies (654 participants) compared subcutaneous canakinumab compared with intramuscular triamcinolone acetonide 40 mg in the treatment of acute gout flares of no more than five days' duration. Doses of canakinumab were varied (10 to 150 mg), but most people (255/368) were treated with canakinumab 150 mg. None of the studies provided data on participant-reported pain relief of 30% or greater. Moderate-quality evidence indicated that canakinumab 150 mg was probably superior to triamcinolone acetonide 40 mg in terms of pain relief, resolution of joint swelling and in achieving a good treatment response at 72 hours following treatment, but was probably associated with an increased risk of adverse events.Mean pain (0- to 100-mm visual analogue scale (VAS), where 0 mm was no pain) was 36 mm after triamcinolone acetonide treatment; pain was further reduced by a mean of 11 mm with canakinumab treatment (mean difference (MD) -10.6 mm, 95% confidence interval (CI) -15.2 to -5.9). Forty-four per cent of participants treated with canakinumab had resolution of joint swelling at 72 hours compared with 32% of participants treated with triamcinolone (risk ratio (RR) 1.39, 95% CI 1.11 to 1.74, number needed to treat for an addition beneficial outcome (NNTB) 9); 65% of participants treated with canakinumab assessed their response to treatment as good or excellent compare with 47% of participants treated with triamcinolone acetonide (RR 1.37, 95% CI 1.16 to 1.61, NNTB 6). Function or health-related quality of life were not measured. In both groups, 0.7% of participants withdrew from treatment (RR 1.1, 95% CI 0.2 to 7.2); there was one death and one alteration of laboratory results in each of the treatment groups. Adverse events were more frequent in participants receiving canakinumab (61%) compared with triamcinolone acetonide (51%; RR 1.2, 95% CI 1.1 to 1.4, number needed to treat for an addition harmful outcome (NNTH) 10).Low-quality evidence from one study (152 participants with an acute gout flare of no more than 48 hours' duration and affecting fewer than four joints) comparing rilonacept 320 mg with indomethacin (50 mg three times a day for three days followed by 25 mg three times a day for up to nine days) indicated that indomethacin may improve pain more than rilonacept at 24 to 72 hours, and there may be no evidence of a difference in withdrawal rates or adverse events. The mean change (improvement) in pain from baseline with indomethacin was 4.3 points (measured on a 0 to 10 numerical rating scale, where 0 was no pain); pain was improved by a mean of only 2.5 points with rilonacept (MD 2.52, 95% CI 0.29 to 4.75, 25% less improvement in absolute pain with rilonacept). Inflammation, function health-related quality of life and participant global assessment of treatment success were not measured. Rates of study withdrawals due to adverse events were low in both groups: 1/75 (1%) participants in the rilonacept group compared with 2/76 (3%) participants in the indomethacin group (RR 0.5, 95% CI 0.05 to 5.5). Adverse events were reported in 27/75 (36%) participants in the rilonacept group and 23/76 (30%) in the indomethacin group (RR 1.2, 95% CI 0.8 to 1.9). AUTHORS' CONCLUSIONS: Moderate-quality evidence indicated that compared with a single suboptimal 40-mg dose of intramuscular injection of triamcinolone acetonide, a single subcutaneous dose of 150 mg of canakinumab probably results in better pain relief, joint swelling and participant-assessed global assessment of treatment response in people with an acute gout flare but is probably associated with an increased risk of adverse events. The cost of canakinumab is over 5000 times higher than triamcinolone acetonide; however, there are no data on the cost-effectiveness of this approach. We found no studies comparing canakinumab with more commonly used first-line therapies for acute gout flares such as NSAIDs or colchicine. Low-quality evidence indicated that compared with maximum doses of indomethacin (50 mg three times a day), 320 mg of rilonacept may provide less pain relief with a similar rate of adverse events.

10 Review Synovial fluid analysis for crystals. 2011

Pascual, Eliseo / Sivera, Francisca / Andrés, Mariano. ·Rheumatology Section, Hospital General Universitario de Alicante, Spain. pascual_eli@gva.es ·Curr Opin Rheumatol · Pubmed #21285711.

ABSTRACT: PURPOSE OF REVIEW: Describe why this review is timely and relevant. Identifying monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals allows a quick and definitive diagnosis of both gout and CPPD arthritis, and remains the accepted gold standard. These diseases are still often diagnosed on inaccurate clinical grounds. Crystal identification has received little critical attention since its introduction, and it appears necessary to review the technique paying special attention to the possible reasons which deter clinicians. RECENT FINDINGS: Describe the main themes in the literature covered by the article. Synovial fluid analysis for crystals is a simple procedure allowing immediate and definite diagnosis of gout and CPPD arthritis when clinics are fitted with a proper microscope and the rheumatologists appropriately trained. This review also illustrates how crystal analysis in synovial fluid can be initially approached with both the widely available ordinary light microscope and a simple polarized one and with good results. SUMMARY: This study describes the implications of the findings for clinical practice or research. We hope that those not performing synovial fluid analysis will be stimulated to acquire or perfect the technique and obtain a compensated polarized microscope to comply with current standards.

11 Article Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort. 2018

Ranieri, Laura / Contero, Carolina / Peral, Maria-Luisa / Calabuig, Irene / Zapater, Pedro / Andres, Mariano. ·Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain. · Universidad Miguel Hernández, Elche, Alicante, Spain. · Clinical Pharmacology Deparment, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain. · Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain. drmarianoandres@gmail.com. · Universidad Miguel Hernández, Elche, Alicante, Spain. drmarianoandres@gmail.com. ·Arthritis Res Ther · Pubmed #29566736.

ABSTRACT: BACKGROUND: Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout.  METHODS: This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis. RESULTS: We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = - 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = - 0.47, p = 0.833). There was no association with febuxostat (beta = - 0.116, p = 0.514). CONCLUSION: Diuretics do not appear to have a significant impact on managing gout.

12 Article Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment. 2017

Andrés, Mariano / Bernal, José Antonio / Sivera, Francisca / Quilis, Neus / Carmona, Loreto / Vela, Paloma / Pascual, Eliseo. ·Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain. · Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. · Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain. · Instituto de Salud Musculoesquelética, Madrid, Spain. ·Ann Rheum Dis · Pubmed #28093417.

ABSTRACT: OBJECTIVES: Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk. METHODS: Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves. RESULTS: 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS. CONCLUSIONS: The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout.

13 Article Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. 2014

Sivera, Francisca / Andrés, Mariano / Carmona, Loreto / Kydd, Alison S R / Moi, John / Seth, Rakhi / Sriranganathan, Melonie / van Durme, Caroline / van Echteld, Irene / Vinik, Ophir / Wechalekar, Mihir D / Aletaha, Daniel / Bombardier, Claire / Buchbinder, Rachelle / Edwards, Christopher J / Landewé, Robert B / Bijlsma, Johannes W / Branco, Jaime C / Burgos-Vargas, Rubén / Catrina, Anca I / Elewaut, Dirk / Ferrari, Antonio J L / Kiely, Patrick / Leeb, Burkhard F / Montecucco, Carlomaurizio / Müller-Ladner, Ulf / Ostergaard, Mikkel / Zochling, Jane / Falzon, Louise / van der Heijde, Désirée M. ·Department Reumatologia, Hospital General Universitario de Elda, , Elda, Spain. ·Ann Rheum Dis · Pubmed #23868909.

ABSTRACT: We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010-2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.

14 Article Gout treatment: should we aim for rapid crystal dissolution? 2013

Pascual, Eliseo / Andrés, Mariano / Vela, Paloma. ·Sección de Reumatología, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Av. Pintor Baeza 12, Alicante 03010, Spain. pascual_eli@gva.es ·Ann Rheum Dis · Pubmed #23322814.

ABSTRACT: Monosodium urate crystal deposition in gout precedes the first attack and, while hyperuricaemia persists, it grows and expands to other sites. Fortunately, it is reversible and slowly dissolves when serum uric acid (SUA) is lowered below its saturation point of about 6.8 mg/dl and with certainty below 6 mg/dl. Crystals finally disappear from joints, taking longer in those patients with longer disease duration, probably because of a larger accumulated load of crystals. The SUA level achieved affects the velocity of crystal dissolution and tophi reduction. Accordingly, by deciding the SUA level cut-off point to be achieved by treatment we are determining the time of crystal disappearance and cure of gout. 6 mg/dl is the usual target level, but lower levels appear appropriate to us, particularly in certain situations.

15 Minor Urate crystals and inflammation. Cardiovascular impact of gout. 2018

Calvo Aranda, Enrique / Andres, Mariano / Gonzalez Martin, Jorge / Abdelkader Abu-Sneimeh, Afnan / Carrion, Ofelia / Sainz, Felipe / Garcia de la Peña, Paloma / Pascual, Eliseo. ·Rheumatology Unit of Hospital Universitario HM Sanchinarro, Madrid, Spain. Electronic address: https://twitter.com/enriquecalvoA. · Rheumatology Unit of Hospital General Universitario, Alicante, Spain; Clinical Medicine Unit, Miguel Hernandez University, Alicante, Spain. · Rheumatology Unit of Hospital Universitario HM Sanchinarro, Madrid, Spain. · Angiology and Vascular Surgery Unit Hospital Universitario HM Sanchinarro, Madrid, Spain. · Rheumatology Unit of Hospital Universitario HM Sanchinarro, Madrid, Spain; Clinical and Medical Sciences Unit, San Pablo CEU University, Madrid, Spain. ·Int J Cardiol · Pubmed #30223359.

ABSTRACT: -- No abstract --

16 Minor Febuxostat for Patients With Gout and Severe Chronic Kidney Disease: Which Is the Appropriate Dosage? Comment on the Article by Saag et al. 2016

Quilis, Neus / Andrés, Mariano / Gil, Susana / Ranieri, Laura / Vela, Paloma / Pascual, Eliseo. ·Hospital General Universitario De Alicante. · Hospital General Universitario De Alicante, and Universidad Miguel Hernández, Alicante, Spain. ·Arthritis Rheumatol · Pubmed #27273838.

ABSTRACT: -- No abstract --

17 Minor Gout mimicking rheumatoid arthritis. 2016

Sivera, Francisca / Andres, Mariano / Pascual, Eliseo. ·Department of Rheumatology, Hospital General Universitario, Elda, Spain. Electronic address: fransimas@yahoo.es. · Department of Rheumatology, Hospital General Universitario, Alicante, Spain. · Department of Rheumatology, Hospital General Universitario de Alicante, Universidad Miguel Hernandez, Alicante, Spain. ·Semin Arthritis Rheum · Pubmed #27105757.

ABSTRACT: -- No abstract --

18 Minor Effects of Xanthine Oxidase Inhibitors on Cardiovascular Disease in Patients with Gout: Ascertaining the Efficacy of Treatment Matters. 2015

Andrés, Mariano / Sivera, Francisca / Pascual, Eliseo. ·Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain. · Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain. · Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain; Departamento de Medicina (Reumatología), Universidad Miguel Hernández, Alicante, Spain. ·Am J Med · Pubmed #26319669.

ABSTRACT: -- No abstract --

19 Minor Comment on: The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. 2015

Andrés, Mariano / Pascual, Eliseo / Vela, Paloma. ·Sección de Reumatología, Hospital General Universitario de Alicante and Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain drmarianoandres@gmail.com. · Sección de Reumatología, Hospital General Universitario de Alicante and Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain Sección de Reumatología, Hospital General Universitario de Alicante and Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. ·Rheumatology (Oxford) · Pubmed #25936791.

ABSTRACT: -- No abstract --

20 Minor Back pain due to lumbar gouty flare--a prospective diagnosis. 2013

Andrés, Mariano / Vela, Paloma / Volar, Lucian Cristian / Avilés, Yanne / Pascual, Eliseo. · ·J Rheumatol · Pubmed #23908548.

ABSTRACT: -- No abstract --