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Gout: HELP
Articles by Christian D. Mallen
Based on 43 articles published since 2010
(Why 43 articles?)
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Between 2010 and 2020, C. Mallen wrote the following 43 articles about Gout.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline The British Society for Rheumatology Guideline for the Management of Gout. 2017

Hui, Michelle / Carr, Alison / Cameron, Stewart / Davenport, Graham / Doherty, Michael / Forrester, Harry / Jenkins, Wendy / Jordan, Kelsey M / Mallen, Christian D / McDonald, Thomas M / Nuki, George / Pywell, Anthony / Zhang, Weiya / Roddy, Edward / Anonymous5550907. ·Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby. · Hamell1st Floor Dome Building, The Quadrant, Richmond, TW9 1DT UK. · Renal Medicine, Guy's Campus, Kings College London, London. · Research Institute for Primary Care and Health Sciences, Keele University, Keele. · Academic Rheumatology, University of Nottingham, Nottingham. · Rheumatology, Brighton and Sussex University Hospitals NHS Trust, Brighton. · Medicines Monitoring Unit, Ninewells Hospital and Medical School, Dundee. · Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh. · Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK. ·Rheumatology (Oxford) · Pubmed #28549195.

ABSTRACT: -- No abstract --

2 Guideline The British Society for Rheumatology Guideline for the Management of Gout. 2017

Hui, Michelle / Carr, Alison / Cameron, Stewart / Davenport, Graham / Doherty, Michael / Forrester, Harry / Jenkins, Wendy / Jordan, Kelsey M / Mallen, Christian D / McDonald, Thomas M / Nuki, George / Pywell, Anthony / Zhang, Weiya / Roddy, Edward / Anonymous5520907. ·Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby. · Hamell,1st Floor Dome Building, The Quadrant, Richmond TW9 1DT, UK. · Renal Medicine, Guy's Campus, Kings College London, London. · Research Institute for Primary Care and Health Sciences, Keele University, Keele. · Academic Rheumatology, University of Nottingham, Nottingham. · Rheumatology, Brighton and Sussex University Hospitals NHS Trust, Brighton. · Medicines Monitoring Unit, Ninewells Hospital and Medical School, Dundee. · Institute for Genetics and Molecular Medicine, University of Edinburgh. · Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK. ·Rheumatology (Oxford) · Pubmed #28549177.

ABSTRACT: -- No abstract --

3 Guideline 2016 updated EULAR evidence-based recommendations for the management of gout. 2017

Richette, P / Doherty, M / Pascual, E / Barskova, V / Becce, F / Castañeda-Sanabria, J / Coyfish, M / Guillo, S / Jansen, T L / Janssens, H / Lioté, F / Mallen, C / Nuki, G / Perez-Ruiz, F / Pimentao, J / Punzi, L / Pywell, T / So, A / Tausche, A K / Uhlig, T / Zavada, J / Zhang, W / Tubach, F / Bardin, T. ·AP-HP, hôpital Lariboisière, service de Rhumatologie, F-75010 Paris, France; Inserm, UMR1132, Hôpital Lariboisière, F-75010 Paris, France; Universitè Paris Diderot, Sorbonne Paris Citè, F-75205 Paris, France. · Academic Rheumatology, University of Nottingham, Nottingham, UK. · Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. · Institute of Rheumatology RAMS, Moscow, Russia. · Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland. · AP-HP, Dèpartement d'Epidèmiologie et Recherche Clinique, Hôpital Bichat, Paris, France: APHP, Centre de Pharmacoèpidèmiologie, Paris, France: Univ Paris Diderot, Paris, France: INSERM UMR 1123 ECEVE, Paris, France. · Patient from Nottingham, UK, Paris. · Department of Rheumatology, VieCuri Medical Centre, Venlo, and Scientific IQ HealthCare, Radboud UMC, Nijmegen, The Netherlands. · Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands. · Arthritis Research UK Primary Care Centre University of Keele, Keele, UK. · Osteoarticular Research Group, University of Edinburgh, Edinburgh, UK. · Seccion de Rheumatologia, Hospital de Cruces, Baracaldo, Spain. · Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal. · Rheumatology Unit, University of Padova, Padova, Italy. · Service de Rhumatologie, CHUV and Universitè de Lausanne, Lausanne, Switzerland. · Department of Rheumatology, University Clinic at the Technical University Dresden, Germany. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Czech Republic. ·Ann Rheum Dis · Pubmed #27457514.

ABSTRACT: BACKGROUND: New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations. METHODS: The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach. RESULTS: Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended. CONCLUSIONS: These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.

4 Review Gout and risk of chronic kidney disease and nephrolithiasis: meta-analysis of observational studies. 2015

Roughley, Matthew J / Belcher, John / Mallen, Christian D / Roddy, Edward. ·School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK. mattjroughley@gmail.com. · School of Computing and Mathematics, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.belcher@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK. c.d.mallen@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK. e.roddy@keele.ac.uk. ·Arthritis Res Ther · Pubmed #25889144.

ABSTRACT: INTRODUCTION: To determine the prevalence of chronic kidney disease and nephrolithiasis in people with gout, and the association between gout and prevalent or incident chronic kidney disease and nephrolithiasis. METHODS: Systematic review and meta-analysis of epidemiological studies. Data sources; MEDLINE, EMBASE and CINAHL databases, hand-searched reference lists, citation history and contact with authors. ELIGIBILITY CRITERIA: cohort, case-control or cross-sectional studies which examined the occurrence of chronic kidney disease or nephrolithiasis amongst adults with gout (with or without a non-gout comparator group) in primary care or general population samples. Prevalence and risk estimate meta-analyses were performed using a random-effects model. RESULTS: Seventeen studies were included in the meta-analysis (chronic kidney disease n = 7, nephrolithiasis n = 8, both n = 2). Pooled prevalence estimates of chronic kidney disease stage ≥3 and self-reported lifetime nephrolithiasis in people with gout were 24% (95% confidence interval 19% to 28%) and 14% (95% CI 12% to 17%) respectively. Gout was associated with both chronic kidney disease (pooled adjusted odds ratio 2.41, 95% confidence interval 1.86 to 3.11) and self-reported lifetime nephrolithiasis (1.77, 1.43 to 2.19). CONCLUSIONS: Chronic kidney disease and nephrolithiasis are commonly found amongst patients with gout. Gout is independently associated with both chronic kidney disease and nephrolithiasis. Patients with gout should be actively screened for chronic kidney disease and its consequences.

5 Review Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. 2015

Clarson, L E / Chandratre, P / Hider, S L / Belcher, J / Heneghan, C / Roddy, E / Mallen, C D. ·Keele University, Keele, UK l.clarson@keele.ac.uk. · Keele University, Keele, UK. · Oxford University, Oxford, UK. ·Eur J Prev Cardiol · Pubmed #24281251.

ABSTRACT: BACKGROUND: Hyperuricaemia, the biochemical precursor to gout, has been shown to be an independent risk factor for mortality from cardiovascular disease (CVD), although studies examining the clinical phenomenon of gout and risk of CVD mortality report conflicting results. This study aimed to produce a pooled estimate of risk of mortality from cardiovascular disease in patients with gout. DESIGN: Systematic review and meta-analysis. METHODS: Electronic bibliographic databases were searched from inception to November 2012, with results reviewed by two independent reviewers. Studies were included if they reported data on CVD mortality in adults with gout who were free of CVD at time of entry into the study. Pooled hazard ratios (HRs) for this association were calculated both unadjusted and adjusted for traditional vascular risk factors. RESULTS: Six papers, including 223,448 patients, were eligible for inclusion (all (CVD) mortality n = 4, coronary heart disease (CHD) mortality n = 3, and myocardial infarction mortality n = 3). Gout was associated with an excess risk of CVD mortality (unadjusted HR 1.51 (95% confidence interval, CI, 1.17-1.84)) and CHD mortality (unadjusted HR 1.59, 95% CI 1.25-1.94)). After adjusting for traditional vascular risk factors, the pooled HR for both CVD mortality (HR 1.29, 95% CI 1.14-1.44) and CHD mortality (HR 1.42, 95% CI 1.22-1.63) remained statistically significant, but none of the studies reported a significant association with myocardial infarction. CONCLUSIONS: Gout increases the risk of mortality from CVD and CHD, but not myocardial infarction, independently of vascular risk factors.

6 Review Gout. 2013

Roddy, Edward / Mallen, Christian D / Doherty, Michael. ·Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele ST5 5BG, UK. ·BMJ · Pubmed #24473446.

ABSTRACT: -- No abstract --

7 Review Health-related quality of life in gout: a systematic review. 2013

Chandratre, Priyanka / Roddy, Edward / Clarson, Lorna / Richardson, Jane / Hider, Samantha L / Mallen, Christian D. ·Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK. e.roddy@keele.ac.uk. ·Rheumatology (Oxford) · Pubmed #23934311.

ABSTRACT: OBJECTIVES: To identify the instruments that have been used to measure health-related quality of life (HRQOL) in gout and assess their clinimetric properties, determine the distribution of HRQOL in gout and identify factors associated with poor HRQOL. METHODS: Medline, CINAHL, EMBASE and PsycINFO were searched from inception to October 2012. Search terms pertained to gout, health or functional status, clinimetric properties and HRQOL. Study data extraction and quality assessment were performed by two independent reviewers. RESULTS: From 474 identified studies, 22 met the inclusion criteria. Health Assessment Questionnaire Disability Index (HAQ-DI) and Short Form 36 (SF-36) were most frequently used and highest rated due to robust construct and concurrent validity, despite high floor and ceiling effects. The Gout Impact Scale had good content validity. Gout had a greater impact on physical HRQOL compared to other domains. Both gout-specific features (attack frequency and intensity, intercritical pain and number of joints involved) and comorbid disease were associated with poor HRQOL. Evidence for objective features such as tophi and serum uric acid was less robust. Limitations of existing studies include cross-sectional design, recruitment from specialist clinic settings and frequent use of generic instruments. CONCLUSION: Most studies have used the generic HAQ-DI and SF-36. Gout-specific characteristics and comorbidities contribute to poor HRQOL. There is a need for a cohort study in primary care (where most patients with gout are treated) to determine which factors predict changes in HRQOL over time. This will enable those at risk of deterioration to be identified and better targeted for treatment.

8 Article Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. 2020

Roddy, Edward / Clarkson, Kris / Blagojevic-Bucknall, Milica / Mehta, Rajnikant / Oppong, Raymond / Avery, Anthony / Hay, Elaine M / Heneghan, Carl / Hartshorne, Liz / Hooper, Julie / Hughes, Gemma / Jowett, Sue / Lewis, Martyn / Little, Paul / McCartney, Karen / Mahtani, Kamal R / Nunan, David / Santer, Miriam / Williams, Sam / Mallen, Christian D. ·Primary Care Centre Versus Arthritis; School of Primary, Community and Social Care, Keele University, Keele, UK e.roddy@keele.ac.uk. · Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK. · Primary Care Centre Versus Arthritis; School of Primary, Community and Social Care, Keele University, Keele, UK. · Keele Clinical Trials Unit, Keele University, Keele, UK. · Birmingham Acute Care Research/Heart of England NHS Foundation Trust/Institute of Applied Health Research (BCTU), University of Birmingham, Birmingham, UK. · Health Economics, University of Birmingham, Birmingham, UK. · Division of Primary Care, University of Nottingham, Nottingham, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. · Primary Care and Population Sciences, University of Southampton, Southampton, UK. ·Ann Rheum Dis · Pubmed #31666237.

ABSTRACT: OBJECTIVES: To compare the effectiveness and safety of naproxen and low-dose colchicine for treating gout flares in primary care. METHODS: This was a multicentre open-label randomised trial. Adults with a gout flare recruited from 100 general practices were randomised equally to naproxen 750 mg immediately then 250 mg every 8 hours for 7 days or low-dose colchicine 500 mcg three times per day for 4 days. The primary outcome was change in worst pain intensity in the last 24 hours (0-10 Numeric Rating Scale) from baseline measured daily over the first 7 days: mean change from baseline was compared between groups over days 1-7 by intention to treat. RESULTS: Between 29 January 2014 and 31 December 2015, we recruited 399 participants (naproxen n=200, colchicine n=199), of whom 349 (87.5%) completed primary outcome data at day 7. There was no significant between-group difference in average pain-change scores over days 1-7 (colchicine vs naproxen: mean difference -0.18; 95% CI -0.53 to 0.17; p=0.32). During days 1-7, diarrhoea (45.9% vs 20.0%; OR 3.31; 2.01 to 5.44) and headache (20.5% vs 10.7%; 1.92; 1.03 to 3.55) were more common in the colchicine group than the naproxen group but constipation was less common (4.8% vs 19.3%; 0.24; 0.11 to 0.54). CONCLUSION: We found no difference in pain intensity over 7 days between people with a gout flare randomised to either naproxen or low-dose colchicine. Naproxen caused fewer side effects supporting naproxen as first-line treatment for gout flares in primary care in the absence of contraindications. TRIAL REGISTRATION NUMBER: ISRCTN (69836939), clinicaltrials.gov (NCT01994226), EudraCT (2013-001354-95).

9 Article 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. 2020

Richette, Pascal / Doherty, Michael / Pascual, Eliseo / Barskova, Victoria / Becce, Fabio / Castaneda, Johann / Coyfish, Malcolm / Guillo, Sylvie / Jansen, Tim / Janssens, Hein / Lioté, Frédéric / Mallen, Christian D / Nuki, George / Perez-Ruiz, Fernando / Pimentao, José / Punzi, Leonardo / Pywell, Anthony / So, Alexander K / Tausche, Anne-Kathrin / Uhlig, Till / Zavada, Jakub / Zhang, Weiya / Tubach, Florence / Bardin, Thomas. ·Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France pascal.richette@aphp.fr. · Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France. · Academic Rheumatology, University of Nottingham, Nottingham, UK. · Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. · Institute of Rheumatology, RAMS, Moscow, Russian. · Radiology, Lausanne University Hospital, Lausanne, Switzerland. · AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123 ECEVE, CIC-1421, Paris, France, Paris, France. · Nottingham, UK. · Département d'Epidémiologie et Recherche Clinique, Paris, France. · Rheumatology, VieCuri, Venlo, Netherlands. · Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. · Department of Rhumatologie, Hôpital Lariboisière, Paris, France. · INSERM UMR-1132 and Université Paris Diderot, Paris, France. · Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. · Centre Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK. · Servicio de Reumatologia, Hospital de Cruces, Baracaldo, Spain. · Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal. · Department of Medicine, University of Padua, Padua, Italy. · Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland. · Department of Internal Medicine, Section of Rheumatology, University Clinic Carl Gustav Carus, Dresden, Saxonia, Germany. · Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Institute of Rheumatology, Prague, Czech Republic, Czech Republic. · Academic Rheumatology, Nottingham University, Nottingham, UK. · Biostatistics and epidemiology, APHP, Hopital Pitié Salpetrière, Paris, France. · Rheumatology, Assistance Publique - Hopitaux de Paris, Paris, France. ·Ann Rheum Dis · Pubmed #31167758.

ABSTRACT: Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

10 Article Naproxen or low-dose colchicine for gout flares in primary care? Response to: 'Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care' by Parperis 2019

Roddy, Edward / Mallen, Christian D / Anonymous5691013. ·School of Primary, Community and Social Care, Keele University, Keele, UK e.roddy@keele.ac.uk. · School of Primary, Community and Social Care, Keele University, Keele, UK. · Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK. ·Ann Rheum Dis · Pubmed #31801739.

ABSTRACT: -- No abstract --

11 Article Gender-specific risk factors for gout: a systematic review of cohort studies. 2019

Evans, Peter L / Prior, James A / Belcher, John / Hay, Charles A / Mallen, Christian D / Roddy, Edward. ·Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. · Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@keele.ac.uk. · Research and Innovation, Wythenshawe Hospital, Manchester University Foundation Hospital Trust, Wythenshawe, UK. ·Adv Rheumatol · Pubmed #31234907.

ABSTRACT: BACKGROUND: Though gout is more prevalent in men than women, it remains unclear whether gender influences risk factors for incident gout. We aimed to systematically review all cohort studies examining risk factors for the development of gout by gender. METHODS: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched from inception to March 2019. Risk factors for gout examined were: age, ethnicity, consumption of alcohol, meat, seafood, dairy products, purine-rich vegetables, coffee and fructose, vitamin C intake, the Dietary Approaches to Stop Hypertension (DASH) diet, metabolic syndrome, BMI, waist and chest circumference, waist-to-hip ratio, weight change, diabetes mellitus, dyslipidaemias, renal disease, psoriasis, hypertension, diuretic use and anti-diabetic medication. Cohort studies were included if examining (at least) one of these risk factors for gout in either gender in the general population or primary care. Sample characteristics from included articles and their reported risk estimates were described using narrative synthesis. RESULTS: Thirty-three articles were included, 20 (60.6%)directly compared risk factors by gender, 10 (30.3%) used men-only samples, 3 (9.1%) used women-only samples. Articles comparing risk across genders found similar increases in most risk factors. However, in men, metabolic syndrome (Hazard Ratio (95% CI) 1.37(1.20-1.58)) presented a risk of incident gout compared to none in women (> 50 years 1.15(0.85-1.54); ≤50 years 1.29(0.76-2.17)). Compared to men, women showed greater associated risk with higher consumption of fish and shellfish (HR (95% CI) Men: 1.02 (0.86-1.22); Women 1.36 (1.12-1.65)). CONCLUSIONS: Risk factors for developing gout did not typically differ between genders and therefore similar preventative advice can be provided. Exceptions were metabolic syndrome in men and excessive seafood consumption in women, but these singular articles need further examination and in general more research into the risk factors for gout which includes women is required.

12 Article Venous thromboembolism in patients with gout and the impact of hospital admission, disease duration and urate-lowering therapy. 2019

Sultan, Alyshah Abdul / Muller, Sara / Whittle, Rebecca / Roddy, Edward / Mallen, Christian / Clarson, Lorna. ·Arthritis Research UK Primary Care Centre (Abdul Sultan, Muller, Whittle, Roddy, Mallen, Clarson), Research Institute for Primary Care & Health Sciences, Keele University, UK; Haywood Academic Rheumatology Centre (Roddy), Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK alyshah.sultan@hotmail.com. · Arthritis Research UK Primary Care Centre (Abdul Sultan, Muller, Whittle, Roddy, Mallen, Clarson), Research Institute for Primary Care & Health Sciences, Keele University, UK; Haywood Academic Rheumatology Centre (Roddy), Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK. ·CMAJ · Pubmed #31160496.

ABSTRACT: BACKGROUND: Systemic inflammatory diseases have been associated with increased risk of venous thromboembolism. We aimed to quantify the risk of venous thromboembolism in patients with gout, the most common inflammatory arthritis, and to assess how disease duration, hospital admission and urate-lowering therapy affect this risk. METHODS: We used data from the population-representative, England-based Clinical Practice Research Datalink linked to Hospital Episode Statistics, to identify incident gout cases between 1998 and 2017. We matched cases individually to 1 control without gout on age, gender, general practice and follow-up time. We calculated absolute and relative risks of venous thromboembolism, stratified by age, gender and hospital admission. Among those with gout, we assessed the risk of venous thromboembolism by exposure to urate-lowering therapy. RESULTS: We identified 62 234 patients with incident gout matched to 62 234 controls. Gout was associated with higher risk of venous thromboembolism compared with controls (absolute rate 37.3 [95% confidence interval (CI) 35.5-39.3] v. 27.0 [95% CI 25.5-28.9] per 10 000 person-years, adjusted hazard ratio [HR] 1.25, 95% CI 1.15-1.35). The excess risk in patients with gout, which was sustained up to a decade after diagnosis, was present during the time outside hospital stay (adjusted HR 1.30, 95% CI 1.18-1.42), but not during it (adjusted HR 1.01, 95% CI 0.83-1.24). The risk of venous thromboembolism was similar among patients prescribed versus not prescribed urate-lowering therapy (incidence rate ratio 1.04, 95% CI 0.89-1.23). INTERPRETATION: Gout was associated with higher risk of venous thromboembolism, particularly when the patient was not in hospital and regardless of exposure to urate-lowering therapy. Although the observed excess risk may not be sufficient to warrant preventive intervention, clinical vigilance may be required when caring for these patients.

13 Article The Risk of Gout Among Patients With Sleep Apnea: A Matched Cohort Study. 2019

Blagojevic-Bucknall, Milica / Mallen, Christian / Muller, Sara / Hayward, Richard / West, Sophie / Choi, Hyon / Roddy, Edward. ·Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK. · Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK. · Massachusetts General Hospital, Boston. ·Arthritis Rheumatol · Pubmed #30160059.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) is associated with a range of serious comorbidities. This study was undertaken to investigate whether people with OSA are more likely to develop gout, in the short and long term, compared to those without OSA. METHODS: A matched retrospective cohort study was undertaken using the UK Clinical Practice Research Datalink. Individuals age ≥18 years who received a diagnosis of OSA between 1990 and 2010 were identified and matched on age, sex, and practice with up to 4 individuals without OSA; follow-up was until the end of 2015. Hazard ratios (HRs) were estimated using Cox regression adjusted for general health, lifestyle, and comorbidity characteristics. The risk of developing gout was assessed at different time points, and the body mass index (BMI) category-specific results were presented. RESULTS: The study sample included 15,879 patients with OSA and 63,296 without. The median follow-up was 5.8 years. We found that 4.9% of patients with OSA and 2.6% of patients without the disorder developed gout. The incidence rate per 1,000 person-years was 7.83 (95% confidence interval [95% CI] 7.29-8.40) and 4.03 (95% CI 3.84-4.23) among those with and without OSA, respectively. The adjusted HR was 1.42 (95% CI 1.29-1.56). The risk of developing gout among OSA patients compared to those without was highest 1-2 years after the index date (HR 1.64 [95% CI 1.30-2.06]). This finding persisted among those who were overweight and obese. For those with normal BMI, the highest significant HR (2.02 [95% CI 1.13-3.62]) was observed at 2-5 years after the index date. CONCLUSION: In this study, patients with OSA continued to be at higher risk of developing gout beyond the first year following the diagnosis. Our results further indicate that peak incidences of gout vary according to BMI.

14 Article Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study. 2018

Roughley, Matthew / Sultan, Alyshah Abdul / Clarson, Lorna / Muller, Sara / Whittle, Rebecca / Belcher, John / Mallen, Christian D / Roddy, Edward. ·East London NHS Foundation Trust, Trust Headquarters, 9 Alie Street, London, E1 8DE, UK. mattjroughley@gmail.com. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. · School of Computing and Mathematics, Keele University, Keele, Staffordshire, ST5 5BG, UK. · Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK. ·Arthritis Res Ther · Pubmed #30376864.

ABSTRACT: BACKGROUND: An association between gout and renal disease is well-recognised but few studies have examined whether gout is a risk factor for subsequent chronic kidney disease (CKD). Additionally, the impact of urate-lowering therapy (ULT) on development of CKD in gout is unclear. The objective of this study was to quantify the risk of CKD stage ≥ 3 in people with gout and the impact of ULT. METHODS: This was a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD). Patients with incident gout were identified from general practice medical records between 1998 and 2016 and randomly matched 1:1 to patients without a diagnosis of gout based on age, gender, available follow-up time and practice. Primary outcome was development of CKD stage ≥ 3 based on estimated glomerular filtration rate (eGFR) or recorded diagnosis. Absolute rates (ARs) and adjusted hazard ratios (HRs) were calculated using Cox regression models. Risk of developing CKD was assessed among those prescribed ULT within 1 and 3 years of gout diagnosis. RESULTS: Patients with incident gout (n = 41,446) were matched to patients without gout. Development of CKD stage ≥ 3 was greater in the exposed group than in the unexposed group (AR 28.6 versus 15.8 per 10,000 person-years). Gout was associated with an increased risk of incident CKD (adjusted HR 1.78 95% CI 1.70 to 1.85). Those exposed to ULT had a greater risk of incident CKD, but following adjustment this was attenuated to non-significance in all analyses (except on 3-year analysis of women (adjusted HR 1.31 95% CI 1.09 to 1.59)). CONCLUSIONS: This study has demonstrated gout to be a risk factor for incident CKD stage ≥ 3. Further research examining the mechanisms by which gout may increase risk of CKD and whether optimal use of ULT can reduce the risk or progression of CKD in gout is suggested.

15 Article Obesity, hypertension and diuretic use as risk factors for incident gout: a systematic review and meta-analysis of cohort studies. 2018

Evans, Peter L / Prior, James A / Belcher, John / Mallen, Christian D / Hay, Charles A / Roddy, Edward. ·Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. · Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@keele.ac.uk. ·Arthritis Res Ther · Pubmed #29976236.

ABSTRACT: BACKGROUND: Gout treatment remains suboptimal. Identifying populations at risk of developing gout may provide opportunities for prevention. Our aim was to assess the risk of incident gout associated with obesity, hypertension and diuretic use. METHODS: We conducted a systematic review and meta-analysis of prospective and retrospective cohort studies in adults (age ≥ 18 years) from primary care or the general population, exposed to obesity, hypertension or diuretic use and with incident gout as their outcome. RESULTS: A total of 9923 articles were identified: 14 met the inclusion criteria, 11 of which contained data suitable for pooling in the meta-analysis. Four articles were identified for obesity, 10 for hypertension and six for diuretic use, with four, nine and three articles included respectively for each meta-analysis. Gout was 2.24 times more likely to occur in individuals with body mass index ≥ 30 kg/m CONCLUSIONS: Obesity, hypertension and diuretic use are risk factors for incident gout, each more than doubling the risk compared to those without these risk factors. Patients with these risk factors should be recognised by clinicians as being at greater risk of developing gout and provided with appropriate management and treatment options.

16 Article Risk of fragility fracture among patients with gout and the effect of urate-lowering therapy. 2018

Sultan, Alyshah Abdul / Whittle, Rebecca / Muller, Sara / Roddy, Edward / Mallen, Christian D / Bucknall, Milica / Helliwell, Toby / Hider, Samantha / Paskins, Zoe. ·Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK. · Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK z.paskins@keele.ac.uk. ·CMAJ · Pubmed #29759964.

ABSTRACT: BACKGROUND: Previous studies that quantified the risk of fracture among patients with gout and assessed the potential effect of urate-lowering therapy have provided conflicting results. Our study aims to provide better estimates of risk by minimizing the effect of selection bias and confounding on the observed association. METHODS: We used data from the Clinical Practice Research Datalink, which records primary care consultations of patients from across the United Kingdom. We identified patients with incident gout from 1990 to 2004 and followed them up until 2015. Each patient with gout was individually matched to 4 controls on age, sex and general practice. We calculated absolute rate of fracture and hazard ratios (HRs) using Cox regression models. Among patients with gout, we assessed the impact of urate-lowering therapy on fracture, and used landmark analysis and propensity score matching to account for immortal time bias and confounding by indication. RESULTS: We identified 31 781 patients with incident gout matched to 122 961 controls. The absolute rate of fracture was similar in both cases and controls (absolute rate = 53 and 55 per 10 000 person-years, respectively) corresponding to an HR of 0.97 (95% confidence interval 0.92-1.02). Our finding remained unchanged when we stratified our analysis by age and sex. We did not observe statistically significant differences in the risk of fracture among those prescribed urate-lowering therapy within 1 and 3 years after gout diagnosis. INTERPRETATION: Overall, gout was not associated with an increased risk of fracture. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fracture.

17 Article Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. 2018

Bevis, Megan / Blagojevic-Bucknall, Milisa / Mallen, Christian / Hider, Samantha / Roddy, Edward. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK. · Staffordshire and Stoke-on-Trent Rheumatology Partnership NHS Trust, Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. ·Rheumatology (Oxford) · Pubmed #29672754.

ABSTRACT: Objective: To investigate how comorbid conditions cluster in patients with gout in a UK primary care population. Methods: A cross-sectional study was performed using baseline data from a primary-care-based prospective observational cohort of people aged ⩾18 years with gout. Participants with gout were identified through primary care medical records. Factor analysis was performed to obtain distinct clusters of comorbidity variables including obesity, hypertension, diabetes mellitus, hyperlipidaemia, coronary heart disease, heart failure, chronic kidney disease (CKD) and cancer. Hierarchical cluster analysis of patient observations was also performed to identify homogenous subgroups of patients based on combinations of their comorbidities. Results: Four distinct comorbidity clusters (C1-C4) were identified in 1079 participants [mean (s.d.) age 65.5 years (12.5); 909 (84%) male]. Cluster C1 (n = 197, 18%) was the oldest group and had the most frequent attacks of gout; 97% had CKD. Participants in C2 (n = 393, 36%) had isolated gout with few comorbidities but drank alcohol more frequently. In cluster C3 (n = 296, 27%), hypertension, diabetes mellitus, hyperlipidaemia, coronary heart disease and/or CKD were prevalent, and urate-lowering therapy was prescribed more frequently than in other clusters. All patients in C4 (193, 18%) had hypertension and were more likely to be obese than other clusters. Conclusion: Four distinct comorbidity clusters were identified. People with multiple comorbidities were more likely to receive allopurinol. Tailoring of treatments depending on cluster and comorbidities should be considered.

18 Article Gout Severity, Socioeconomic Status, and Work Absence: A Cross-Sectional Study in Primary Care. 2018

Bowen-Davies, Zachary / Muller, Sara / Mallen, Christian D / Hayward, Richard A / Roddy, Edward. ·Research Institute for Primary Care & Health Sciences, Keele University, UK. · Research Institute for Primary Care & Health Sciences, Keele University, Keele UK, and Haywood Academic Rheumatology Centre, Haywood Hospital, UK. ·Arthritis Care Res (Hoboken) · Pubmed #29579363.

ABSTRACT: OBJECTIVE: To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence. METHODS: Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (OR RESULTS: A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (OR CONCLUSION: Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.

19 Article Health-related quality of life in gout in primary care: Baseline findings from a cohort study. 2018

Chandratre, Priyanka / Mallen, Christian / Richardson, Jane / Muller, Sara / Hider, Samantha / Rome, Keith / Blagojevic-Bucknall, Milisa / Roddy, Edward. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. · Auckland University of Technology, Auckland, New Zealand. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. Electronic address: e.roddy@keele.ac.uk. ·Semin Arthritis Rheum · Pubmed #29398125.

ABSTRACT: OBJECTIVES: To examine gout-related, comorbid, and sociodemographic characteristics associated with generic and disease-specific health-related quality of life (HRQOL) in gout. METHODS: Adults with gout from 20 general practices were mailed a questionnaire containing the Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form-36 Physical Function subscale (PF-10), Gout Impact Scale (GIS), and questions about gout-specific, comorbid and sociodemographic characteristics. Variables associated with HRQOL were examined using multivariable linear regression models. RESULTS: A total of 1184 completed questionnaires were received (response 65.9%). Worse generic and gout-specific HRQOL was associated with frequent gout attacks (≥5 attacks PF-10 β = -4.90, HAQ-DI β = 0.14, GIS subscales β = 8.94, 33.26), current attack (HAQ-DI β = 0.15, GIS β = -1.94, 18.89), oligo/polyarticular attacks (HAQ-DI β = 0.11, GIS β = 0.78, 7.86), body pain (PF-10 β = -10.68, HAQ-DI β = 0.29, GIS β = 2.61, 11.89), anxiety (PF-10 β = -1.81, HAQ-DI β = 0.06, GIS β = 0.38, 1.70), depression (PF-10 β = -1.98, HAQ-DI β = 0.06, GIS 0.42, 1.47) and alcohol non-consumption (PF-10 β = -16.10, HAQ-DI β = 0.45). Gout-specific HRQOL was better in Caucasians than non-Caucasians (GIS β = -13.05, -13.48). Poorer generic HRQOL was associated with diabetes mellitus (PF-10 β = -4.33, HAQ-DI β = 0.14), stroke (PF-10 β = -12.21, HAQ-DI β = 0.37), renal failure (PF-10 β = -9.43, HAQ-DI β = 0.21), myocardial infarction (HAQ-DI β = 0.17), female gender (PF-10 β = -17.26, HAQ-DI β = 0.43), deprivation (PF-10 β = -7.80, HAQ-DI β = 0.19), and body mass index ≥35kg/m CONCLUSIONS: HRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy. Both gout-specific and generic questionnaires identify the impact of disease-specific features on HRQOL but studies focusing on comorbidity should include generic instruments.

20 Article Factors Influencing Allopurinol Initiation in Primary Care. 2017

Clarson, Lorna E / Hider, Samantha L / Belcher, John / Roddy, Edward / Mallen, Christian D. ·Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom l.clarson@keele.ac.uk. · Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom. · Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent, Partnership NHS Trust, Haywood Hospital, Burslem, Staffordshire, United Kingdom. ·Ann Fam Med · Pubmed #29133496.

ABSTRACT: Despite guidance on appropriate initiation, urate-lowering therapy is prescribed for only a minority of patients with gout. Electronic health records for 8,142 patients with gout were used to investigate the effect of age, sex, comorbidities, number of consultations, and meeting internationally agreed eligibility criteria on time to allopurinol initiation. Time to first prescription was modeled using multilevel Cox proportional hazards regression. Allopurinol initiation was positively associated with meeting eligibility criteria at diagnosis of gout, but negatively associated with becoming eligible after diagnosis. Managing gout as a chronic disease, with regular reviews to discuss allopurinol treatment, may reduce barriers to treatment.

21 Article Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study. 2017

Balasubramaniam, Gowrie / Parker, Trisha / Turner, David / Parker, Mike / Scales, Jonathan / Harnett, Patrick / Harrison, Michael / Ahmed, Khalid / Bhagat, Sweta / Marianayagam, Thiraupathy / Pitzalis, Costantino / Mallen, Christian / Roddy, Edward / Almond, Mike / Dasgupta, Bhaskar. ·Department of Renal Medicine, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Southend, Essex, UK. · Clinical Trials Unit, Anglia Ruskin University, Bishops Hall Lane, Chelmsford, UK. · Norwich Medical School, University of East Anglia, Norwich, UK. · School of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester, UK. · The Princess Alexandria Hospital NHS Trust, Harlow, Essex, UK. · West Suffolk Hospital NHS Foundation Trust, Bury Saint Edmunds, Suffolk. · Lister Hospital, East and North Herfordshire NHS Trust, Corey Mills Lane, Stevenage, Hertfordshire, UK. · Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London, London, UK. · Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK. ·BMJ Open · Pubmed #28877949.

ABSTRACT: INTRODUCTION: Acute gout occurs in people with chronic kidney disease, who are commonly older people with comorbidities such as hypertension, heart disease and diabetes. Potentially harmful treatments are administered to these vulnerable patients due to a lack of clear evidence. Newly available treatment that targets a key inflammatory pathway in acute gout attacks provides an opportunity to undertake the first-ever trial specifically looking treating people with kidney disease. This paper describes the protocol for a feasibility randomised controlled trial (RCT) comparing anakinra, a novel interleukin-1 antagonist versus steroids in people with chronic kidney disease (ASGARD). METHODS AND ANALYSIS: ASGARD is a two-parallel group double-blind, double-dummy multicentre RCT comparing anakinra 100 mg, an interleukin-1 antagonist, subcutaneous for 5 days against intramuscular methylprednisolone 120 mg. The primary objective is to assess the feasibility of the trial design and procedures for a definitive RCT. The specific aims are: (1) test recruitment and retention rates and willingness to be randomised; (2) test eligibility criteria; (3) collect and analyse outcome data to inform sample and power calculations for a trial of efficacy; (4) collect economic data to inform a future economic evaluation estimating costs of treatment and (5) assess capacity of the project to scale up to a national multicentre trial. We will also gather qualitative insights from participants. It aims to recruit 32 patients with a 1:1 randomisation. Information from this feasibility study will help design a definitive trial and provide general information in designing acute gout studies. ETHICS AND DISSEMINATION: The London-Central Ethics Committee approved the protocol. The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: EudraCT No. 2015-001787-19, NCT/Clinicalstrials.gov No. NCT02578394, pre-results, WHO Universal Trials Reference No. U1111-1175-1977. NIHR Grant PB-PG-0614-34090.

22 Article Gout and subsequent erectile dysfunction: a population-based cohort study from England. 2017

Abdul Sultan, Alyshah / Mallen, Christian / Hayward, Richard / Muller, Sara / Whittle, Rebecca / Hotston, Matthew / Roddy, Edward. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. a.abdul.sultan@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. · Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LQ, UK. ·Arthritis Res Ther · Pubmed #28587655.

ABSTRACT: BACKGROUND: An association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England. METHODS: We utilised the UK-based Clinical Practice Research Datalink to identify 9653 men with incident gout age- and practice-matched to 38,218 controls. Absolute and relative rates of incident ED were calculated using Cox regression models. Absolute rates within specific time periods before and after gout diagnosis were compared to control using a Poisson regression model. RESULTS: Overall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184-202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24-1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27-2.08). Similar findings were also observed for severe ED warranting pharmacological intervention. CONCLUSIONS: We have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

23 Article Improving management of gout in primary care: a new UK management guideline. 2017

Mallen, Christian D / Davenport, Graham / Hui, Michelle / Nuki, George / Roddy, Edward. ·Institute for Primary Care and Health Sciences, Keele University, Keele. · Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby. · University of Edinburgh, Edinburgh. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, and Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent. ·Br J Gen Pract · Pubmed #28546417.

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24 Article Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. 2016

Walsh, Ciaran P / Prior, James A / Chandratre, Priyanka / Belcher, John / Mallen, Christian D / Roddy, Edward. ·Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. · Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@keele.ac.uk. ·BMC Musculoskelet Disord · Pubmed #27639692.

ABSTRACT: BACKGROUND: Patients' perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use. METHODS: A health questionnaire was sent to 1805 people with gout aged ≥18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics. RESULTS: One thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively). CONCLUSIONS: Patients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of ULT.

25 Article A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout. 2016

Richardson, Jane C / Liddle, Jennifer / Mallen, Christian D / Roddy, Edward / Hider, Samantha / Prinjha, Suman / Ziebland, Sue. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK. j.c.richardson@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. ·BMC Musculoskelet Disord · Pubmed #27267878.

ABSTRACT: BACKGROUND: Although international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout. METHODS: A qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used. RESULTS: Participants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring. CONCLUSION: Patients' understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients' perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through "a joint effort over a period of time".

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