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Gout: HELP
Articles by Christian D. Mallen
Based on 34 articles published since 2008
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Between 2008 and 2019, C. Mallen wrote the following 34 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 / Anonymous6680907. ·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 / Anonymous6650907. ·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 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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 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.

ABSTRACT: -- No abstract --

15 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.

16 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".

17 Article Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study. 2016

Prior, James Andrew / Mallen, Christian D / Chandratre, Priyanka / Muller, Sara / Richardson, Jane / Roddy, Edward. ·Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom. Electronic address: j.a.prior@keele.ac.uk. · Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom. ·Joint Bone Spine · Pubmed #27068619.

ABSTRACT: OBJECTIVES: To determine the prevalence of anxiety and depression in gout, examine associations between gout characteristics and these comorbidities and determine the role of allopurinol in any such relationships. METHOD: As part of a prospective cohort study, a baseline questionnaire was sent to 1805 participants with gout aged≥18 years from UK primary care. Participants had a gout diagnosis or prescriptions for allopurinol or colchicine in their medical records 2 years prior to baseline. Prevalence of anxiety was defined using the Generalised Anxiety Disorder questionnaire and depression using the Patient Health Questionnaire. Logistic regression was used to examine any association between gout characteristics (12-month attack frequency, oligo/polyarticular gout and gout duration) and the presence of anxiety or depression. Crude and adjusted associations were reported as odds ratios (OR) and 95% confidence intervals (CI). Adjusted gout characteristics were stratified by allopurinol use. RESULTS: One thousand one hundred and eighty-four participants responded to baseline (65.6%). Prevalence of anxiety and depression were 10.0% and 12.6% respectively. There was no association between gout characteristics and anxiety. However, there was an association between attack frequency and depression amongst those gout patients using allopurinol (2.87 [1.2 to 6.6]) and also between oligo/polyarticular gout and depression (2.01 [1.2 to 3.3]), irrespective of allopurinol use (2.09 [1.1 to 4.0]) or not (2.64 [1.0 to 6.8]). CONCLUSION: Patients experiencing frequent gout attacks or attacks in multiple joints are likely to experience depressive symptoms, even when using allopurinol. Depression may influence medication adherence and participation in routine reviews, hence impacting adversely on gout management outcomes.

18 Article Impact of gout on the risk of atrial fibrillation. 2016

Kuo, Chang-Fu / Grainge, Matthew J / Mallen, Christian / Zhang, Weiya / Doherty, Michael. ·Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham and. · Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, weiya.zhang@nottingham.ac.uk. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #26683193.

ABSTRACT: OBJECTIVES: To examine the risk of atrial fibrillation (AF) at the time of first diagnosis of gout compared with matched controls and to follow incident gout patients and their matched controls after diagnosis to compare their subsequent risk of AF. METHODS: From the UK Clinical Practice Research Data-link, 45 378 incident gout patients and 45 378 age-, sex-, practice-, registration year- and index year-matched controls were identified. Index dates were initial diagnosis date for gout patients and their matched controls. The risk of AF at diagnosis [odds ratios (ORs), using conditional logistic regression] and after the diagnosis of gout [hazard ratios (HRs), using Cox proportional models] were estimated, adjusted for BMI, smoking, alcohol consumption, ischaemic heart disease, heart failure, heart valve disease, hyperthyroidism and other comorbidities and medications. RESULTS: The prevalence of AF at index date in gout patients (male, 72.3%; mean age, 62.4 ± 15.1 years) was 7.42% (95% CI 7.18, 7.66%) and in matched controls 2.83% (95% CI 2.67, 2.98%). The adjusted OR (95% CI) was 1.45 (1.29, 1.62). The cumulative probability of AF at 1, 2, 5 and 10 years after index date was 1.08, 2.03, 4.77 and 9.68% in gout patients and 0.43, 1.08, 2.95 and 6.33% in controls, respectively (log-rank test, P < 0.001). The adjusted HR (95% CIs) was 1.09 (1.03, 1.16). CONCLUSION: This population-based study indicates that gout is independently associated with a higher risk of AF at diagnosis and the risk is also higher after the diagnosis.

19 Article "You want to get on with the rest of your life": a qualitative study of health-related quality of life in gout. 2016

Chandratre, Priyanka / Mallen, Christian D / Roddy, Edward / Liddle, Jennifer / Richardson, Jane. ·Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. · Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.c.richardson@keele.ac.uk. ·Clin Rheumatol · Pubmed #26245722.

ABSTRACT: The objective of the study is to examine the impact of gout and its treatments on health-related quality of life (HRQOL) using focus group interviews. From the baseline phase of a cohort study of HRQOL in gout, 17 participants (15 males, mean age 71 years) with varying attack frequency and treatment with and without allopurinol participated in one of four focus group interviews. All interviews were audio-recorded and transcribed verbatim. Data was analysed thematically. Physical and psychosocial HRQOL in gout was affected by characteristics of acute gout (particularly the unpredictable nature of attacks, location of joint involved in an attack, pain and modifications in lifestyle), lack of understanding of gout by others (association with unhealthy lifestyle, symptoms ridiculed as non-severe and non-serious) as well as participants (not considered a disease) and the lack of information provided by physicians (about causes and pharmacological as well as non-pharmacological treatments of gout). Participants emphasised the impact of acute attacks of gout and prioritised dietary modifications and treatment of acute attacks over long-term urate-lowering therapy. Characteristics of acute gout, lack of understanding and information about gout and its treatments perpetuate poor HRQOL. HRQOL (maintenance of usual diet and reduced frequency of attacks) was associated with urate-lowering treatment. Better patient, public and practitioner education about gout being a chronic condition associated with co-morbidities and poor HRQOL may improve understanding and long-term treatment of gout.

20 Article Comorbidities in patients with gout prior to and following diagnosis: case-control study. 2016

Kuo, Chang-Fu / Grainge, Matthew J / Mallen, Christian / Zhang, Weiya / Doherty, Michael. ·Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. · Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Ann Rheum Dis · Pubmed #25398375.

ABSTRACT: OBJECTIVES: To determine the burden of comorbidities in patients with gout at diagnosis and the risk of developing new comorbidities post diagnosis. METHODS: There were 39 111 patients with incident gout and 39 111 matched controls identified from the UK Clinical Practice Research Data-link. The risk of comorbidity before (ORs) and after the diagnosis of gout (HRs) were estimated, adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption. RESULTS: Gout was associated with adjusted ORs (95% CIs) of 1.39 (1.34 to 1.45), 1.89 (1.76 to 2.03) and 2.51 (2.19 to 2.86) for the Charlson index of 1-2, 3-4 and ≥5, respectively. Cardiovascular and genitourinary diseases, in addition to hyperlipidaemia, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, osteoarthritis and depression, were associated with a higher risk for gout. Gout was also associated with an adjusted HR (95% CI) of 1.41 (1.34 to 1.48) for having a Charlson index ≥1. Median time to first comorbidity was 43 months in cases and 111 months in controls. Risks for incident comorbidity were higher in cardiovascular, genitourinary, metabolic/endocrine and musculoskeletal diseases, in addition to liver diseases, hemiplegia, depression, anaemia and psoriasis in patients with gout. After additionally adjusting for all comorbidities at diagnosis, gout was associated with a HR (95% CI) for all-cause mortality of 1.13 (1.08 to 1.18; p<0.001). CONCLUSIONS: The majority of patients with gout have worse pre-existing health status at diagnosis and the risk of incident comorbidity continues to rise following diagnosis. The range of associated comorbidities is broader than previously recognised and merits further evaluation.

21 Article "Why me? I don't fit the mould … I am a freak of nature": a qualitative study of women's experience of gout. 2015

Richardson, Jane C / Liddle, Jennifer / Mallen, Christian D / Roddy, Edward / Prinjha, Suman / Ziebland, Sue / Hider, Samantha. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.c.richardson@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.liddle@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. c.d.mallen@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. e.roddy@keele.ac.uk. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. suman.prinjha@phc.ox.ac.uk. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. sue.ziebland@phc.ox.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. s.hider@keele.ac.uk. ·BMC Womens Health · Pubmed #26710971.

ABSTRACT: BACKGROUND: Gout is more common in men, and is often perceived by both patients and health practitioners to be a disorder of men, but its prevalence in women is increasing. Little is known about women's experience of gout and the impact it has on their lives. It is important for practitioners to be aware of these areas, given the increasing numbers of women with gout they are likely to see in the future. This study aimed to explore women's experiences of gout. METHODS: A qualitative research design was used. Semi-structured interviews were conducted with 43 people, of whom 14 were women. Interviews were video and/or tape recorded and transcribed verbatim. Data from the interviews was first grouped into broad categories, followed by a more detailed thematic analysis and interpretation. RESULTS: Participants' ages ranged from 32 to 82. Nine participants were retired and five were in fulltime work. Four themes emerged: (1) experience of onset, help seeking and diagnosis (2) understanding and finding information about gout, (3) impact on identity, and (4) impact on roles and relationships. CONCLUSIONS: The diagnostic process for women with gout can be uncertain due to lack of awareness of gout in women (by health care professionals and women themselves). Women do not have a good understanding of the condition and find it difficult to find information that feels relevant to them. Gout has a major impact on women's identity and on their roles and relationships. These findings are of importance to health care professionals dealing with women with potential gout and those with an existing diagnosis.

22 Article Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration. 2015

Liddle, Jennifer / Roddy, Edward / Mallen, Christian D / Hider, Samantha L / Prinjha, Suman / Ziebland, Sue / Richardson, Jane C. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK. · Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK. ·BMJ Open · Pubmed #26369796.

ABSTRACT: OBJECTIVE: To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. DESIGN: Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. PARTICIPANTS AND SETTING: A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. RESULTS: Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. CONCLUSIONS: This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences.

23 Article Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score-matched landmark analysis. 2015

Kuo, Chang-Fu / Grainge, Matthew J / Mallen, Christian / Zhang, Weiya / Doherty, Michael. ·Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham and. · Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, weiya.zhang@nottingham.ac.uk. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Rheumatology (Oxford) · Pubmed #26170376.

ABSTRACT: OBJECTIVE: To examine the association between allopurinol use and all-cause mortality for patients with incident gout. METHODS: We compared all-cause mortality in incident gout patients who received allopurinol for at least 6 months within the exposure window (1 year or 3 years) with those who did not, using the UK Clinical Practice Research Data-link. Landmark analysis was used to account for immortal time bias and propensity score matching was used to control for potential effects of known confounders. RESULTS: Of 23 332 incident gout patients identified, the propensity score-matched cohorts contained 1016 patients exposed to allopurinol on the date 1 year from diagnosis (landmark date) and 1016 allopurinol non-users. Over a median follow-up period of 10 years after the landmark date, there were 437 allopurinol users and 443 allopurinol non-users who died during follow-up. Allopurinol users and non-users had similar risk for all-cause mortality (hazard ratio 0.99; 95% CI 0.87, 1.12). In the 3-year landmark analysis, 3519 allopurinol users (1280 died) were compared with 3519 non-users (1265 died). The hazard ratio for all-cause mortality was 1.01 (95% CI 0.92, 1.09). CONCLUSION: This propensity score-matched landmark analysis in a population of incident gout patients in the UK primary care setting found a neutral effect on the risk of all-cause mortality. Our study provides reassurance about the prescription of allopurinol for gout patients early in their disease course to prevent untoward consequences of chronic uncontrolled hyperuricaemia. However, whether higher than the commonly used dose of allopurinol could influence mortality remains to be determined.

24 Article Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK clinical practice research datalink. 2015

Clarson, Lorna E / Hider, Samantha L / Belcher, John / Heneghan, Carl / Roddy, Edward / Mallen, Christian D. ·Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK. · Department of Primary Care Health Sciences, Oxford University, Oxford, UK. ·Ann Rheum Dis · Pubmed #25165032.

ABSTRACT: OBJECTIVES: To determine whether gout increases risk of incident coronary heart disease (CHD), cerebrovascular (CVD) and peripheral vascular disease (PVD) in a large cohort of primary care patients with gout, since there have been no such large studies in primary care. METHODS: A retrospective cohort study was performed using data from the Clinical Practice Research Datalink (CPRD). Risk of incident CHD, CVD and PVD was compared in 8386 patients with an incident diagnosis of gout, and 39 766 age, sex and registered general practice-matched controls, all aged over 50 years and with no prior vascular history, in the 10 years following incidence of gout, or matched index date (baseline). Multivariable Cox Regression was used to estimate HRs and covariates included sex and baseline measures of age, Body Mass Index, smoking, alcohol consumption, Charlson comorbidity index, history of hypertension, hyperlipidaemia, chronic kidney disease, statin use and aspirin use. RESULTS: Multivariable analysis showed men were at increased risk of any vascular event (HRs (95% CIs)) HR 1.06 (1.01 to 1.12), any CHD HR 1.08 (1.01 to 1.15) and PVD HR 1.18 (1.01 to 1.38), while women were at increased risk of any vascular event, HR 1.25 (1.15 to 1.35), any CHD HR 1.25 (1.12 to 1.39), and PVD 1.89 (1.50 to 2.38)) but not any CVD. CONCLUSIONS: In this cohort of over 50s with gout, female patients with gout were at greatest risk of incident vascular events, even after adjustment for vascular risk factors, despite a higher prevalence of both gout and vascular disease in men. Further research is required to establish the reason for this sex difference.

25 Article Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. 2015

Kuo, Chang-Fu / Grainge, Matthew J / Mallen, Christian / Zhang, Weiya / Doherty, Michael. ·Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. · Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. · Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK. ·Ann Rheum Dis · Pubmed #24431399.

ABSTRACT: OBJECTIVES: To describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012. METHODS: We used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients. RESULTS: In 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012. CONCLUSIONS: In recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor.

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