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Gout: HELP
Articles by Francisca Sivera
Based on 24 articles published since 2008
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Between 2008 and 2019, Francisca Sivera wrote the following 24 articles about Gout.
 
+ Citations + Abstracts
1 Review Managing Gout in the Patient with Renal Impairment. 2018

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

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

2 Review Gout: Diagnosis and treatment. 2017

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

ABSTRACT: -- No abstract --

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

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

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

4 Review Dietary supplements for chronic gout. 2014

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

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

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

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

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

6 Review The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. 2014

Wechalekar, Mihir D / Vinik, Ophir / Moi, John H Y / Sivera, Francisca / van Echteld, Irene A A M / van Durme, Caroline / Falzon, Louise / Bombardier, Claire / Carmona, Loreto / Aletaha, Daniel / Landewé, Robert B / van der Heijde, Désirée M F M / Buchbinder, Rachelle. ·From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD, ·J Rheumatol Suppl · Pubmed #25180124.

ABSTRACT: OBJECTIVE: To determine the efficacy and safety of glucocorticoids (GC), colchicine, nonsteroidal antiinflammatory drugs (NSAID), interleukin-1 (IL-1) inhibitors, and paracetamol to treat acute gout. METHODS: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to September 2011. Randomized controlled trials (RCT) or quasi-RCT in adults with acute gout that compared GC, colchicine, NSAID, IL-1 inhibitors, and paracetamol to no treatment, placebo, another intervention, or combination therapy were included. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events. Data were pooled where appropriate. RESULTS: Twenty-six trials evaluating GC (N = 5), NSAID (N = 21), colchicine (N = 2), and canakinumab (N = 1) were included. No RCT assessed paracetamol or intraarticular (IA) GC. No RCT compared systemic GC with placebo. Moderate quality evidence (3 trials) concluded that systemic GC were as effective as NSAID but safer. Low quality evidence (1 trial) showed that both high- and low-dose colchicine were more effective than placebo, and low-dose colchicine was no different to placebo with respect to safety but safer than high-dose colchicine. Low quality evidence (1 trial) showed no difference between NSAID and placebo with regard to pain or inflammation. No NSAID was superior to another. Moderate quality evidence (1 trial) found that 150 mg canakinumab was more effective than a single dose of intramuscular GC (40 mg triamcinolone) and equally safe. CONCLUSION: GC, NSAID, low-dose colchicine, and canakinumab all effectively treat acute gout. There was insufficient evidence to rank them. Systemic GC appeared safer than NSAID and lower-dose colchicine was safer than higher-dose colchicine.

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

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

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

8 Review Interleukin-1 inhibitors for acute gout. 2014

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

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

9 Review Synovial fluid analysis for crystals. 2011

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

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

10 Article Brief Report: Validation of a Definition of Flare in Patients With Established Gout. 2018

Gaffo, Angelo L / Dalbeth, Nicola / Saag, Kenneth G / Singh, Jasvinder A / Rahn, Elizabeth J / Mudano, Amy S / Chen, Yi-Hsing / Lin, Ching-Tsai / Bourke, Sandra / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Hernández-Llinas, Hansel / Neogi, Tuhina / Vargas-Santos, Ana Beatriz / da Rocha Castelar-Pinheiro, Geraldo / Amorim, Rodrigo B C / Uhlig, Till / Hammer, Hilde B / Eliseev, Maxim / Perez-Ruiz, Fernando / Cavagna, Lorenzo / McCarthy, Geraldine M / Stamp, Lisa K / Gerritsen, Martijn / Fana, Viktoria / Sivera, Francisca / Taylor, William. ·University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama. · University of Auckland, Auckland, New Zealand. · University of Alabama at Birmingham. · Taichung Veterans General Hospital, Taichung, Taiwan. · Chiang Mai University, Chiang Mai, Thailand. · Hospital General de Mexico, Mexico City, Mexico. · Boston University School of Medicine, Boston, Massachusetts. · Boston University School of Medicine, Boston, Massachusetts, and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Diakonhjemmet Hospital, Oslo, Norway. · Research Institute of Rheumatology of Russia, Moscow, Russia. · University of the Basque Country, Cruces University Hospital, and Biocruces Health Research Institute, Vizcaya, Spain. · University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy. · Mater Misericordiae University Hospital, Dublin, Ireland. · University of Otago, Christchurch, New Zealand. · Westfries Gasthuis, Hoorn, The Netherlands. · Rigshospitalet Glostrup, Copenhagen, Denmark. · Hospital General Universitario Elda, Elda, Spain. · University of Wellington, Wellington, New Zealand. ·Arthritis Rheumatol · Pubmed #29161469.

ABSTRACT: OBJECTIVE: To perform external validation of a provisional definition of disease flare in patients with gout. METHODS: Five hundred nine patients with gout were enrolled in a cross-sectional study during a routine clinical care visit at 17 international sites. Data were collected to classify patients as experiencing or not experiencing a gout flare, according to a provisional definition. A local expert rheumatologist performed the final independent adjudication of gout flare status. Sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curves were used to determine the diagnostic performance of gout flare definitions. RESULTS: The mean ± SD age of the patients was 57.5 ± 13.9 years, and 89% were male. The definition requiring fulfillment of at least 3 of 4 criteria (patient-defined gout flare, pain at rest score of >3 on a 0-10-point numerical rating scale, presence of at least 1 swollen joint, and presence of at least 1 warm joint) was 85% sensitive and 95% specific in confirming the presence of a gout flare, with an accuracy of 92%. The ROC area under the curve was 0.97. The definition based on a classification and regression tree algorithm (entry point, pain at rest score >3, followed by patient-defined flare "yes") was 73% sensitive and 96% specific. CONCLUSION: The definition of gout flare that requires fulfillment of at least 3 of 4 patient-reported criteria is now validated to be sensitive, specific, and accurate for gout flares, as demonstrated using an independent large international patient sample. The availability of a validated gout flare definition will improve the ascertainment of an important clinical outcome in studies of gout.

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

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

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

12 Article Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard. 2017

Ogdie, Alexis / Taylor, William J / Neogi, Tuhina / Fransen, Jaap / Jansen, Tim L / Schumacher, H Ralph / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Eliseev, Maxim / McCarthy, Geraldine / Stamp, Lisa K / Perez-Ruiz, Fernando / Sivera, Francisca / Ea, Hang-Korng / Gerritsen, Martijn / Cagnotto, Giovanni / Cavagna, Lorenzo / Lin, Chingtsai / Chou, Yin-Yi / Tausche, Anne-Kathrin / Lima Gomes Ochtrop, Manuella / Janssen, Matthijs / Chen, Jiunn-Horng / Slot, Ole / Lazovskis, Juris / White, Douglas / Cimmino, Marco A / Uhlig, Till / Dalbeth, Nicola. ·University of Pennsylvania, Philadelphia. · University of Otago, Wellington, New Zealand. · Boston University School of Medicine, Boston, Massachusetts. · VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands. · Chiang Mai University, Chiang Mai, Thailand. · Hospital General de México, Mexico City, Mexico. · Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia. · University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland. · University of Otago Christchurch, Christchurch, New Zealand. · Hospital Universitario Cruces, BioCruces Health Research Institute, and Basque Country University, Barakaldo, Spain. · Hospital General Universitario de Elda, Alicante, Spain. · Université Paris Diderot, INSERM UMR 1132 and Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France. · Westfries Gasthuis, Hoorn, The Netherlands. · University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy, and Skane University Hospital Malmö/Lund, Lund, Sweden. · University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy. · Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China. · University Hospital Carl Gustav Carus, Dresden, Germany. · Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Rijnstate Hospital, Arnhem, The Netherlands. · China Medical University Hospital, Taichung, Taiwan, Republic of China. · Copenhagen University Hospital Glostrup, Glostrup, Denmark. · Riverside Professional Centre, Sydney, Nova Scotia, Canada. · Waikato District Health Board and Waikato Clinical School, Hamilton, New Zealand. · University of Genoa, Genoa, Italy. · Diakonhjemmet Hospital, Oslo, Norway. · University of Auckland, Auckland, New Zealand. ·Arthritis Rheumatol · Pubmed #27748084.

ABSTRACT: OBJECTIVE: To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS: We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS: US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION: US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.

13 Article Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard. 2016

Dalbeth, Nicola / Schumacher, H Ralph / Fransen, Jaap / Neogi, Tuhina / Jansen, Tim L / Brown, Melanie / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Eliseev, Maxim / McCarthy, Geraldine / Stamp, Lisa K / Perez-Ruiz, Fernando / Sivera, Francisca / Ea, Hang-Korng / Gerritsen, Martijn / Scire, Carlo A / Cavagna, Lorenzo / Lin, Chingtsai / Chou, Yin-Yi / Tausche, Anne-Kathrin / da Rocha Castelar-Pinheiro, Geraldo / Janssen, Matthijs / Chen, Jiunn-Horng / Cimmino, Marco A / Uhlig, Till / Taylor, William J. ·University of Auckland, Auckland, New Zealand. · University of Pennsylvania, Philadelphia. · Radboud University Medical Centre, Nijmegen, The Netherlands. · Boston University School of Medicine, Boston, Massachusetts. · Viecuri Medical Center, Venlo, The Netherlands. · University of Otago, Wellington, New Zealand. · Chiang Mai University, Chiang Mai, Thailand. · Hospital General de Mexico, Mexico City, Mexico. · Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia. · Geraldine McCarthy, MD, FRCPI, University College Dublin School of Medicine and Medical Science, Dublin, Ireland. · University of Otago, Christchurch, New Zealand. · Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain. · Hospital General Universitario de Elda, Alicante, Spain. · Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, INSERM, UMR 1132, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Hôpital Lariboisière, Paris, France. · Westfries Gasthuis, Hoorn, The Netherlands. · Carlo A. Scire, MD, PhD, Italian Society for Rheumatology, Milan, Italy. · University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy. · Taichung Veterans General Hospital, Taichung, Taiwan. · University Hospital Carl Gustav Carus, Dresden, Germany. · Universidade de Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Rijnstate Hospital, Arnhem, The Netherlands. · China Medical University School of Medicine, Taichung, Taiwan. · University of Genoa, Genoa, Italy. · Diakonhjemmet Hospital, Oslo, Norway. ·Arthritis Care Res (Hoboken) · Pubmed #27014846.

ABSTRACT: OBJECTIVE: To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. METHODS: Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard. RESULTS: For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%). CONCLUSION: A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.

14 Article Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated. 2016

Taylor, William J / Fransen, Jaap / Dalbeth, Nicola / Neogi, Tuhina / Ralph Schumacher, H / Brown, Melanie / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Eliseev, Maxim / McCarthy, Geraldine / Stamp, Lisa K / Perez-Ruiz, Fernando / Sivera, Francisca / Ea, Hang-Korng / Gerritsen, Martijn / Scire, Carlo A / Cavagna, Lorenzo / Lin, Chingtsai / Chou, Yin-Yi / Tausche, Anne-Kathrin / da Rocha Castelar-Pinheiro, Geraldo / Janssen, Matthijs / Chen, Jiunn-Horng / Slot, Ole / Cimmino, Marco / Uhlig, Till / Jansen, Tim L. ·From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In ·J Rheumatol · Pubmed #26628602.

ABSTRACT: OBJECTIVE: To determine the frequency of adverse events of diagnostic arthrocentesis in patients with possible gout. METHODS: Consecutive patients underwent arthrocentesis and were evaluated at 6 weeks to determine adverse events. The 95% CI were obtained by bootstrapping. RESULTS: Arthrocentesis was performed in 910 patients, and 887 (97.5%) were evaluated for adverse events. Any adverse event was observed in 12 participants (1.4%, 95% CI 0.6-2.1). There was 1 case (0.1%, 95% CI 0-0.34) of septic arthritis. CONCLUSIONS: Diagnostic arthrocentesis is associated with a low frequency of adverse events. Septic arthritis rarely occurs.

15 Article Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. 2016

de Lautour, Hugh / Taylor, William J / Adebajo, Ade / Alten, Rieke / Burgos-Vargas, Ruben / Chapman, Peter / Cimmino, Marco A / da Rocha Castelar Pinheiro, Geraldo / Day, Ric / Harrold, Leslie R / Helliwell, Philip / Janssen, Matthijs / Kerr, Gail / Kavanaugh, Arthur / Khanna, Dinesh / Khanna, Puja P / Lin, Chingtsai / Louthrenoo, Worawit / McCarthy, Geraldine / Vazquez-Mellado, Janitzia / Mikuls, Ted R / Neogi, Tuhina / Ogdie, Alexis / Perez-Ruiz, Fernando / Schlesinger, Naomi / Ralph Schumacher, H / Scirè, Carlo A / Singh, Jasvinder A / Sivera, Francisca / Slot, Ole / Stamp, Lisa K / Tausche, Anne-Kathrin / Terkeltaub, Robert / Uhlig, Till / van de Laar, Mart / White, Douglas / Yamanaka, Hisashi / Zeng, Xuejun / Dalbeth, Nicola. ·Auckland District Health Board, Auckland, New Zealand. · University of Otago, Wellington, New Zealand. · University of Sheffield, Sheffield, UK. · Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany. · Hospital General de México, Mexico City, Mexico. · Christchurch Hospital, Christchurch, New Zealand. · Università di Genova, Genova, Italy. · Pedro Ernesto University Hospital, Rio de Janeiro, Brazil. · University of New South Wales and St Vincent's Hospital, Sydney, Australia. · University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Rijnstate Hospital, Arnhem, The Netherlands. · Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC. · University of California School of Medicine, San Diego. · University of Michigan, Ann Arbor. · University of Michigan and Ann Arbor VA Medical Center, Ann Arbor. · Taichung Veteran's General Hospital, Taichung, Taiwan. · Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Mater Misericordiae University Hospital and University College, Dublin, Ireland. · Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha. · Boston University School of Medicine, Boston, Massachusetts. · University of Pennsylvania, Philadelphia. · Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain. · Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. · IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy. · University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham. · Hospital General Universitario Elda, Elda, Spain. · Copenhagen University Hospital Glostrup, Glostrup, Denmark. · University of Otago, Christchurch, New Zealand. · University Hospital Carl Gustav Carus, Dresden, Germany. · University of California San Diego VA Medical Center, La Jolla. · National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Universiteit Twente, Erschede, The Netherlands. · Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand. · Tokyo Women's Medical University, Tokyo, Japan. · Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China. · University of Auckland and Auckland District Health Board, Auckland, New Zealand. ·Arthritis Care Res (Hoboken) · Pubmed #26414176.

ABSTRACT: OBJECTIVE: To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS: Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS: There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION: These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.

16 Article Performance of classification criteria for gout in early and established disease. 2016

Taylor, William J / Fransen, Jaap / Dalbeth, Nicola / Neogi, Tuhina / Schumacher, H Ralph / Brown, Melanie / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Eliseev, Maxim / McCarthy, Geraldine / Stamp, Lisa K / Perez-Ruiz, Fernando / Sivera, Francisca / Ea, Hang-Korng / Gerritsen, Martijn / Scire, Carlo / Cavagna, Lorenzo / Lin, Chingtsai / Chou, Yin-Yi / Tausche, Anne-Kathrin / da Rocha Castelar-Pinheiro, Geraldo / Janssen, Matthijs / Chen, Jiunn-Horng / Slot, Ole / Cimmino, Marco / Uhlig, Till / Jansen, Tim L. ·Department of Medicine, University of Otago, Wellington, New Zealand. · Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA. · VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Servicio de Reumatología, Hospital General de México, México City, México. · Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia. · School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland. · Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand. · Rheumatology Division, Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain. · Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain. · University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France INSERM, UMR 1132, Hôpital Lariboisière, Paris, France Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, 2, Rue Ambroise Paré, Paris, France. · Department of Rheumatology, Amsterdam Rheumatology Immunology Center (ARC), Westfries Gasthuis, Hoorn, the Netherlands. · Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy. · Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy. · Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC. · Taichung Veterans' General Hospital, Taichung, Taiwan, ROC. · Division of Rheumatology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany. · Division of Rheumatology, Department of Internal Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil. · Department of Rheumatology, Rijnstate Hospital, Arnhem, the Netherlands. · School of Medicine, China Medical University, Taichung, Taiwan, ROC Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC. · Centre of Rheumatology and Spine Disorders, Copenhagen University Hospital Glostrup, Glostrup, Denmark. · Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy. · National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Vinderen, Oslo, Norway. ·Ann Rheum Dis · Pubmed #25351521.

ABSTRACT: OBJECTIVES: To compare the sensitivity and specificity of different classification criteria for gout in early and established disease. METHODS: This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less. RESULTS: Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease. CONCLUSIONS: Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

17 Article Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout. 2015

Taylor, William J / Fransen, Jaap / Jansen, Tim L / Dalbeth, Nicola / Schumacher, H Ralph / Brown, Melanie / Louthrenoo, Worawit / Vazquez-Mellado, Janitzia / Eliseev, Maxim / McCarthy, Geraldine / Stamp, Lisa K / Perez-Ruiz, Fernando / Sivera, Francisca / Ea, Hang-Korng / Gerritsen, Martijn / Scire, Carlo / Cavagna, Lorenzo / Lin, Chingtsai / Chou, Yin-Yi / Tausche, Anne Kathrin / Vargas-Santos, Ana Beatriz / Janssen, Matthijs / Chen, Jiunn-Horng / Slot, Ole / Cimmino, Marco A / Uhlig, Till / Neogi, Tuhina. ·University of Otago, Wellington, New Zealand. · Radboud University Medical Centre, Nijmegen, The Netherlands. · University of Auckland, Auckland, New Zealand. · University of Pennsylvania and VA Medical Center, Philadelphia. · Chiang Mai University, Chiang Mai, Thailand. · Hospital General de México, Mexico City, Mexico. · Nasonova Research Institute of Rheumatology, Moscow, Russia. · University College, Mater Misericordiae University Hospital, Dublin, Ireland. · University of Otago Christchurch, Christchurch, New Zealand. · Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya, Spain. · Hospital General Universitario de Elda, Alicante, Spain. · University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, INSERM, UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France. · Amsterdam Rheumatology Immunology Center, Westfries Gasthuis, Hoorn, The Netherlands. · Italian Society for Rheumatology, Milan, Italy. · University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy. · Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. · Taichung Veterans' General Hospital, Taichung, Taiwan. · University Hospital Carl Gustav Carus, Dresden, Germany. · Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Rijnstate Hospital, Arnhem, The Netherlands. · China Medical University and China Medical University Hospital, Taichung, Taiwan. · Copenhagen University Hospital, Glostrup, Denmark. · University of Genoa, Genoa, Italy. · Diakonhjemmet Hospital, Oslo, Norway. · Boston University School of Medicine, Boston, Massachusetts. ·Arthritis Care Res (Hoboken) · Pubmed #25777045.

ABSTRACT: OBJECTIVE: To determine which clinical, laboratory, and imaging features most accurately distinguished gout from non-gout. METHODS: We performed a cross-sectional study of consecutive rheumatology clinic patients with ≥1 swollen joint or subcutaneous tophus. Gout was defined by synovial fluid or tophus aspirate microscopy by certified examiners in all patients. The sample was randomly divided into a model development (two-thirds) and test sample (one-third). Univariate and multivariate association between clinical features and monosodium urate-defined gout was determined using logistic regression modeling. Shrinkage of regression weights was performed to prevent overfitting of the final model. Latent class analysis was conducted to identify patterns of joint involvement. RESULTS: In total, 983 patients were included. Gout was present in 509 (52%). In the development sample (n = 653), the following features were selected for the final model: joint erythema (multivariate odds ratio [OR] 2.13), difficulty walking (multivariate OR 7.34), time to maximal pain <24 hours (multivariate OR 1.32), resolution by 2 weeks (multivariate OR 3.58), tophus (multivariate OR 7.29), first metatarsophalangeal (MTP1) joint ever involved (multivariate OR 2.30), location of currently tender joints in other foot/ankle (multivariate OR 2.28) or MTP1 joint (multivariate OR 2.82), serum urate level >6 mg/dl (0.36 mmoles/liter; multivariate OR 3.35), ultrasound double contour sign (multivariate OR 7.23), and radiograph erosion or cyst (multivariate OR 2.49). The final model performed adequately in the test set, with no evidence of misfit, high discrimination, and predictive ability. MTP1 joint involvement was the most common joint pattern (39.4%) in gout cases. CONCLUSION: Ten key discriminating features have been identified for further evaluation for new gout classification criteria. Ultrasound findings and degree of uricemia add discriminating value, and will significantly contribute to more accurate classification criteria.

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

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

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

19 Article A delphi exercise to identify characteristic features of gout - opinions from patients and physicians, the first stage in developing new classification criteria. 2013

Prowse, Rebecca L / Dalbeth, Nicola / Kavanaugh, Arthur / Adebajo, Adewale O / Gaffo, Angelo L / Terkeltaub, Robert / Mandell, Brian F / Suryana, Bagus P P / Goldenstein-Schainberg, Claudia / Diaz-Torne, Cèsar / Khanna, Dinesh / Lioté, Frederic / Mccarthy, Geraldine / Kerr, Gail S / Yamanaka, Hisashi / Janssens, Hein / Baraf, Herbert F / Chen, Jiunn-Horng / Vazquez-Mellado, Janitzia / Harrold, Leslie R / Stamp, Lisa K / Van De Laar, Mart A / Janssen, Matthijs / Doherty, Michael / Boers, Maarten / Edwards, N Lawrence / Gow, Peter / Chapman, Peter / Khanna, Puja / Helliwell, Philip S / Grainger, Rebecca / Schumacher, H Ralph / Neogi, Tuhina / Jansen, Tim L / Louthrenoo, Worawit / Sivera, Francisca / Taylor, William J / Alten, Rieke. ·University of Otago, Dunedin, New Zealand. ·J Rheumatol · Pubmed #23418379.

ABSTRACT: OBJECTIVE: To identify a comprehensive list of features that might discriminate between gout and other rheumatic musculoskeletal conditions, to be used subsequently for a case-control study to develop and test new classification criteria for gout. METHODS: Two Delphi exercises were conducted using Web-based questionnaires: one with physicians from several countries who had an interest in gout and one with patients from New Zealand who had gout. Physicians rated a list of potentially discriminating features that were identified by literature review and expert opinion, and patients rated a list of features that they generated themselves. Agreement was defined by the RAND/UCLA disagreement index. RESULTS: Forty-four experienced physicians and 9 patients responded to all iterations. For physicians, 71 items were identified by literature review and 15 more were suggested by physicians. The physician survey showed agreement for 26 discriminatory features and 15 as not discriminatory. The patients identified 46 features of gout, for which there was agreement on 25 items as being discriminatory and 7 items as not discriminatory. CONCLUSION: Patients and physicians agreed upon several key features of gout. Physicians emphasized objective findings, imaging, and patterns of symptoms, whereas patients emphasized severity, functional results, and idiographic perception of symptoms.

20 Article Developing a provisional definition of flare in patients with established gout. 2012

Gaffo, Angelo L / Schumacher, H Ralph / Saag, Kenneth G / Taylor, William J / Dinnella, Janet / Outman, Ryan / Chen, Lang / Dalbeth, Nicola / Sivera, Francisca / Vázquez-Mellado, Janitzia / Chou, Chung-Tei / Zeng, Xuejun / Perez-Ruiz, Fernando / Kowalski, Sergio C / Goldenstein-Schainberg, Claudia / Chen, Lan / Bardin, Thomas / Singh, Jasvinder A. ·Birmingham VA Medical Center and University of Alabama at Birmingham, AL, USA. ·Arthritis Rheum · Pubmed #22083456.

ABSTRACT: OBJECTIVE: Various nonvalidated criteria for disease flare have been used in studies of gout. Our objective was to develop empirical definitions for a gout flare from patient-reported features. METHODS: Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of the number of criteria independently associated with the flare and classification and regression tree approaches were developed. RESULTS: The mean ± SD age of the study participants was 56.2 ± 15 years, 207 of them (98%) were men, and 54 of them (26%) had flares of gout. The presence of any patient-reported warm joint, any patient-reported swollen joint, patient-reported pain at rest score of >3 (0-10 scale), and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91% and specificity 82%). Requiring all 4 criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest with a score of >3, followed by patient self-reported flare, as the rule associated with the gold standard (sensitivity 83% and specificity 90%). CONCLUSION: We propose definitions for a disease flare based on self-reported items in patients previously diagnosed as having gout. Patient-reported flare, joint pain at rest, warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.

21 Article Progress in measurement instruments for acute and chronic gout studies. 2009

Grainger, Rebecca / Taylor, William J / Dalbeth, Nicola / Perez-Ruiz, Fernando / Singh, Jasvinder A / Waltrip, Royce W / Schlesinger, Naomi / Evans, Robert / Edwards, N Lawrence / Sivera, Francisca / Diaz-Torne, Cesar / MacDonald, Patricia A / McQueen, Fiona M / Schumacher, H Ralph. ·Department of Medicine, University of Otago, and the Malaghan Institute of Medical Research, Wellington 6242, New Zealand. ·J Rheumatol · Pubmed #19820224.

ABSTRACT: Consensus exercises have identified and prioritized domains of measurement for studies in acute and chronic gout. In parallel, the technical properties of instruments for measurement in many of these domains have been assessed, with the main objective to consider the instruments in the context of the OMERACT filter of truth, discrimination, and feasibility. These data were presented and discussed at OMERACT 9 in the gout workshop, in breakout groups, and at informal meetings of the gout group. In acute gout, instruments for domains of pain, joint swelling, joint tenderness, and patient and physician global assessment have been assessed. In chronic gout, some validation exercises have been performed in instruments for domains serum urate, tophus measurement, health-related quality of life (HRQOL). In voting at OMERACT 9, the Medical Outcomes Study Short-Form 36 was endorsed as a valid instrument for measurement of HRQOL. Methods of tophus measurement were considered to have met some criteria of the OMERACT filter, but these require further work, particularly regarding sensitivity to change over shorter time periods. Priorities for future research include measurement of joint inflammation in acute gout and disability in acute and chronic gout.

22 Article Outcome domains for studies of acute and chronic gout. 2009

Schumacher, H Ralph / Taylor, William / Edwards, Lawrence / Grainger, Rebecca / Schlesinger, Naomi / Dalbeth, Nicola / Sivera, Francisca / Singh, Jasvinder / Evans, Robert / Waltrip, Royce W / Diaz-Torne, Cesar / MacDonald, Patricia / McQueen, Fiona / Perez-Ruiz, Fernando. ·Rheumatology Section, Veterans Affairs Medical Center, University & Woodland Avenues, Philadelphia, Pennsylvania 19104, USA. schumacr@mail.med.upenn.edu ·J Rheumatol · Pubmed #19820223.

ABSTRACT: Discussion and voting at OMERACT 9 confirmed 5 essential domains for outcomes of acute gout: pain, joint swelling, joint tenderness, patient global assessment and activity limitations. For studies in chronic gout 7 essential domains are: serum urate, acute gout attacks, tophus burden, health-related quality of life, activity limitations, pain, and patient global assessment. Implications of patient perspectives, discretionary domains for specific studies, measurement instruments and a possible responder index are under study.

23 Minor Gout mimicking rheumatoid arthritis. 2016

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

ABSTRACT: -- No abstract --

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

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

ABSTRACT: -- No abstract --