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Gout: HELP
Articles by William J. Taylor
Based on 64 articles published since 2008
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Between 2008 and 2019, W. Taylor wrote the following 64 articles about Gout.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. 2012

Khanna, Dinesh / Khanna, Puja P / Fitzgerald, John D / Singh, Manjit K / Bae, Sangmee / Neogi, Tuhina / Pillinger, Michael H / Merill, Joan / Lee, Susan / Prakash, Shraddha / Kaldas, Marian / Gogia, Maneesh / Perez-Ruiz, Fernando / Taylor, Will / Lioté, Frédéric / Choi, Hyon / Singh, Jasvinder A / Dalbeth, Nicola / Kaplan, Sanford / Niyyar, Vandana / Jones, Danielle / Yarows, Steven A / Roessler, Blake / Kerr, Gail / King, Charles / Levy, Gerald / Furst, Daniel E / Edwards, N Lawrence / Mandell, Brian / Schumacher, H Ralph / Robbins, Mark / Wenger, Neil / Terkeltaub, Robert / Anonymous2310738. ·University of Michigan, Ann Arbor, MI, USA. ·Arthritis Care Res (Hoboken) · Pubmed #23024029.

ABSTRACT: -- No abstract --

2 Guideline 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. 2012

Khanna, Dinesh / Fitzgerald, John D / Khanna, Puja P / Bae, Sangmee / Singh, Manjit K / Neogi, Tuhina / Pillinger, Michael H / Merill, Joan / Lee, Susan / Prakash, Shraddha / Kaldas, Marian / Gogia, Maneesh / Perez-Ruiz, Fernando / Taylor, Will / Lioté, Frédéric / Choi, Hyon / Singh, Jasvinder A / Dalbeth, Nicola / Kaplan, Sanford / Niyyar, Vandana / Jones, Danielle / Yarows, Steven A / Roessler, Blake / Kerr, Gail / King, Charles / Levy, Gerald / Furst, Daniel E / Edwards, N Lawrence / Mandell, Brian / Schumacher, H Ralph / Robbins, Mark / Wenger, Neil / Terkeltaub, Robert / Anonymous2300738. ·University of Michigan, Ann Arbor, MI, USA. ·Arthritis Care Res (Hoboken) · Pubmed #23024028.

ABSTRACT: -- No abstract --

3 Review Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. 2017

Nielsen, Sabrina M / Bartels, Else M / Henriksen, Marius / Wæhrens, Eva E / Gudbergsen, Henrik / Bliddal, Henning / Astrup, Arne / Knop, Filip K / Carmona, Loreto / Taylor, William J / Singh, Jasvinder A / Perez-Ruiz, Fernando / Kristensen, Lars E / Christensen, Robin. ·The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. · Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen, Denmark. · The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark. · Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. · Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. · Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · Institutode Salud Musculoesquelética, Madrid, Spain. · Department of Medicine, University of Otago, Wellington, New Zealand. · Department of Medicine, University of Alabama at Birmingham, & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA. · Rheumatology Division, Hospital de Cruces, Baracaldo, Spain. ·Ann Rheum Dis · Pubmed #28866649.

ABSTRACT: OBJECTIVES: Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS: We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. CONCLUSIONS: The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42016037937.

4 Review Gout Classification Criteria: Update and Implications. 2016

Vargas-Santos, Ana Beatriz / Taylor, William J / Neogi, Tuhina. ·Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, X building, Suite 200, 650 Albany Street, Boston, MA, 02118, USA. · Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. · Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, X building, Suite 200, 650 Albany Street, Boston, MA, 02118, USA. tneogi@bu.edu. ·Curr Rheumatol Rep · Pubmed #27342957.

ABSTRACT: Gout is the most common inflammatory arthritis, with a rising prevalence and incidence worldwide. There has been a resurgence in gout research, fueled, in part, by a number of advances in pharmacologic therapy for gout. The conduct of clinical trials and other observational research in gout requires a standardized and validated means of assembling well-defined groups of patients with gout for such research purposes. Recently, an international collaborative effort that involved a data-driven process with state-of-the art methodology supported by the American College of Rheumatology and the European League Against Rheumatism led to publication of new gout classification criteria.

5 Review Imaging as a potential outcome measure in gout studies: A systematic literature review. 2016

Durcan, Laura / Grainger, Rebecca / Keen, Helen I / Taylor, William J / Dalbeth, Nicola. ·Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument St, Baltimore, MD 21287. Electronic address: ldurcan1@jhmi.edu. · Department of Medicine, University of Otago, Wellington, New Zealand. · University of Western Australia, Perth, Australia. · Division of Medicine, University of Auckland, Auckland, New Zealand. ·Semin Arthritis Rheum · Pubmed #26522139.

ABSTRACT: OBJECTIVE: Despite major progress in the imaging of gout, it is unclear which domains these techniques can evaluate and whether imaging modalities have the potential to provide valid outcome measures. The aim of this study was to assess the use of imaging instruments in gout according to the Outcomes in Rheumatology Clinical Trials (OMERACT) filter to inform the development of imaging as an outcome measure. METHODS: A systematic literature search of imaging modalities for gout was undertaken. Articles were assessed by two reviewers to identify imaging domains and summarize information according to the OMERACT filter. RESULTS: The search identified 78 articles (one abstract). Modalities included were conventional radiography (CR) (16 articles), ultrasound (US) (29), conventional computed tomography (CT) (11), dual energy computed tomography (DECT) (20), and magnetic resonance imaging (MRI) (16). Three domains were identified as follows: urate deposition, joint damage, and inflammation. Although sufficient data were available to assess feasibility, validity, and reliability, comprehensive assessment of discrimination was not possible due to the paucity of prospective imaging studies. CR is widely accessible, inexpensive with a validated damage scoring system. US and MRI offer radiation-free methods of evaluating urate deposition, damage and inflammation, but may be limited by accessibility. DECT provides excellent definition of urate deposition and bone damage, but has restricted availability and requires radiation. CONCLUSIONS: Imaging methods can detect urate deposition, damage, and inflammation in gout. More than one modality may be required depending on the domains and therapeutic agent of interest. No single imaging method currently fulfils all aspects of the OMERACT filter for any domain.

6 Review Imaging as an Outcome Measure in Gout Studies: Report from the OMERACT Gout Working Group. 2015

Grainger, Rebecca / Dalbeth, Nicola / Keen, Helen / Durcan, Laura / Lawrence Edwards, N / Perez-Ruiz, Fernando / Diaz-Torne, Cesar / Singh, Jasvinder A / Khanna, Dinesh / Simon, Lee S / Taylor, William J. ·From the Department of Medicine, University of Otago Wellington, Wellington; Department of Medicine, University of Auckland, New Zealand; Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Medicine, University of Florida, Gainesville, Florida, USA; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Division of Rheumatology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan; SDG LLC, Cambridge, Massachusetts, USA.R. Grainger, PhD, FRACP, Senior Lecturer, Rheumatologist, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Associate Professor, Department of Medicine, University of Auckland; L. Durcan, Rheumatology Fellow, MD, Mater Misericordiae University Hospital; H. Keen, PhD, Associate Professor, School of Medicine and Pharmacology, University of Western Australia; N.L. Edwards, MD, Professor of Medicine, Department of Medicine, University of Florida; F. Perez-Ruiz, MD, Professor, Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute; C. Diaz-Torne, PhD, Associate Professor and Rheumatologist; J.A. Singh, MBBS, MPH, Associate Professor of Medicine; Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham; D. Khanna, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Michigan; L.S. Simon, MD, Principal Advisor, SDG LLC; W.J. Taylor, PhD, FRACP, Associate Professor and Rheumatologist, Department of Medicine, University of Otago Wellington. ·J Rheumatol · Pubmed #25641895.

ABSTRACT: OBJECTIVE: The gout working group at the Outcome Measures in Rheumatology (OMERACT) 12 meeting in 2014 aimed to determine which imaging modalities show the most promise for use as measurement instruments for outcomes in studies of people with chronic gout and to identify the key foci for future research about the performance of these imaging techniques with respect to the OMERACT filter 2.0. METHODS: During the gout session, a systematic literature review of the data addressing imaging modalities including plain radiography (XR), conventional computed tomography (CT), dual-energy computed tomography (DECT), magnetic resonance imaging (MRI), and ultrasound (US) and the fulfillment of the OMERACT filter 2.0 was presented. RESULTS: The working group identified 3 relevant domains for imaging in gout studies: urate deposition (tophus burden), joint inflammation, and structural joint damage. CONCLUSION: The working group prioritized gaps in the data and identified a research agenda.

7 Review Imaging modalities for the classification of gout: systematic literature review and meta-analysis. 2015

Ogdie, Alexis / Taylor, William J / Weatherall, Mark / Fransen, Jaap / Jansen, Tim L / Neogi, Tuhina / Schumacher, H Ralph / Dalbeth, Nicola. ·Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Medicine, University of Otago, Wellington, New Zealand. · Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands. · Sections of Epidemiology and Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Medicine, University of Auckland, Auckland, New Zealand. ·Ann Rheum Dis · Pubmed #24915980.

ABSTRACT: BACKGROUND: Although there has been major progress in gout imaging, no gout classification criteria currently include advanced imaging techniques. OBJECTIVE: To examine the usefulness of imaging modalities in the classification of gout when compared to monosodium urate (MSU) crystal confirmation as the gold standard, in order to inform development of new gout classification criteria. METHODS: We systematically reviewed the published literature concerning the diagnostic performance of plain film radiography, MRI, ultrasound (US), conventional CT and dual energy CT (DECT). Only studies with MSU crystal confirmation as the gold standard were included. When more than one study examined the same imaging feature, the data were pooled and summary test characteristics were calculated. RESULTS: 11 studies (9 manuscripts and 2 meeting abstracts) satisfied the inclusion criteria. All were set in secondary care, with mean gout disease duration of at least 7 years. Three features were examined in more than one study: the double contour sign (DCS) on US, tophus on US, and MSU crystal deposition on DECT. The pooled (95% CI) sensitivity and specificity of US DCS were 0.83 (0.72 to 0.91) and 0.76 (0.68 to 0.83), respectively; of US tophus, were 0.65 (0.34 to 0.87) and 0.80 (0.38 to 0.96), respectively; and of DECT, were 0.87 (0.79 to 0.93) and 0.84 (0.75 to 0.90), respectively. CONCLUSIONS: US and DECT show promise for gout classification but the few studies to date have mostly been in patients with longstanding, established disease. The contribution of imaging over clinical features for gout classification criteria requires further examination.

8 Review The emerging role of biotechnological drugs in the treatment of gout. 2014

Cavagna, L / Taylor, W J. ·Division of Rheumatology, University and IRCCS Policlinico S.Matteo Foundation, Viale Golgi 2, 27100 Pavia, Italy. · Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington 6242, New Zealand. ·Biomed Res Int · Pubmed #24839602.

ABSTRACT: One of the most important therapeutic advances obtained in the field of rheumatology is the availability of the so-called bio(techno)logical drugs, which have deeply changed treatment perspectives in diseases such as rheumatoid arthritis and ankylosing spondylitis. According to the steadily increasing attention on gout, due to well-established prognostic and epidemiology implications, in the last 5 years, the same change of perspective has been observed also for this disease. In fact, several bio(techno)logical agents have been investigated both for the management of the articular gout symptoms, targeting mainly interleukin-1 β , as well as urate-lowering therapies such as recombinant uricases. Among the IL-1 β inhibitors, the majority of studies involve drugs such as anakinra, canakinumab, and rilonacept, but other compounds are under development. Moreover, other potential targets have been suggested, as, for example, the TNF alpha and IL-6, even if data obtained are less robust than those of IL-1 β inhibitors. Regarding urate-lowering therapies, the recombinant uricases pegloticase and rasburicase clearly showed their effectiveness in gout patients. Also in this case, new compounds are under development. The aim of this review is to focus on the various aspects of different bio(techno)logical drugs in gouty patients.

9 Review Outcome measures in acute gout: a systematic literature review. 2014

Dalbeth, Nicola / Zhong, Cathy S / Grainger, Rebecca / Khanna, Dinesh / Khanna, Puja P / Singh, Jasvinder A / McQueen, Fiona M / Taylor, William J. ·From the Department of Medicine, University of Auckland, Auckland; Department of Medicine, University of Otago, Wellington, New Zealand; Division of Rheumatology, University of Michigan, Ann Arbor, Michigan; and Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama, USA. ·J Rheumatol · Pubmed #24334652.

ABSTRACT: OBJECTIVE: Five core domains have been endorsed by Outcome Measures in Rheumatology (OMERACT) for acute gout: pain, joint swelling, joint tenderness, patient global assessment, and activity limitation. We evaluated instruments for these domains according to the OMERACT filter: truth, feasibility, and discrimination. METHODS: A systematic search strategy for instruments used to measure the acute gout core domains was formulated. For each method, articles were assessed by 2 reviewers to summarize information according to the specific components of the OMERACT filter. RESULTS: Seventy-seven articles and abstracts met the inclusion criteria. Pain was most frequently reported (76 studies, 20 instruments). The pain instruments used most often were 100 mm visual analog scale (VAS) and 5-point Likert scale. Both methods have high feasibility, face and content validity, and within- and between-group discrimination. Four-point Likert scales assessing index joint swelling and tenderness have been used in numerous acute gout studies; these instruments are feasible, with high face and content validity, and show within- and between-group discrimination. Five-point Patient Global Assessment of Response to Treatment (PGART) scales are feasible and valid, and show within- and between-group discrimination. Measures of activity limitations were infrequently reported, and insufficient data were available to make definite assessments of the instruments for this domain. CONCLUSION: Many different instruments have been used to assess the acute gout core domains. Pain VAS and 5-point Likert scales, 4-point Likert scales of index joint swelling and tenderness and 5-point PGART instruments meet the criteria for the OMERACT filter.

10 Review New classification criteria for gout: a framework for progress. 2013

Dalbeth, Nicola / Fransen, Jaap / Jansen, Tim L / Neogi, Tuhina / Schumacher, H Ralph / Taylor, William J. ·Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand. n.dalbeth@auckland.ac.nz. ·Rheumatology (Oxford) · Pubmed #23611919.

ABSTRACT: The definitive classification or diagnosis of gout normally relies upon the identification of MSU crystals in SF or from tophi. Where microscopic examination of SF is not available or is impractical, the best approach may differ depending upon the context. For many types of research, clinical classification criteria are necessary. The increasing prevalence of gout, advances in therapeutics and the development of international research collaborations to understand the impact, mechanisms and optimal treatment of this condition emphasize the need for accurate and uniform classification criteria for gout. Five clinical classification criteria for gout currently exist. However, none of the currently available criteria has been adequately validated. An international project is currently under way to develop new validated gout classification criteria. These criteria will be an essential step forward to advance the research agenda in the modern era of gout management.

11 Review Systematic review of the prevalence of gout and hyperuricaemia in Australia. 2012

Robinson, P C / Taylor, W J / Merriman, T R. ·University of Queensland Diamantina Institute Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia University of Otago, Wellington Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt Department of Biochemistry, University of Otago, Dunedin, New Zealand. ·Intern Med J · Pubmed #24020339.

ABSTRACT: AIMS: Gout is a growing health problem worldwide especially in affluent countries, such as Australia. Gout and hyperuricaemia are associated with the metabolic syndrome, diabetes mellitus, obesity and hypertension. More importantly, Australia has a growing prevalence of these important health problems. The aim of this study was to systematically review published information regarding the prevalence of gout and hyperuricaemia in Australia. METHODS: A systematic search was undertaken of the MEDLINE, EMBASE and Web of Science databases, as well as relevant websites for journal articles and reports relating to the prevalence of hyperuricaemia and gout in Australia. RESULTS: Twenty-five journal articles and five reports were included in the review. Data collected in a standardised way show gout increased in prevalence from 0.5% population prevalence to 1.7% population prevalence from 1968 to 1995/1996. There has been a significant rise in the prevalence of gout in the Australian Aboriginal population from 0% in 1965 to 9.7% in men and 2.9% in women in 2002. Consistent with the rise in gout prevalence, serum uric acid in blood donors has increased from 1959 to 1980 (17% in 30- to 40-year-old men). CONCLUSIONS: The rate of gout and hyperuricaemia in Australia is high in relation to comparable countries and is increasing. The prevalence of gout in elderly male Australians is second only to New Zealand, which has the highest reported rate in the world. Further research on Aboriginal and Torres Strait Islander gout and hyperuricaemia is required as a result of the lack of contemporary data.

12 Review Gout measures: Gout Assessment Questionnaire (GAQ, GAQ2.0), and physical measurement of tophi. 2011

Taylor, William J. ·University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand. will.taylor@otago.ac.nz ·Arthritis Care Res (Hoboken) · Pubmed #22588771.

ABSTRACT: -- No abstract --

13 Review Methods of tophus assessment in clinical trials of chronic gout: a systematic literature review and pictorial reference guide. 2011

Dalbeth, Nicola / Schauer, Cameron / Macdonald, Patricia / Perez-Ruiz, Fernando / Schumacher, H Ralph / Hamburger, Steve / Choi, Hyon K / McQueen, Fiona M / Doyle, Anthony / Taylor, William J. ·Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand. n.dalbeth@auckland.ac.nz ·Ann Rheum Dis · Pubmed #21216814.

ABSTRACT: OBJECTIVE: To identify methods of tophus measurement for gout studies, summarise the properties of these methods and compile a detailed pictorial reference guide to demonstrate the methods. METHODS: A systematic search strategy for methods of tophus measurement was formulated. For each method, papers were assessed by two reviewers to summarise information according to the specific components of the Outcomes Measures in Rheumatology (OMERACT) filter: feasibility, truth and discrimination. Detailed images were obtained to construct the reference guide. RESULTS: Eight methods of tophus measurement were identified: counting the total number of tophi, physical measurement using tape measure, physical measurement using Vernier callipers, digital photography, ultrasonography (US), MRI, CT and dual energy CT. Feasibility aspects of the methods are well documented. Physical measurement techniques are more feasible than advanced imaging methods, but do not allow for assessment of intra-articular tophi or for data storage and central reading. The truth aspect of the filter has been documented for many methods, particularly Vernier callipers, US, MRI and CT. Reliability of most methods has been reported as very good or excellent. Sensitivity to change has been reported for all methods except MRI and CT. CONCLUSION: A variety of methods of tophus assessment have been described for use in clinical trials of chronic gout. Physical measurement techniques (particularly the Vernier calliper method) and US measurement of tophus size appear to meet most aspects of the OMERACT filter.

14 Review Serum urate as a soluble biomarker in chronic gout-evidence that serum urate fulfills the OMERACT validation criteria for soluble biomarkers. 2011

Stamp, Lisa K / Zhu, Xiaoyu / Dalbeth, Nicola / Jordan, Sarah / Edwards, N Lawrence / Taylor, William. ·Department of Medicine, University of Otago, Christchurch, New Zealand. lisa.stamp@cdhb.govt.nz ·Semin Arthritis Rheum · Pubmed #21056459.

ABSTRACT: OBJECTIVES: To determine whether serum urate (SU) fulfills the Outcome measures in Rheumatology (OMERACT) soluble biomarker criteria. METHODS: The OMERACT soluble biomarker criteria were adapted for use in chronic gout. Potential outcome measures for use in chronic gout were identified. The literature was reviewed to determine which of the potential outcome measures were appropriate and whether there was evidence within the current literature to fulfill the OMERACT biomarker criteria. RESULTS: The assay for measurement of SU is reliable, internationally standardized, and readily accessible for use in clinical practice. The effects of sources of variability, including age, sex, ethnicity, circadian rhythms, body mass index, renal/hepatic function, and fasting, are well documented. Tophus regression was identified as appropriate structural outcome measure; however, given that not all patients have clinically apparent tophi, the number of gout flares is also identified as a key outcome measure. CONCLUSIONS: Serum urate fulfills all the OMERACT biomarker criteria with the exception of its effects on outcome measures. Further analysis of existing and new data sets to determine whether a reduction in SU predicts a reduction in gout flares, the number/size of tophi, and patient reported outcomes using validated measures for these outcomes are required.

15 Review Establishing outcome domains for evaluating treatment of acute and chronic gout. 2008

Grainger, Rebecca / Taylor, William J. ·Department of Medicine, Wellington School of Medicine & Health Sciences, University of Otago, Wellington 6242, New Zealand. ·Curr Opin Rheumatol · Pubmed #18349747.

ABSTRACT: PURPOSE OF REVIEW: Novel therapies for gout have recently been developed which has prompted considerable efforts in defining the relevant outcomes for measurement in intervention trials of gout. This review summarizes the consensus exercises refining domains for measurement and the work of individual groups in assessment of the validity of measurement tools for these domains. RECENT FINDINGS: Recent publications have focused on the consensus exercises and validation studies of measurement tools, particularly in relation to tophus size and imaging. SUMMARY: Consensus on potential outcome domains has been achieved, but measuring these domains requires further validation in observational studies and confirmation of relevance from people with gout. Further work is also required in refining measurements of tophus size and imaging scores. The role of a response criteria measure is also yet to be defined, especially in relation to reduction in flare frequency, or whether composite criteria are necessary.

16 Article The nomenclature of the basic disease elements of gout: A content analysis of contemporary medical journals. 2018

Bursill, David / Taylor, William J / Terkeltaub, Robert / Dalbeth, Nicola. ·Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand; Adelaide Medical School, University of Adelaide, Australia. · Department of Medicine, University of Otago, Wellington, New Zealand. · Veterans Affairs Medical Center, University of California, San Diego, CA. · Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand. Electronic address: n.dalbeth@auckland.ac.nz. ·Semin Arthritis Rheum · Pubmed #29706241.

ABSTRACT: OBJECTIVES: There is currently no standardised nomenclature for the basic disease elements of gout. This study aimed to identify these elements and examine how they are labelled in contemporary medical literature. METHODS: We analysed articles from the ten highest ranked general rheumatology journals, and five highest ranked general internal medicine journals (by Impact Factor, according to 2015 Thomson-Reuters Journal Citation Reports), published between 1 January 2012 and 31 January 2017. For each journal, articles relevant to gout and hyperuricaemia were identified by the search terms 'gout' and/or 'urate' and/or 'uric acid' using MEDLINE. Basic disease elements were identified and their labels extracted. Labels designated 'unique' used different words or phrases to describe an element. RESULTS: A total of 549 articles were analysed. Eleven basic disease elements and 343 unique labels were identified. Labelling was imprecise for most elements. 'An episode of acute inflammation triggered by the presence of pathogenic crystals' was represented by a total of 162 unique labels; 33.6% of articles referring to this element used at least four unique labels. For articles referencing 'the circulating form of the final enzymatic product generated by xanthine oxidase in purine metabolism in humans', the labels 'uric acid' and 'urate' were used with similar frequency (63.0% and 62.5%, respectively), and both labels were used in 25.9% of articles. CONCLUSION: Labelling of the basic disease elements of gout is characterised by imprecision, inaccuracy and lack of clarity. Consensus regarding the nomenclature of these elements is required.

17 Article Predictors of activity limitation in people with gout: a prospective study. 2018

Stewart, Sarah / Rome, Keith / Eason, Alastair / House, Meaghan E / Horne, Anne / Doyle, Anthony J / Knight, Julie / Taylor, William J / Dalbeth, Nicola. ·Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand. sarah.stewart@aut.ac.nz. · Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand. · Department of Radiology, Auckland District Health Board, Auckland, New Zealand. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Radiology with Anatomy, University of Auckland, Auckland, New Zealand. · Department of Medicine, University of Otago, Wellington, New Zealand. ·Clin Rheumatol · Pubmed #29680870.

ABSTRACT: The objective of the study was to determine clinical factors associated with activity limitation and predictors of a change in activity limitation after 1 year in people with gout. Two hundred ninety-five participants with gout (disease duration < 10 years) attended a baseline assessment which included medical and disease-specific history, pain visual analog score and plain radiographs scored for erosion and narrowing. Activity limitation was assessed using the Health Assessment Questionnaire-II (HAQ-II). After 1 year, participants were invited to complete a further HAQ-II; follow-up questionnaires were available for 182 participants. Fully saturated and stepwise regression analyses were used to determine associations between baseline characteristics and HAQ-II at baseline and 1 year, and to determine predictors of worsening HAQ-II in those with normal baseline scores. Median (range) baseline HAQ-II was 0.20 (0-2.50) and 0.20 (0-2.80) after 1 year of follow-up. Pain score was the strongest independent predictor of baseline HAQ-II, followed by radiographic narrowing score, type 2 diabetes, swollen joint count, BMI, age and urate (model R

18 Article Serum urate as surrogate endpoint for flares in people with gout: A systematic review and meta-regression analysis. 2018

Stamp, Lisa / Morillon, Melanie B / Taylor, William J / Dalbeth, Nicola / Singh, Jasvinder A / Lassere, Marissa / Christensen, Robin. ·Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch, New Zealand. Electronic address: lisa.stamp@cdhb.health.nz. · Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Denmark; Department of Medicine, Vejle Hospital, Denmark. · Department of Medicine, University of Otago, Wellington, New Zealand. · Department of Medicine, University of Auckland, New Zealand. · Department of Medicine, University of Alabama at Birmingham & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. · Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia. · Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. ·Semin Arthritis Rheum · Pubmed #29566967.

ABSTRACT: OBJECTIVES: The primary efficacy outcome in trials of urate lowering therapy (ULT) for gout is serum urate (SU). The aim of this study was to examine the strength of the relationship between SU and patient-important outcomes to determine whether SU is an adequate surrogate endpoint for clinical trials. METHODS: Multiple databases through October 2017 were searched. Randomized controlled trials comparing any ULT in people with gout with any control or placebo, ≥three months duration were included. Open label extension (OLE) trial data were included in secondary analyses. Standardized data elements were extracted independently by two reviewers. RESULTS: Ten RCTs and 3 OLE studies were identified. From the RCTs (maximum duration 24 months) meta-regression did not reveal an association between the relative risk of a gout flare and the difference in proportions of individuals with SU < 6mg/dL (P = 0.47; R CONCLUSIONS: Based on aggregate clinical trial-level data an association between SU and gout flare could not be confirmed. However, based on observational ecological study design data-including longer duration extension studies-SU < 6mg/dL was associated with reduced gout flares.

19 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.

20 Article Performance of the 2015 ACR-EULAR classification criteria for gout in a primary care population presenting with monoarthritis. 2017

Janssens, Hein J E M / Fransen, Jaap / Janssen, Matthijs / Neogi, Tuhina / Schumacher, H Ralph / Jansen, Tim L / Dalbeth, Nicola / Taylor, William J. ·Department of Primary and Community Care, Radboud University Medical Center, Nijmegen. · Department Family Physicians, Primary Healthcare Center Lobede, Lobith-Tolkamer. · Department of Rheumatology, Radboud University Medical Center, Nijmegen. · Department of Rheumatology, Rijnstate hospital, Arnhem, the Netherlands. · Department of Medicine, Boston University School of Medicine, Boston, MA. · Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands. · School of Medicine, University of Auckland, Auckland. · Department of Medicine, University of Otago, Wellington, New Zealand. ·Rheumatology (Oxford) · Pubmed #28431109.

ABSTRACT: Objective: To test the performance of the 2015 ACR-EULAR gout classification criteria against presence of SF MSU crystals in a primary healthcare population. Methods: The criteria were applied to an existing dataset of consecutive patients with monoarthritis presenting to Dutch family physicians; all patients underwent microscopic SF analysis by design. The data had been prospectively collected to develop a diagnostic decision rule for gout in 2010. Diagnostic performance was assessed by calculating area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and constructing calibration plots for the full version of the criteria (including SF analysis results of all patients) and the clinical-only version (not including SF analysis results). Performance of both versions was compared with the 2010 diagnostic rule. Results: Of 381 patients enrolled into the study, 216 (57%) were MSU crystal-positive. The full and clinical-only versions of the criteria had satisfactory area under the receiver operating characteristic curve (0.96 and 0.87, respectively), high specificity (0.98 and 0.84), high PPV (0.98 and 0.84), but lower sensitivity (0.68 and 0.68) and NPV (0.70 and 0.67). Specificity and PPV of both versions were higher compared with 0.71 and 0.89 of the 2010 diagnostic decision rule. The decison rule had the highest sensitivity and NPV (0.99 and 0.97). Conclusion: This study presents the first external validation of the 2015 ACR-EULAR gout classification criteria in a primary healthcare setting. The criteria perform well in this setting in patients presenting with monoarthritis for the purpose of enrolling into gout clinical trials.

21 Article Predictors of Mortality in People with Recent-onset Gout: A Prospective Observational Study. 2017

Vincent, Zoë L / Gamble, Greg / House, Meaghan / Knight, Julie / Horne, Anne / Taylor, William J / Dalbeth, Nicola. ·From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand. · Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland. · From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand. n.dalbeth@auckland.ac.nz. · Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland. n.dalbeth@auckland.ac.nz. ·J Rheumatol · Pubmed #27980010.

ABSTRACT: OBJECTIVE: To determine mortality rates and predictors of death at baseline in people with a recent onset of gout. METHODS: People with gout disease duration < 10 years were recruited from primary and secondary care settings. Comprehensive clinical assessment was completed at baseline. Participants were prospectively followed for at least 1 year. Information about death was systematically collected from primary and secondary health records. Standardized mortality ratios (SMR) were calculated and risk factors for mortality were analyzed using Cox proportional hazard regression models. RESULTS: The mean (SD) followup duration was 5.1 (1.6) years (a total 1511 patient-yrs accrued). Of the 295 participants, 43 (14.6%) had died at the time of censorship (SMR 1.96, 95% CI 1.44-2.62). In the reduced Cox proportional hazards model, these factors were independently associated with an increased risk of death from all causes: older age (70-80 yrs: HR 9.96, 95% CI 3.30-30.03; 80-91 yrs: HR 9.39, 95% CI 2.68-32.89), Māori or Pacific ethnicity (HR 2.48, 95% CI 1.17-5.29), loop diuretic use (HR 3.99, 95% CI 2.15-7.40), serum creatinine (per 10 CONCLUSION: People with gout disease duration < 10 years have an increased risk of death. The presence of subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.

22 Article Crystal identification of synovial fluid aspiration by polarized light microscopy. An online test suggesting that our traditional rheumatologic competence needs renewed attention and training. 2017

Berendsen, D / Neogi, T / Taylor, W J / Dalbeth, N / Jansen, T L. ·Department of Rheumatology, Ziekenhuisgroep Twente, Almelo, The Netherlands. d.berendsen@zgt.nl. · Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA. · Department of Medicine, University of Otago, POB 7343, Wellington, Wellington, 6039, New Zealand. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Department of Rheumatology, VieCuri MC, Venlo, The Netherlands. · Scientific IQ Healthcare RadboudUMC, Nijmegen, The Netherlands. ·Clin Rheumatol · Pubmed #27837341.

ABSTRACT: Testing a reading exercise for identification of several typical crystal such as the negatively birefringent needle-shaped crystals that are under polarized light microscopy is the gold standard for diagnosing gout. The objective of this study was to assess current performance of crystal identification by professionals involved in examining synovial fluid in routine care. Rheumatologists, trainees, lab technicians, and other physicians with an interest in crystal arthritis completed an online test. The test consisted of 30 images: 8 monosodium urate (MSU) crystals, 5 calcium pyrophosphate (CPP), 4 cholesterol, 2 depot methylprednisolone, 2 calcium oxalate, 2 rice bodies, 1 hydroxyapatite, 1 liquid lipid, 1 fibrin, 1 Charcot-Leyden, and 5 different artifacts. Of the 22 non-MSU slides, a subset of 8 was pre-designated that were thought to be clinically important to be identified as non-MSU. The primary outcome was defined as the correct identification of all eight MSU slides plus the identification of all eight pre-defined non-MSU slides as non-MSU. The online test was completed by 110 participants. The primary outcome was achieved by 39%. Correct identification of all MSU images was achieved by 81%, correct identification of all 8 pre-defined non-MSU, CPP images, and all 22 non-MSU images as non-MSU by 68, 68, and 23%, respectively. MSU crystals were well identified, but incorrect identification of non-MSU crystals occurred frequently. This study suggests that there is room for improvement regarding crystal identification of particularly CPP and other non-MSU crystals even in this highly motivated group.

23 Article Illness Perceptions and Mortality in Patients With Gout: A Prospective Observational Study. 2017

Serlachius, Anna / Gamble, Greg / House, Meaghan / Vincent, Zoe L / Knight, Julie / Horne, Anne / Taylor, William J / Petrie, Keith J / Dalbeth, Nicola. ·University of Auckland, Auckland, New Zealand. · University of Otago, Wellington, New Zealand. ·Arthritis Care Res (Hoboken) · Pubmed #27813363.

ABSTRACT: OBJECTIVE: To examine whether illness perceptions independently predict mortality in early-onset gout. METHODS: Between December 2006 and January 2014, a total of 295 participants with early-onset gout (<10 years) were recruited in Auckland and Wellington, New Zealand. The participants were followed up until February 2015, and mortality information was collected. Participants with complete data were included in the current study (n = 242). Cox proportional hazards models were used to examine the association between illness perceptions and mortality risk, after adjustment for covariates associated with disease severity and mortality in gout. RESULTS: In a Cox proportional hazards model adjusted for predictors of disease severity and mortality in gout (number of tophi, serum urate level, and frequency of flares), consequence beliefs, identity beliefs, concern beliefs, and emotional response to gout were associated with all-cause mortality (hazard ratios [HRs] 1.29, 1.15, 1.18, and 1.19, respectively; P < 0.05 for all). In the fully saturated model, the association between consequence beliefs and mortality remained robust after additional adjustment for ethnicity, disease duration, diuretic use, serum creatinine, and pain score (HR 1.18 [95% confidence interval 1.02-1.37]; P = 0.029). CONCLUSION: Negative beliefs about the impact of gout and severity of symptoms, as well as concerns about gout and the emotional response to gout, were independently associated with all-cause mortality. Illness perceptions are important and potentially modifiable risk factors to target in future interventions.

24 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.

25 Article What Outcomes are Important for Gout Patients? In-Depth Qualitative Research into the Gout Patient Experience to Determine Optimal Endpoints for Evaluating Therapeutic Interventions. 2017

Tatlock, Sophi / Rüdell, Katja / Panter, Charlotte / Arbuckle, Rob / Harrold, Leslie R / Taylor, William J / Symonds, Tara. ·Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK. sophi.tatlock@adelphivalues.com. · AstraZeneca, Da Vinci Building, Melbourn Science Park, Royston, Cambridgeshire, SG86EE, UK. · Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK. · Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. · Rehabilitation Teaching and Research Unit, University of Otago Wellington, PO Box 7343, Wellington, New Zealand. · Clinical Outcomes Solutions Ltd, Shearway Road, Folkestone, CT194RH, UK. ·Patient · Pubmed #27384670.

ABSTRACT: BACKGROUND AND OBJECTIVES: Characterized by sudden onset of severe joint pain, swelling, redness, and tenderness to touch, gout 'flare ups' have a substantial impact on quality of life (QoL). This research employed a patient-centered approach to explore the symptoms and impacts of gout, and assess the content validity of existing patient-reported outcomes (PROs). METHODS: Qualitative interviews were conducted with 30 US gout patients (non-tophaceous: n = 20, tophaceous: n = 10) and five expert rheumatologists. Each interview included both concept elicitation (CE) questioning to learn about the patient experience and cognitive debriefing to assess the content validity of three PRO instruments (HAQ-DI, GAQ, and TIQ-20). Nine of the patients provided further real-time qualitative data through a smart phone application. All qualitative data were subject to thematic analysis using Atlas.ti. Two patient advisors and three expert clinicians were engaged as advisors at key stages throughout the research. RESULTS: Interview and real-time data identified the same core symptoms and proximal impact concepts. Severe pain (typically in joints of extremities) was described as the cardinal symptom, often accompanied by swelling, redness, heat, sensitivity to touch, and stiffness. Domains of QoL impacted included physical functioning, sleep, daily activities, and work. The PRO instruments were generally well-understood by patients, but each included items with questionable relevance to at least some of the sample, dependent on the specific joints affected. CONCLUSIONS: Gout patients experience severe pain in affected joints, resulting in substantial limitations in physical functioning. Both the HAQ-DI and the TIQ-20 are useful for specific research purposes in the gout population, although modifications are recommended.

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