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Gout: HELP
Articles from Singapore Republic
Based on 30 articles published since 2008
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These are the 30 published articles about Gout that originated from Singapore Republic during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Dual-energy CT in gout - A review of current concepts and applications. 2017

Chou, Hong / Chin, Teck Yew / Peh, Wilfred C G. ·Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, Singapore, Singapore. ·J Med Radiat Sci · Pubmed #28238226.

ABSTRACT: Dual-energy computed tomography (DECT) is a relatively recent development in the imaging of gouty arthritis. Its availability and usage have become increasingly widespread in recent years. DECT is a non-invasive method for the visualisation, characterisation and quantification of monosodium urate crystal deposits which aids the clinician in the early diagnosis, treatment and follow-up of this condition. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout. Techniques in image acquisition, processing and interpretation will be discussed along with pitfalls, artefacts and clinical applications.

2 Review Colchicine--Update on mechanisms of action and therapeutic uses. 2015

Leung, Ying Ying / Yao Hui, Laura Li / Kraus, Virginia B. ·Department of Rheumatology & Immunology, Singapore General Hospital, The Academia, Level 4, 20 College Rd, Singapore 169856; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore. Electronic address: katyccc@hotmail.com. · Department of Rheumatology & Immunology, Singapore General Hospital, The Academia, Level 4, 20 College Rd, Singapore 169856. · Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC. ·Semin Arthritis Rheum · Pubmed #26228647.

ABSTRACT: OBJECTIVES: To review the literature and provide an update on the mechanisms of action and therapeutic uses of oral colchicine in arthritis and inflammatory conditions. METHODS: We performed PubMed database searches through June 2014 for relevant studies in the English literature published since the last update of colchicine in 2008. Searches encompassed colchicine mechanisms of action and clinical applications in medical conditions. A total of 381 articles were reviewed. RESULTS: The primary mechanism of action of colchicine is tubulin disruption. This leads to subsequent down regulation of multiple inflammatory pathways and modulation of innate immunity. Newly described mechanisms include various inhibitory effects on macrophages including the inhibition of the NACHT-LRRPYD-containing protein 3 (NALP3) inflammasome, inhibition of pore formation activated by purinergic receptors P2X7 and P2X2, and stimulation of dendritic cell maturation and antigen presentation. Colchicine also has anti-fibrotic activities and various effects on endothelial function. The therapeutic use of colchicine has extended beyond gouty arthritis and familial Mediterranean fever, to osteoarthritis, pericarditis, and atherosclerosis. CONCLUSION: Further understanding of the mechanisms of action underlying the therapeutic efficacy of colchicine will lead to its potential use in a variety of conditions.

3 Review The unwelcome visitor. 2012

Teng, Gim Gee / Tong, Chung Yan / How, Choon How / Goh, Lay Hoon. ·University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. gim_gee_teng@nuhs.edu.sg ·Singapore Med J · Pubmed #22941126.

ABSTRACT: Gout is a chronic, progressive inflammatory disease with intermittent arthritic flares, which should not be regarded as a minor inconvenience or nuisance. It can be effectively controlled when the patient's serum urate level is reduced to less than 360 μmol/l (6 mg/dL) by consistent use of urate-lowering pharmacotherapy. Colchicine prophylaxis for gouty flares during titration of urate-lowering therapy has been underused. Holistic long-term management of gout must encompass patient education, evidence-based dietary advice, screening and aggressive treatment of comorbidities such as hypertension, diabetes mellitus, dyslipidaemia and renal impairment. Acute therapies for recurrent attacks with non-steroidal anti-inflammatory drugs, colchicine and/or corticosteroids should be used judiciously, especially in the elderly, due to the risk of toxicities. With appreciation of the underlying pathogenesis and artful use of the limited drug options, control of gout can be effectively achieved, bringing tremendous satisfaction to the patient and doctor.

4 Review MR imaging of tophaceous gout revisited. 2011

Khoo, J N / Tan, S C. ·Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608. jennnee.khoo@gmail.com ·Singapore Med J · Pubmed #22173256.

ABSTRACT: Gout is the most common form of microcrystalline arthropathy, and does not usually pose a diagnostic challenge when patients have a typical presentation, appropriate biochemical picture and classical radiographic appearance. However, magnetic resonance (MR) imaging is increasingly used as the first-line imaging modality in patients with first presentation of joint pain or mass, and tophaceous gout is frequently a forgotten differential diagnosis. This article serves to review the MR imaging characteristics and appearance of gouty tophi in various joints, their clinical presentations and complications, as well as the common differential diagnoses.

5 Review A re-look at an old disease: a multimodality review on gout. 2011

Dhanda, S / Jagmohan, P / Quek, S T. ·Department of Diagnostic Imaging, National University Hospital, Singapore. sunitadhanda63@gmail.com ·Clin Radiol · Pubmed #21658689.

ABSTRACT: Gout, the most common form of microcrystalline arthropathy has always interested radiologists. The diagnosis of gout is primarily based on clinical and laboratory findings; however, it has well known and characteristic radiographic manifestations. Radiographs remain the examination of choice in the diagnosis of joint involvement. Plain radiographs are less sensitive to early changes in gout than other imaging techniques. Recently, magnetic resonance imaging (MRI), ultrasound (US), and computed tomography (CT) have demonstrated an increasing role in early diagnosis of gouty arthritis, for assessing the extent of soft-tissue involvement and as problem-solving tools for diagnostically difficult cases. Cross-sectional imaging can also be used for guiding needle aspirations in patients with an acute attack of gout, which may simulate an infective process clinically. This pictorial review illustrates the main imaging features of gout on radiographs, MRI, CT, and ultrasound with the aim of helping the radiologist to make a confident diagnosis in radiographically typical cases and to serve as a problem-solving tool in cases that present a diagnostic dilemma.

6 Article Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study. 2018

Waldman, Boris / Ansquer, Jean-Claude / Sullivan, David R / Jenkins, Alicia J / McGill, Neil / Buizen, Luke / Davis, Timothy M E / Best, James D / Li, Liping / Feher, Michael D / Foucher, Christelle / Kesaniemi, Y Antero / Flack, Jeffrey / d'Emden, Michael C / Scott, Russell S / Hedley, John / Gebski, Val / Keech, Anthony C / Anonymous6130938. ·National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. · Centre Hospitalier Universitaire de Dijon, Dijon, France; Clinsciences, Dijon, France. · Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Sydney Medical School, University of Sydney, Sydney, NSW, Australia. · School of Medicine, University of Western Australia, Fremantle, WA, Australia. · Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Imperial College London, London, UK. · Lipid Clinic, Chelsea and Westminster Hospital Foundation Trust, London, UK; Department of Clinical and Experimental Medicine, University of Surrey, Surrey, UK. · Clinsciences, Dijon, France. · Oulu Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland. · South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia. · Endocrine Research Unit, Royal Brisbane Hospital, Brisbane, QLD, Australia. · Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand. · Department of Internal Medicine, Wairau Hospital, Blenheim, New Zealand. · National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. Electronic address: tony@ctc.usyd.edu.au. ·Lancet Diabetes Endocrinol · Pubmed #29496472.

ABSTRACT: BACKGROUND: Gout is a painful disorder and is common in type 2 diabetes. Fenofibrate lowers uric acid and reduces gout attacks in small, short-term studies. Whether fenofibrate produces sustained reductions in uric acid and gout attacks is unknown. METHODS: In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, participants aged 50-75 years with type 2 diabetes were randomly assigned to receive either co-micronised fenofibrate 200 mg once per day or matching placebo for a median of 5 years follow-up. We did a post-hoc analysis of recorded on-study gout attacks and plasma uric acid concentrations according to treatment allocation. The outcomes of this analysis were change in uric acid concentrations and risk of on-study gout attacks. The FIELD study is registered with ISRCTN, number ISRCTN64783481. FINDINGS: Between Feb 23, 1998, and Nov 3, 2000, 9795 patients were randomly assigned to fenofibrate (n=4895) or placebo (n=4900) in the FIELD study. Uric acid concentrations fell by 20·2% (95% CI 19·9-20·5) during the 6-week active fenofibrate run-in period immediately pre-randomisation (a reduction of 0·06 mmol/L or 1 mg/dL) and remained -20·1% (18·5-21·7, p<0·0001) lower in patients taking fenofibrate than in those on placebo in a random subset re-measured at 1 year. With placebo allocation, there were 151 (3%) first gout events over 5 years, compared with 81 (2%) among those allocated fenofibrate (HR with treatment 0·54, 95% CI 0·41-0·70; p<0·0001). In the placebo group, the cumulative proportion of patients with first gout events was 7·7% in patients with baseline uric acid concentration higher than 0·36 mmol/L and 13·9% in those with baseline uric acid concentration higher than 0·42 mmol/L, compared with 3·4% and 5·7%, respectively, in the fenofibrate group. Risk reductions were similar among men and women and those with dyslipidaemia, on diuretics, and with elevated uric acid concentrations. For participants with elevated baseline uric acid concentrations despite taking allopurinol at study entry, there was no heterogeneity of the treatment effect of fenofibrate on gout risk. Taking account of all gout events, fenofibrate treatment halved the risk (HR 0·48, 95% CI 0·37-0·60; p<0·0001) compared with placebo. INTERPRETATION: Fenofibrate lowered uric acid concentrations by 20%, and almost halved first on-study gout events over 5 years of treatment. Fenofibrate could be a useful adjunct for preventing gout in diabetes. FUNDING: None.

7 Article Factors influencing medication adherence in patients with gout: A descriptive correlational study. 2018

Chua, Xin Hui Jasmine / Lim, Siriwan / Lim, Fui Ping / Lim, Yee Nah Anita / He, Hong-Gu / Teng, Gim Gee. ·Division of Nursing, National University Hospital, Singapore. · National University Health System, Singapore. · Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Division of Rheumatology, National University Hospital, University Medicine Cluster, Singapore. ·J Clin Nurs · Pubmed #28618105.

ABSTRACT: AIMS AND OBJECTIVES: To examine the factors influencing adherence to urate-lowering therapy in patients with gout in Singapore. BACKGROUND: Gout is the most common type of chronic inflammatory arthritis. Urate-lowering therapy is used to treat gout by reducing serum uric acid levels. However, adherence to urate-lowering therapy among patients remains poor. To date, there have been no available studies based on a conceptual framework that examined factors influencing medication adherence in patients with gout. DESIGN: Cross-sectional, descriptive correlational study. METHODS: A convenience sample of outpatients (n = 108) was recruited between October 2014-January 2015 from a tertiary hospital in Singapore. Outcomes were measured by relevant valid and reliable instruments. Descriptive statistics and parametric tests including multiple linear regression were used to analyse the data. RESULTS: Although 44.4% of the participants were high adherers to urate-lowering therapy, the mean adherence level was moderate. Significant differences in medication adherence scores were found among the subgroups of gender, ethnicity, marital status, employment status and presence of comorbidity. Medication adherence was positively significantly correlated with age, number of comorbidities and beliefs about medicines. Linear regression showed that higher level of beliefs about medicines, presence of comorbidity and being married were factors positively influencing medication adherence. CONCLUSIONS: This study revealed moderate adherence to urate-lowering therapy in patients with gout in Singapore, indicating the need for strategies to improve adherence by considering its main influencing factors. Future research should be conducted to develop interventions targeted at modifying patients' beliefs about medicines in order to improve medication adherence. RELEVANCE TO CLINICAL PRACTICE: Findings from this study allow healthcare providers to quickly and easily identify patients who may have low adherence. Nurses should take the lead in educating patients on the mechanism of urate-lowering therapy and highlight the importance of adhering to it.

8 Article Gout and risk of knee replacement for severe knee osteoarthritis in the Singapore Chinese Health Study. 2017

Teng, G G / Leung, Y Y / Ang, L-W / Yuan, J-M / Koh, W-P. ·University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. Electronic address: gim_gee_teng@nuhs.edu.sg. · Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School Singapore, Singapore. Electronic address: katy.leung.y.y@singhealth.com.sg. · Epidemiology & Disease Control Division, Ministry of Health, Singapore. Electronic address: ANG_Li_Wei@moh.gov.sg. · Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. Electronic address: yuanj@upmc.edu. · Duke-NUS Medical School Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. Electronic address: woonpuay.koh@duke-nus.edu.sg. ·Osteoarthritis Cartilage · Pubmed #28757187.

ABSTRACT: OBJECTIVE: While cross-sectional and retrospective case-control studies suggest that gout is associated with knee osteoarthritis (KOA), no prospective study has evaluated the risk of total knee replacement (TKR) for KOA in association with gout. We prospectively evaluated the association between gout and the risk of TKR due to severe KOA. DESIGN: We used data from the Singapore Chinese Health Study (SCHS), a prospective cohort with 63,257 Chinese adults aged 45-74 years at recruitment (1993-1998). Self-report of physician-diagnosed gout was enquired at follow-up I interview (1999-2004) from 52,322 subjects. TKR cases for KOA after follow-up I were identified via linkage with nationwide hospital discharge database through 31 December 2011. Multivariable Cox proportional hazards regression model was applied with adjustment for potential risk factors of KOA. RESULTS: Among 51,858 subjects (22,180 men and 29,678 women) included in this analysis, after average 9.7 follow-up years, there were 1,435 cases of TKR. Gout was associated with 39% higher risk of TKR in women [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.08-1.79] but not in men (HR 0.78; 95% CI 0.49-1.23). The positive gout-TKR association in women remained after excluding participants with self-reported history of arthritis (HR 1.57; 95% CI 1.04-2.37). This association was stronger in women who were lean (body mass index [BMI] < 23 kg/m CONCLUSION: Gout is associated with risk of severe KOA, especially in lean women, suggesting the crystal arthritis may play a role in the pathogenesis or progression of OA.

9 Article Prevalence of foot problems in people with inflammatory arthritis in Singapore. 2016

Carter, K / Lahiri, M / Cheung, P P / Santosa, A / Rome, K. ·Podiatry Department, Rehabilitation Centre, National University Health System Singapore, Singapore, Singapore. · Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore, Singapore. · Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand. ·J Foot Ankle Res · Pubmed #27594920.

ABSTRACT: BACKGROUND: Foot problems are highly prevalent in people with inflammatory arthritis reported from studies in the UK, Europe and New Zealand, but there is limited evidence from Southeast Asia. The study aim was to evaluate the prevalence of foot problems in people with inflammatory arthritis in Singapore. METHODS: People with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a tertiary hospital in Singapore. Disease and clinical characteristics included age, sex, disease duration, current blood tests and medications. The Leeds Foot Impact Scale was used to evaluate foot impairment/disability and the Modified Health Assessment Questionnaire was used to assess global function. RESULTS: We recruited 101 people with inflammatory arthritis, of which 50 % were female. The majority of participants were Chinese (70 %). The mean (SD) age was 52 (15) years, and the mean (SD) disease duration was 9.3 (0.3) years. The most commonly reported inflammatory arthritic conditions were rheumatoid arthritis (46), gout (31) and spondyloarthritis (15 %). The mean (SD) of the total Leeds Foot Impact Scale was 17 (13) indicating moderate to severe levels of foot impairment and activity limitation. Over 80 of participants reported foot pain during the course of their condition, and 48 % reported current foot pain. Despite the high prevalence of foot pain, only 21 participants (21 %) had been referred to a podiatrist. CONCLUSION: This is the first study to investigate the prevalence of foot problems in people with inflammatory arthritis from Singapore. The majority of the participants reported foot problems, but had not been referred to a podiatry service.

10 Article Pancreatic gout and the role of multimodality imaging in its management. 2016

Koh, Huiliang / Low, How Cheng / Seet, Ju Ee / Chua, Wynne Yuru. ·Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore. · Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore. · Department of Pathology, National University Hospital, Singapore, Singapore. ·BMJ Case Rep · Pubmed #27190122.

ABSTRACT: Uric acid deposition in the pancreas is very rare and neither an endoscopic ultrasound (EUS) nor a contrast-enhanced CT image of this condition has ever been published. We describe a case of asymptomatic pancreatic gout that was detected incidentally on CT. Imaging features mimicked pancreatic neoplasm, warranting further evaluation with EUS-guided fine-needle aspiration. Samples revealed debris encrusted with monosodium urate crystals. Follow-up CT showed complete resolution with urate-lowering therapy. We aim to augment current knowledge on the imaging of pancreatic gout and discuss its management.

11 Article Bidirectional Association between Diabetes and Gout: the Singapore Chinese Health Study. 2016

Pan, An / Teng, Gim Gee / Yuan, Jian-Min / Koh, Woon-Puay. ·Department of Epidemiology and Biostatistics, and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. · Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. · University Medicine Cluster, Division of Rheumatology, National University of Singapore and National University Health System, Singapore. · Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. · Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. · Duke-NUS Graduate Medical School Singapore, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. ·Sci Rep · Pubmed #27161168.

ABSTRACT: We aimed to prospectively investigate the bidirectional association between type 2 diabetes (T2D) and gout. We analyzed follow-up data from the Singapore Chinese Health Study, when self-reports of diagnosed diabetes and gout were enquired at follow-ups I and II. Individuals who participated in both follow-ups and were free of cardiovascular disease or cancer at follow-up I were included. For T2D to gout (analysis I), prevalent gout were further excluded (final n = 31,137). For gout to T2D (analysis II), prevalent diabetes were excluded (final n = 28,668). Cox regression models were used to estimate relative risks (RRs). In the analysis I, the RR of diabetes to incident gout (682 cases) was 0.77 (95% CI 0.60-0.97). In the analysis II, the RR of gout to incident diabetes (2223 cases) was 1.36 (1.12-1.63), but became insignificant after adjustment for hypertension and BMI (1.00; 0.83-1.21). The gout to diabetes association was modified by BMI (Pinteraction = 0.04) and hypertension (Pinteraction = 0.007), and it was marginally significant in adults with BMI<24 while significant among non-hypertensive participants, but not in their counterparts. In conclusion, our results suggest that diabetes is associated with a lower risk of incident gout, while gout is positively related to diabetes among normal weight and non-hypertensive adults.

12 Article Intestinal Microbiota Distinguish Gout Patients from Healthy Humans. 2016

Guo, Zhuang / Zhang, Jiachao / Wang, Zhanli / Ang, Kay Ying / Huang, Shi / Hou, Qiangchuan / Su, Xiaoquan / Qiao, Jianmin / Zheng, Yi / Wang, Lifeng / Koh, Eileen / Danliang, Ho / Xu, Jian / Lee, Yuan Kun / Zhang, Heping. ·Key Laboratory of Dairy Biotechnology and Bioengineering, Education Ministry of P. R. China, Huhhot, Inner Mongolia, 010018, China. · The First Affiliated Hospital, Baotou Medical College, Baotou, Inner Mongolia, 014010, China. · Department of Microbiology, Yong Loo Li School of Medicine, National University of Singapore, 5 Science Drive 2, 117597, Singapore. · Single-Cell Center, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao, Shandong, 266101, China. ·Sci Rep · Pubmed #26852926.

ABSTRACT: Current blood-based approach for gout diagnosis can be of low sensitivity and hysteretic. Here via a 68-member cohort of 33 healthy and 35 diseased individuals, we reported that the intestinal microbiota of gout patients are highly distinct from healthy individuals in both organismal and functional structures. In gout, Bacteroides caccae and Bacteroides xylanisolvens are enriched yet Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted. The established reference microbial gene catalogue for gout revealed disorder in purine degradation and butyric acid biosynthesis in gout patients. In an additional 15-member validation-group, a diagnosis model via 17 gout-associated bacteria reached 88.9% accuracy, higher than the blood-uric-acid based approach. Intestinal microbiota of gout are more similar to those of type-2 diabetes than to liver cirrhosis, whereas depletion of Faecalibacterium prausnitzii and reduced butyrate biosynthesis are shared in each of the metabolic syndromes. Thus the Microbial Index of Gout was proposed as a novel, sensitive and non-invasive strategy for diagnosing gout via fecal microbiota.

13 Article Cigarette Smoking and the Risk of Incident Gout in a Prospective Cohort Study. 2016

Gee Teng, Gim / Pan, An / Yuan, Jian-Min / Koh, Woon-Puay. ·National University of Singapore and National University Health System, Singapore. · University of Pittsburgh, Pittsburgh, Pennsylvania. ·Arthritis Care Res (Hoboken) · Pubmed #26714165.

ABSTRACT: OBJECTIVE: Cigarette smoking is shown to reduce serum urate. However, its impact on risk of gout is unknown. We prospectively examined the relationship between cigarette smoking and gout risk in this Asian cohort. METHODS: We analyzed the data from the Singapore Chinese Health Study, a cohort of 63,257 Chinese ages 45-74 years at recruitment in 1993-1998. Information on cigarette smoking and other lifestyle factors was collected through in-person interviews at recruitment. This analysis included 53,213 participants who took part in either the first followup (1999-2004) and/or the second followup interviews (2006-2010). Cox proportional hazards models were used to assess the relationship between cigarette smoking and gout risk. RESULTS: A total of 2,244 incident cases of physician-diagnosed gout were identified after a mean followup of 11.1 years. Among men, compared to never smokers, the risk of gout in current smokers was decreased by 27% (hazard ratio [HR] 0.73 [95% confidence interval (95% CI) 0.63-0.84]). This risk reduction was greater in lean male smokers (HR 0.69 [95% CI 0.57-0.83]) than overweight smokers (HR 0.87 [95% CI 0.67-1.13]) (P = 0.09 for interaction). This inverse association with smoking was rapidly attenuated to become null even in former smokers who had recently quit smoking. Conversely, there was no association between smoking and gout risk in women. In a companion cross-sectional study, current smokers had significantly lower levels of serum urate than former and never smokers, and this observation was present in men and not women. CONCLUSION: Current smoking is associated with lower risk of gout in men in this Asian cohort.

14 Article Psoriasis and uric acid: a population-based cross-sectional study. 2016

Lai, Y C / Yew, Y W. ·Harvard TH Chan School of Public Health, Boston, MA, USA. · Department of Dermatology, National Skin Centre, Singapore. ·Clin Exp Dermatol · Pubmed #26643816.

ABSTRACT: BACKGROUND: Psoriasis has been reported to be associated with raised serum uric acid levels and gout, and uric acid has been demonstrated to mediate inflammatory pathways via secretion of pro-inflammatory chemokines. AIM: To evaluate the association between psoriasis, serum uric acid levels and gout in a cross-sectional study using the US National Health and Nutrition Examination Survey (NHANES) database. METHODS: Data on clinical history of psoriasis, gout and other relevant medical conditions from the questionnaire as well as laboratory parameters for serum uric acid and lipid levels in the periods 2003-2006 and 2011-2012 were analysed. Multivariate analysis with logistic regression modelling was performed, with hyperuricaemia as the dependent variable, and age, sex, ethnicity, body mass index, metabolic syndrome, current smoking status, alcohol consumption and history of psoriasis as the independent variables. RESULTS: Of the 11 282 study participants, 297 (2.6%) reported a history of psoriasis and 1493 (13.2%) were found to have hyperuricaemia. Patients with psoriasis were at increased risk of having hyperuricaemia, compared with those without psoriasis (OR = 1.37; P = 0.04). They were also more likely to report a history of gout (OR = 1.83; P < 0.05). However, neither association was significant after adjusting for potential confounders with multivariate logistic regression. CONCLUSION: In conclusion, there was insufficient evidence to show that psoriasis is an independent risk factor of hyperuricaemia or gout. A raised serum uric acid level may be a consequence of metabolic syndrome, which in turn is associated with psoriasis.

15 Article Evolution of gout: "malignant" change over time? 2015

Eide, Sterling Ellis / Khor, Yiu Ming / Seet, Ju Ee / Sia, David Soon Yiew. ·Department of Diagnostic Imaging, National University Hospital of Singapore, Singapore. · Department of Nuclear Medicine, Singapore General Hospital, Singapore. · Department of Pathology, National University Hospital of Singapore, Singapore. ·J Radiol Case Rep · Pubmed #26629292.

ABSTRACT: Gout is a common entity; yet it is such a great mimicker in its imaging features that it can confuse clinicians and radiologists alike, sometimes leading to unnecessary investigations and treatment. We present a case of a 52 year old male renal transplant patient who presented with a slow growing mass in his left shin. The initial radiograph demonstrated a non-aggressive looking calcified lesion. A fine needle aspiration demonstrated this lesion to be gout deposition. The lesion was unchanged in the following eight years until the patient reported a sudden growth in size. Imaging showed features of an aggressive lesion with disruption of the previous calcification as well as enhancement on magnetic resonance imaging. Surgical excision biopsy was performed in view of the worrisome features on imaging and the histology showed tophaceous gout. Following description of our case, we reviewed the clinical and imaging features of gout and discussed its differential diagnoses.

16 Article Cost-effectiveness analysis of genotyping for HLA-B*5801 and an enhanced safety program in gout patients starting allopurinol in Singapore. 2015

Dong, Di / Tan-Koi, Wei-Chuen / Teng, Gim Gee / Finkelstein, Eric / Sung, Cynthia. ·Health Services & Systems Research Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore. · Vigilance & Compliance Branch, Health Sciences Authority, 11 Biopolis Way, #11-01, Helios, Singapore 138667, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. · Division of Rheumatology, National University Health System, University Medicine Cluster, Singapore. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore. ·Pharmacogenomics · Pubmed #26554739.

ABSTRACT: AIMS: Allopurinol is an efficacious urate-lowering therapy (ULT), but is associated with rare serious adverse drug reactions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with higher risk among HLA-B*5801 carriers. We assessed the cost-effectiveness of HLA-B*5801 testing, an enhanced safety program or strategies with both components. METHODS: The analysis adopted a health systems perspective and considered Singaporean patients with chronic gout, over a lifetime horizon, using allopurinol or probenecid. The model incorporated SJS/TEN and gout treatment outcomes, allele frequencies, drug prices and other medical costs. RESULTS: Based on cost-effectiveness threshold of US$50,000 per quality-adjusted life year, HLA-B*5801-guided ULT selection or enhanced safety program was not cost effective. Avoidance of ULTs was the least preferred strategy as uncontrolled gout leads to lower quality-adjusted life years and higher costs. CONCLUSION: The analysis underscores the need for biomarkers with higher positive predictive value for SJS/TEN, less expensive genetic tests or safety programs, or more effective gout drugs. .

17 Article Bidirectional Association between Self-Reported Hypertension and Gout: The Singapore Chinese Health Study. 2015

Pan, An / Teng, Gim Gee / Yuan, Jian-Min / Koh, Woon-Puay. ·Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. · Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore; University Medicine Cluster, Division of Rheumatology, National University Hospital and National University Health System, Singapore, Republic of Singapore. · Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America. · Duke-NUS Graduate Medical School Singapore, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. ·PLoS One · Pubmed #26510154.

ABSTRACT: It has been hypothesized that the association between hypertension and gout is bidirectional, however, few studies have examined this in a prospective cohort. We analyzed data from the Singapore Chinese Health Study (SCHS) follow-up I (1999-2004) and II (2006-2010) interviews, when both physician-diagnosed hypertension and gout were self-reported. We included participants with data for both follow-up interviews and who were free of heart disease, stroke and cancer at follow-up I. The analysis of hypertension and risk of gout included 31,137 participants when prevalent gout cases were excluded, while the analysis of gout and risk of hypertension included 20,369 participants when prevalent hypertension cases were excluded. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The mean age at follow-up I was 60.1 (SD 7.3) years, and the average follow-up was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 682 incident cases were identified. Compared to normotensive participants, hypertensive patients had an 88% increased risk of developing gout (HR 1.88; 95% CI 1.61-2.21). In the parallel analysis, 5,450 participants reported to have newly diagnosed hypertension during follow-up. Compared to participants without gout, those with gout had an 18% increased risk of developing hypertension (HR 1.18; 95% CI 1.02-1.37). The bidirectional association was stronger in normal weight adults compared to overweight/obese individuals (Pinteraction = 0.06 and 0.04, respectively). The hypertension to gout association was stronger in women compared to men (Pinteraction = 0.04), while the gout to hypertension association was evident in women but not in men (Pinteraction = 0.02). In conclusion, our results suggest that the hypertension-gout association is bidirectional in this cohort of Singapore Chinese adults. The potential interactions of the bidirectional association with obesity and sex deserve further investigations.

18 Article Food Sources of Protein and Risk of Incident Gout in the Singapore Chinese Health Study. 2015

Teng, Gim Gee / Pan, An / Yuan, Jian-Min / Koh, Woon-Puay. ·National University Health System, Singapore, Singapore, and National University of Singapore, Yong Loo Lin School of Medicine, Singapore. · National University of Singapore, Saw Swee Hock School of Public Health, Singapore, and Huazhong University of Science and Technology, School of Public Health and Tongji Medical College, Wuhan, China. · University of Pittsburgh Cancer Institute, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania. · Duke-NUS Graduate Medical School, Singapore, and National University of Singapore, Saw Swee Hock School of Public Health, Singapore. ·Arthritis Rheumatol · Pubmed #25808549.

ABSTRACT: OBJECTIVE: Prospective studies evaluating diet in relation to the risk of gout in Asian populations are lacking. The purpose of this study was to examine the relationship between the consumption of dietary protein from each of its major sources and the risk of gout in a Chinese population. METHODS: We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese adults who were 45-74 years old at recruitment during the years 1993-1998. Habitual diet information was collected via a validated semiquantitative food frequency questionnaire, and physician-diagnosed gout was self-reported during 2 followup interviews up to the year 2010. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), with adjustment for potential confounders, among 51,114 eligible study participants who were free of gout at baseline and responded to our followup interviews. RESULTS: A total of 2,167 participants reported physician-diagnosed gout during the followup period. The multivariate-adjusted HRs (with 95% CIs) of gout, comparing the first quartile with the fourth quartile, were as follows: 1.27 (1.12-1.44; P for trend < 0.001) for total protein, 1.27 (1.11-1.45; P for trend < 0.001) for poultry, 1.16 (1.02-1.32; P for trend = 0.006) for fish and shellfish, 0.86 (0.75-0.98; P for trend = 0.018) for soy food, and 0.83 (0.73-0.95; P for trend = 0.012) for nonsoy legumes. No statistically significant associations were found with protein intake from other sources (red meat, eggs, dairy products, grains, or nuts and seeds). CONCLUSION: In this Chinese population living in Singapore, higher total dietary protein intake from mainly poultry and fish/shellfish was associated with an increased risk of gout, while dietary intake of soy and nonsoy legumes was associated with a reduced risk of gout.

19 Article Tophaceous gouty arthropathy of the lumbar spine. 2014

Saripalli, Kundan / Baskar, Sangeetha. ·Yong Loo Lin School of Medicine, Singapore kundan.reddy.saripalli@nus.edu.sg. · Khoo Teck Puat Hospital, Singapore. ·Clin Med (Lond) · Pubmed #25468860.

ABSTRACT: Gout, classically affecting the first metatarsal joints, knees, fingers and ears, is seldom thrown out as a differential when a patient complains of lower back pain. Symptoms presented by patients with spinal gout may be non-specific and varied; at times, the only clue being that the patient has a previous history of gout. Prompt treatment with anti-inflammatory medication once diagnosis is reached helps to alleviate pain and improves the prognosis of the disease. Therefore, it is vital for the treating physician to keep an open mind and consider spinal gout as a diagnosis once other sinister causes such as osteomyelitis have been ruled out. This greatly reduces the morbidity associated with late treatment of spinal gout.

20 Article Boutonniere deformity presented in a young male. 2014

Singbal, Salil Babla / Quek, Swee Tian. ·Department of Diagnostic Imaging National University Hospital, Singapore. ·Ann Acad Med Singapore · Pubmed #24833080.

ABSTRACT: -- No abstract --

21 Article OMERACT endorsement of measures of outcome for studies of acute gout. 2014

Singh, Jasvinder A / Taylor, William J / Dalbeth, Nicola / Simon, Lee S / Sundy, John / Grainger, Rebecca / Alten, Rieke / March, Lyn / Strand, Vibeke / Wells, George / Khanna, Dinesh / McQueen, Fiona / Schlesinger, Naomi / Boonen, Annelies / Boers, Maarten / Saag, Kenneth G / Schumacher, H Ralph / Edwards, N Lawrence. ·From Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Medicine, University of Otago, Wellington; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; SDG LLC, Cambridge, Massachusetts,; Duke University School of Medicine, Durham, North Carolina, USA, and Duke-National University of Singapore Graduate Medical School, Singapore; Schlosspark-Klinik Teaching Hospital of the Charité, University Medicine Berlin, Berlin, Germany; University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia; Stanford University Division of Immunology and Rheumatology, Portolo Valley, California, USA; University of Ottawa, London, Ontario, Canada; University of Michigan Medical School, Ann Arbor, Michigan, USA; University of Auckland, Department of Molecular Medicine and Pathology, Grafton, Auckland, New Zealand; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Maastricht University Medical Center, Division of Rheumatology, and Caphri Research Institute, University Maastricht; VU University Medical Center, Amsterdam, the Netherlands; University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Rheumatology, University of Florida, Gainsville, Florida, USA. ·J Rheumatol · Pubmed #24334651.

ABSTRACT: OBJECTIVE: To determine the extent to which participants at the Outcome Measures in Rheumatology (OMERACT) 11 meeting agree that instruments used in clinical trials to measure OMERACT core outcome domains in acute gout fulfill OMERACT filter requirements of truth, discrimination, and feasibility; and where future research efforts need to be directed. METHODS: Results of a systematic literature review and analysis of individual-level data from recent clinical studies of acute gout were presented to OMERACT participants. The information was discussed in breakout groups, and opinion was defined by subsequent voting in a plenary session. Endorsement was defined as at least 70% of participants voting in agreement with the proposition (where the denominator excluded those participants who did not vote or who voted "don't know"). RESULTS: The following measures were endorsed for use in clinical trials of acute gout: (1) 5-point Likert scale and/or visual analog scale (0 to 100 mm) to measure pain; (2) 4-point Likert scale for joint swelling; (3) 4-point Likert scale for joint tenderness; and (4) 5-point Likert scale for patient global assessment of response to treatment. Measures for the activity limitations domain were not endorsed. CONCLUSION: Measures of pain, joint swelling, joint tenderness, and patient global assessment in acute gout were endorsed at OMERACT 11. These measures should now be used in clinical trials of acute gout.

22 Article Problem based review: The patient with acute monoarthritis. 2013

Suresh, Ernest. ·Department of Medicine Alexandra Hospital, Jurong Health, 378 Alexandra Road, Singapore 159964. dr_esuresh@hotmail.com ·Acute Med · Pubmed #23732137.

ABSTRACT: Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

23 Article Achieving treat to target in gout: a clinical practice improvement project. 2012

Lim, A Y N / Shen, L / Tan, C H / Lateef, A / Lau, T C / Teng, G G. ·University Medicine Cluster, Division of Rheumatology, National University Health System, 1E Kent Ridge Road, Singapore. ·Scand J Rheumatol · Pubmed #22839705.

ABSTRACT: OBJECTIVE: Gout care is suboptimal because of lack of translation of knowledge into real-world practice, despite evidence-based guidelines. We have developed processes to ensure systematic care for gout patients and determined the predictors for achievement of a target serum uric acid (SUA) concentration of < 360 μmol/L in a prospective cohort of Asian gout patients requiring allopurinol therapy. METHODS: A 1-year clinical practice improvement project was undertaken using evidence-based guidelines and quality planning tools. Interventions included comprehensive patient education, enhanced telephone access, reappointments and refills, upward titration of allopurinol with no limitation specified by renal function, and increased frequency of visits until the target SUA concentration was achieved. The primary outcome was the time to achieve an SUA level of <360 μmol/L. RESULTS: We recruited 126 gout patients. The median time to achieving the target SUA concentration was 36.9 weeks [95% confidence interval (CI) 29.3-44.4]. Based on survival analysis, the proportion of patients achieving the target was 8.1% (95% CI 3.2-13.0), 40.6% (95% CI 31.4-50.8), and 72.0% (95% CI 61.2-82.8) at 3, 6, and 12 months, respectively. On average, our patients who achieved the target were seen once every 2 months and achieved the target after a mean of 2.5 (SD = 1.1) visits. Frequency of follow-up visits and older patients not taking aspirin were independent predictors associated with achieving the target outcome, regardless of renal function. CONCLUSIONS: Optimization of control of SUA is achievable, even in the setting of renal impairment, by redesigning and implementing processes involving changes in physician prescribing habits, enhanced nursing interventions, and patient empowerment and education.

24 Article Gout, anemia, and hepatomegaly in a young man with glycogen storage disease. 2012

Ng, Esther Shu-Ting / Gupta, Sarika / Khin, Saw Myint / Mak, Anselm. ·Department of Medicine, National University Health System, Singapore, Singapore. u0302066@gmail.com ·J Clin Rheumatol · Pubmed #22653625.

ABSTRACT: -- No abstract --

25 Article Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study. 2012

Teng, Gim Gee / Ang, Li-Wei / Saag, Kenneth G / Yu, Mimi C / Yuan, Jian-Min / Koh, Woon-Puay. ·University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. ·Ann Rheum Dis · Pubmed #22172492.

ABSTRACT: OBJECTIVES: Whether the link between gout and mortality is causal or confounded by lifestyle factors or comorbidities remains unclear. Studies in Asia are warranted due to the rapid modernisation of the locale and ageing of the population. METHODS: The association between gout and mortality was examined in a prospective cohort, the Singapore Chinese Health Study, comprising 63 257 Singapore Chinese individuals, aged 45-74 years during the enrolment period of 1993-8. All enrollees were interviewed in person on lifestyle factors, current diet and medical histories. All surviving cohort members were contacted by telephone during 1999-2004 to update selected exposure and medical histories (follow-up I interview), including the history of physician-diagnosed gout. Cause-specific mortality in the cohort was identified via record linkage with the nationwide death registry, up to 31 December 2009. RESULTS: Out of 52 322 participants in the follow-up I interview, 2117 (4.1%) self-reported a history of physician-diagnosed gout, with a mean age at diagnosis of 54.7 years. After a mean follow-up period of 8.1 years, there were 6660 deaths. Relative to non-gout subjects, subjects with gout had a higher risk of death (HR 1.18; 95% CI 1.06 to 1.32), and specifically from death due to coronary heart disease (CHD) (HR 1.38, 95% CI 1.10 to 1.73) and kidney disease (HR 5.81, 95% CI 3.61 to 9.37). All gout-mortality risk associations were present in both genders but the risk estimates appeared higher for women. CONCLUSION: Gout is an independent risk factor for mortality, and specifically for death due to CHD and kidney disease.

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