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Gout: HELP
Articles from Birmingham VA Hospital
Based on 65 articles published since 2008
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These are the 65 published articles about Gout that originated from Birmingham VA Hospital during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Role of serum urate in neurocognitive function and dementia: new evidence contradicts old thinking. 2018

Singh, Jasvinder A. ·Birmingham VA Medical Center, Birmingham, Alabama, USA. · Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. ·Ann Rheum Dis · Pubmed #28939630.

ABSTRACT: -- No abstract --

2 Editorial Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer? 2017

Singh, Jasvinder A. ·Birmingham VA Medical Center, Birmingham, Alabama, USA. · Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. ·Ann Rheum Dis · Pubmed #28039184.

ABSTRACT: -- No abstract --

3 Editorial Chasing crystals out of the body: will treat to serum urate target for gout help us get there? 2017

Singh, Jasvinder A / Uhlig, Till. ·Birmingham VA Medical Center, Birmingham, Alabama, USA. · Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama, USA. · Division of Epidemiology at the School of Public Health, University of Alabama, Birmingham, Alabama, USA. · National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Faculty of Medicine, University of Oslo, Oslo, Norway. ·Ann Rheum Dis · Pubmed #28031165.

ABSTRACT: -- No abstract --

4 Editorial Gout: will the "King of Diseases" be the first rheumatic disease to be cured? 2016

Singh, Jasvinder A. ·Birmingham VA Medical Center, Birmingham, AL, USA. jasvinder.md@gmail.com. · Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. jasvinder.md@gmail.com. · Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. jasvinder.md@gmail.com. ·BMC Med · Pubmed #27832792.

ABSTRACT: Gout is the most common inflammatory arthritis in adults in the Western world. Characterized by hyperuricemia and the effects of acute and chronic inflammation in joints and bursa, gout leads to an agonizing, chronically painful arthritis. Arthritis can also be accompanied by urate nephropathy and subcutaneous urate deposits (tophi). Exciting new developments in the last decade have brought back the focus on this interesting, crystal-induced chronic inflammatory condition. New insights include the role of NALP3 inflammasome-induced inflammation in acute gout, the characterization of diagnostic signs on ultrasound and dual-energy computed tomography imaging modalities, the recognition of target serum urate less than 6 mg/day as the goal for urate-lowering therapies, and evidence-based treatment guidelines. A better understanding of disease mechanisms has enabled drug discovery - three new urate-lowering drugs have been approved in the last decade, with several more in the pipeline. We now recognize the important role that environment and genetics play in the causation of gout. A focus on the cardiac, renal, and metabolic comorbidities of gout will help translational research and discovery over the next decade.

5 Editorial Is the double contour sign specific for gout? Or only for crystal arthritis? 2015

Singh, Jasvinder A / Dalbeth, Nicola. ·Medicine Service, Birmingham VA Medical Center, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama; and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; · University of Auckland, and Auckland District Health Board, Auckland, New Zealand. ·J Rheumatol · Pubmed #25729038.

ABSTRACT: -- No abstract --

6 Editorial When gout goes to the heart: does gout equal a cardiovascular disease risk factor? 2015

Singh, Jasvinder A. ·Medicine Service, Birmingham VA Medical Center, Birmingham, Alabama, USA Medicine and Division of Epidemiology, University of Alabama, Birmingham, Alabama, USA Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Ann Rheum Dis · Pubmed #25603830.

ABSTRACT: -- No abstract --

7 Review Expert opinion on emerging urate-lowering therapies. 2018

Stamp, Lisa K / Merriman, Tony R / Singh, Jasvinder A. ·a Department of Medicine , University of Otago , Christchurch , New Zealand. · b Department of Biochemistry , University of Otago , Dunedin , New Zealand. · c Medicine Service , VA Medical Center , Birmingham , AL , USA. · d Department of Medicine at the School of Medicine , University of Alabama at Birmingham , Birmingham , AL. · e Division of Epidemiology at the School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA. ·Expert Opin Emerg Drugs · Pubmed #30244605.

ABSTRACT: INTRODUCTION: There has been a resurgence in gout therapeutics in the last decade, not only for the management of gout flares, but also for the treatment of hyperuricemia. This editorial summarizes new, emerging therapies for people with gout. Areas covered: We review several new therapies for gout, including those that are focused on lowering serum urate (levotofisopam, ulodesine, verinurad, merbarone, KUX-1151, UR-1102, FYU-981, SEL-212), or treating gout flares (canakinumab, bucillamine) or both (arhalofenate, diacerein). Expert opinion: Among therapies with both urate lowering and anti-inflammatory action, arhalofenate seems promising, but more data are needed. Examining therapies aimed at treating gout flares [anti-inflammatory action], bucillamine has some potential, but more data and Phase III studies are needed, to better understand its efficacy and safety. Among the urate-lowering therapies (ULTs), verinurad seems to be the most promising, while levotofisopam and ulodesine require more data. A uricase-replacement therapy with improved immune reaction (SLE-212) is in a Phase II trial. A number of ULTs including KUX-1151, UR-1102 and FYU-981 are in early development and more will be known once initial data and studies are published.

8 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.

9 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.

10 Review Impaired response or insufficient dosage? Examining the potential causes of "inadequate response" to allopurinol in the treatment of gout. 2014

Stamp, Lisa K / Merriman, Tony R / Barclay, Murray L / Singh, Jasvinder A / Roberts, Rebecca L / Wright, Daniel F B / Dalbeth, Nicola. ·Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch 8140, New Zealand. Electronic address: lisa.stamp@cdhb.health.nz. · Department of Biochemistry, University of Otago, Dunedin, New Zealand. · Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand. · Medicine Service, Birmingham VA Medical Center, Birmingham, AL; Rheumatology Division, University of Alabama, Birmingham, AL. · Department of Surgical Sciences, University of Otago, Dunedin, New Zealand. · School of Pharmacy, University of Otago, Dunedin, New Zealand. · Department of Medicine, University of Auckland, Auckland, New Zealand. ·Semin Arthritis Rheum · Pubmed #24925693.

ABSTRACT: OBJECTIVES: Gout is one of the most common forms of arthritis. It is well established that urate-lowering therapy that aims for a serum urate less than at least 0.36 mmol/l (6 mg/dl) is required for the successful management of gout. Allopurinol, a xanthine oxidase (XO) inhibitor, is the most commonly used urate-lowering therapy. However, many patients fail to achieve the target serum urate on allopurinol; these patients can be considered to have "inadequate response" to allopurinol. Herein, we examine the potential mechanisms and implications of inadequate response to allopurinol. METHODS: The literature was reviewed for potential causes for failure to reach target serum urate in patients receiving allopurinol. RESULTS: The two most common causes of inadequate response to allopurinol are poor adherence and under-dosing of allopurinol. Adherent patients who fail to achieve target serum urate on standard doses of allopurinol form a group that could be considered to be "partially resistant" to allopurinol. There are four potential mechanisms for partial allopurinol resistance: decreased conversion of allopurinol to oxypurinol; increased renal excretion of oxypurinol; abnormality in XO structure and/or function such that oxypurinol is rendered less effective and/or drug interactions. CONCLUSIONS: It is important to determine the reasons for failure to achieve treatment targets with allopurinol, particularly as newer agents become available. The knowledge of the mechanisms for inadequate response may help guide the clinician towards making a therapeutic choice that is more likely to result in achieving the serum urate target.

11 Review Comorbidities in patients with crystal diseases and hyperuricemia. 2014

Sattui, Sebastian E / Singh, Jasvinder A / Gaffo, Angelo L. ·Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Faculty Office Tower 813, 510 20th Street South, Birmingham, AL 35294, USA. · Medicine Service, Center for Surgical Medical Acute Care Research and Transitions (C-SMART), 700 19th Street South, Birmingham VA Medical Center, Birmingham, AL 35233, USA; Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Faculty Office Tower 805B, 200 First Street South West, Rochester, MN 55905, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. · Section of Rheumatology, Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL 35233, USA; Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Shelby Building 201, 1825 University Boulevard, Birmingham, AL 35294, USA. Electronic address: agaffo@uab.edu. ·Rheum Dis Clin North Am · Pubmed #24703346.

ABSTRACT: Crystal arthropathies are among the most common causes of painful inflammatory arthritis. Gout, the most common example, has been associated with cardiovascular and renal disease. In recent years, evidence for these associations and those involving other comorbidities, such as the metabolic syndrome, have emerged, and the importance of asymptomatic hyperuricemia has been established. In this review, an update on evidence, both experimental and clinical, is presented, and associations between hyperuricemia, gout, and several comorbidities are described. Causality regarding calcium pyrophosphate arthropathy and associated comorbidities is also reviewed.

12 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.

13 Review Racial and gender disparities among patients with gout. 2013

Singh, Jasvinder A. ·Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL 35294, USA. Jasvinder.md@gmail.com ·Curr Rheumatol Rep · Pubmed #23315156.

ABSTRACT: Gout affects 8.3 million Americans according to NHANES 2007-2008, approximately 3.9 % of the US population. Gout has substantial effect on physical function, productivity, health-related quality of life (HRQOL), and health care costs. Uncontrolled gout is also associated with significant use of emergency care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared with whites, racial and/or ethnic minorities, especially blacks, have higher prevalence of gout. Blacks are also less likely to receive quality gout care, leading to disproportionate morbidity. Women are less likely than men to receive allopurinol, and less likely to undergo joint aspirations for crystal analysis to establish diagnosis, but those on urate-lowering therapy are as likely as, or more likely than, men to undergo serum urate check within six months of initiation. Although a few studies provide the knowledge related to gender and race and/or ethnicity disparities for gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race and/or ethnicity. These should be investigated in future studies.

14 Review Emerging therapies for gout. 2012

Singh, Jasvinder A. ·Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.com ·Expert Opin Emerg Drugs · Pubmed #23126250.

ABSTRACT: INTRODUCTION: Gout is the commonest inflammatory arthritis in adults that affects 4% of the US population. Gout is symptomatic, leading to joint pain and inflammation, frequent acute flares associated with disability, pain and suffering. When not treated optimally, chronic inflammation can lead to chronic pain, joint destruction and deformities and decrements in function and quality of life. AREAS COVERED: Different therapeutic strategies that are being developed in preclinical and clinical settings are discussed. EXPERT OPINION: Multiple new treatment approaches have emerged for gout. Several target acute inflammation of gout flares by inhibiting interleukin-1, either with an antibody or with a molecule that traps interleukin-1. Two drugs in this category are rilonacept and canakinumab. Similarly, new approaches targeting and increasing urate excretion by the kidney are emerging. One such promising drug is lesinurad that decreases serum urate through inhibition of the uric acid transporter (URAT1) in the proximal tubule of the kidney. We hope these and other new treatments and new strategies for gout will lead to additional options. The expansion of the armamentarium for gout treatment will allow clinicians and patients to increase the chances to have gout remission.

15 Review Risk factors for gout and prevention: a systematic review of the literature. 2011

Singh, Jasvinder A / Reddy, Supriya G / Kundukulam, Joseph. ·Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama, USA. Jasvinder.md@gmail.com ·Curr Opin Rheumatol · Pubmed #21285714.

ABSTRACT: PURPOSE OF REVIEW: Our objective was to perform a systematic review of risk factors and prevention of gout. We searched Medline for fully published reports in English using keywords including but not limited to 'gout', 'epidemiology', 'primary prevention', 'secondary prevention', 'risk factors'. Data from relevant articles meeting inclusion criteria were extracted using standardized forms. RECENT FINDINGS: Of the 751 titles and abstracts, 53 studies met the criteria and were included in the review. Several risk factors were studied. Alcohol consumption increased the risk of incident gout, especially beer and hard liquor. Several dietary factors increased the risk of incident gout, including meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose. Diary intake, folate intake, and coffee consumption were each associated with a lower risk of incident gout and in some cases a lower rate of gout flares. Thiazide and loop diuretics were associated with higher risk of incident gout and higher rate of gout flares. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity, and early menopause were each associated with a higher risk of incident gout and/or gout flares. SUMMARY: Several dietary risk factors for incident gout and gout flares are modifiable. Prevention and optimal management of comorbidities are likely to decreased risk of gout. Research in preventive strategies for the treatment of gout is needed.

16 Review Gout. Hyperuricemia and cardiovascular disease: how strong is the evidence for a causal link? 2009

Gaffo, Angelo L / Edwards, N Lawrence / Saag, Kenneth G. ·Birmingham VA Medical Center, 700 19th St. S, Birmingham, AL 35233, USA. agaffo@uab.edu ·Arthritis Res Ther · Pubmed #19725932.

ABSTRACT: An association between high levels of serum urate and cardiovascular disease has been proposed for many decades. However, it was only recently that compelling basic science data, small clinical trials, and epidemiological studies have provided support to the idea of a true causal effect. In this review we present recently published data that study the association between hyperuricemia and selected cardiovascular diseases, with a final conclusion about the possibility of this association being causal.

17 Review Management of hyperuricemia and gout in CKD. 2008

Gaffo, Angelo L / Saag, Kenneth G. ·Birmingham VA Medical Center, University of Alabama at Birmingham, AL, USA. ·Am J Kidney Dis · Pubmed #18971014.

ABSTRACT: -- No abstract --

18 Clinical Trial Efficacy and safety of febuxostat extended release and immediate release in patients with gout and moderate renal impairment: phase II placebo-controlled study. 2018

Gunawardhana, Lhanoo / Becker, Michael A / Whelton, Andrew / Hunt, Barbara / Castillo, Majin / Saag, Kenneth. ·Takeda Pharmaceuticals, One Takeda Parkway, Deerfield, IL, 60015, USA. lhanoo.gunawardhana@takeda.com. · University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. · Johns Hopkins University, 1737 Beaver Brook Lane, Hunt Valley, MD, 21030, USA. · Takeda Pharmaceuticals, One Takeda Parkway, Deerfield, IL, 60015, USA. · Birmingham VA Medical Center, 700 S. 19th Street, Birmingham, AL, 35233, USA. · University of Alabama at Birmingham, Faculty Office Tower, Suite 820, 1720 2nd Avenue South, Birmingham, AL, 35294, USA. ·Arthritis Res Ther · Pubmed #29848361.

ABSTRACT: BACKGROUND: Febuxostat immediate release (IR), a xanthine oxidase inhibitor, is indicated for the management of hyperuricemia in patients with gout by lowering urate levels. An extended release (XR) formulation of febuxostat was developed to provide equal or superior efficacy on urate lowering compared with the IR formulation and potentially lower the risk of treatment-initiated gout flares due to an altered pattern of drug exposure. The present study evaluated the efficacy and safety of febuxostat XR and IR formulations in patients with gout and moderate renal impairment (estimated glomerular filtrate rate ≥ 30 and < 60 ml/min). METHODS: This was an exploratory, 3-month, phase II, multicenter, placebo-controlled, double-blind proof-of-concept study. Patients (n = 189) were randomized 1:1:1:1:1 to receive placebo or febuxostat IR 40 mg, XR 40 mg, IR 80 mg, or XR 80 mg once daily. Endpoints included: proportion of patients with serum uric acid (sUA) < 5.0 mg/dl at month 3 (primary endpoint), proportion of patients with sUA < 6.0 mg/dl at month 3, and proportion of patients with ≥ 1 gout flare requiring treatment over 3 months. RESULTS: At month 3, all febuxostat treatment groups were associated with greater proportions of patients achieving sUA < 5.0 mg/dl (p < 0.05 vs placebo). A greater proportion of patients receiving XR 40 mg achieved sUA < 5.0 mg/dl versus those receiving IR 40 mg (p = 0.034); proportions were similar in the IR 80 mg and XR 80 mg groups. Higher proportions of febuxostat-treated patients achieved sUA < 6.0 mg/dl at month 3 (p < 0.05 vs placebo) and experienced ≥ 1 gout flare (significant for all comparisons, except XR 40 mg). Incidences of treatment-related adverse events were low across all treatment groups; the majority were mild or moderate with no apparent trends correlating with IR or XR doses. The most common treatment-emergent adverse event was hypertension. One death (unrelated to the study drug) was reported. CONCLUSIONS: These exploratory data demonstrate that febuxostat (XR and IR) formulations were effective and well tolerated in patients with gout and moderate renal impairment. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02128490 Registered on 29 April 2014.

19 Clinical Trial Validation of pain and patient global scales in chronic gout: data from two randomised controlled trials. 2011

Singh, Jasvinder A / Yang, Shuo / Strand, Vibeke / Simon, Lee / Forsythe, Anna / Hamburger, Steve / Chen, Lang. ·Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham VA Medical Center, Alabama, USA. jasvinder.md@gmail.com ·Ann Rheum Dis · Pubmed #21622774.

ABSTRACT: OBJECTIVE: To assess validity of pain and patient global scales in gout. METHODS: The authors used data from pegloticase clinical trials in chronic refractory gout to examine the validity of visual analogue scale (VAS) pain, Short-Form 36 (SF-36) bodily pain subscale and VAS patient global assessment (all scales 0-100). Convergent/divergent validity with clinical characteristics was tested by using Spearman's correlation coefficient. For discriminant ability, the authors compared the change at 6 months between placebo and pegloticase arms and calculated effect size (ES) and standardised response mean (SRM). RESULTS: 212 patients (mean age, 55.4 years, 82% men; 73% with tophaceous gout) provided data. VAS pain was statistically significantly correlated with tender joints (r=0.42), swollen joints (r=0.30), SF-36 physical (r=-0.56) and Mental Component Summary (r=-0.36) and Health Assessment Questionnaire scores (r=0.54; all p-values <0.0001), but not disease duration (r=-0.01; p=0.84), gout flares (r=0.12; p=0.08), comorbidities (r=0.05; p=0.47) or plasma urate (r=0.01; p=0.89). Similar and significant correlation coefficients with tender and swollen joints were noted for VAS patient global assessment (r=0.35 and 0.23; p<0.0012 for both) and SF-36 pain subscale (r=-0.27 and -0.19; p<0.006 for both). Pegloticase group had significantly more improvement than placebo at 6 months, mean (SD): VAS pain, -9.2 (29.3) versus 1.9 (26.4), p=0.0002; SF-36 pain, 14.6 (25.6) versus -0.04 (21.1), p<0.0001; and patient global, -9.3 (26.5) versus 3.4 (22.8), p<0.0001. ES and SRMs in pegloticase group were as follows: VAS pain, 0.34 and 0.30; SF-36 pain, 0.69 and 0.57; patient global, 0.49 and 0.44. CONCLUSION: VAS pain, SF-36 pain and patient global VAS are valid outcome measures in patients with chronic gout.

20 Article Gout and the risk of Parkinson's disease in older adults: a study of U.S. Medicare data. 2019

Singh, Jasvinder A / Cleveland, John D. ·Medicine Service, VA Medical Center, 700 19th St S, Birmingham, Birmingham, AL, 35233, USA. Jasvinder.md@gmail.com. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA. Jasvinder.md@gmail.com. · Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. Jasvinder.md@gmail.com. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA. ·BMC Neurol · Pubmed #30611222.

ABSTRACT: BACKGROUND: In the presence of limited available data, our objective was to assess the association of gout with the risk of incident Parkinson's disease (PD) in adults 65 years or older. METHODS: We used the 5% random sample of Medicare claims data from 2006 to 2012 to examine the association of gout with incident PD. The multivariable Cox regression model adjusted for demographics, comorbidity, and common cardiovascular disease and gout medications. We calculated hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses adjusted for comorbidity categorically, or individually and for additional cardiovascular comorbidities. RESULTS: In a cohort study, 1.72 million Medicare beneficiaries were eligible. The mean age was 75 years (standard deviation [SD], 7.6), 58% were female, 86% were White and 37% had Charlson-Romano comorbidity index score of ≥2. We found that 22,636 people developed incident PD, 1129 with gout and 21,507 without gout. The respective crude incidence rates of incident PD were 3.7 vs. 2.2 per 1000 person-years. We found that gout was associated with 1.14-times higher hazard ratio (95% CI, 1.07, 1.21) of PD in the main analysis; findings were confirmed in sensitivity analyses. We noted that the risk differed slightly by age; ages 65-75, 75-85 and > 85 had hazard ratios of incident PD with gout of 1.27 (95% CI, 1.16, 1.39), 1.07 (95% CI, 0.97, 1.16) and 0.97 (95% CI, 0.79, 1.20), respectively, but no gender or race differences were noted. CONCLUSIONS: Gout was associated with a higher risk of incident PD in older adults, with the risk being significant in the age group 65-75 years. Future studies need to assess the mechanisms of this increased risk.

21 Article Gout and the risk of incident depression in older adults. 2018

Singh, Jasvinder A / Cleveland, John D. ·Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine, USA; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Avenue. South, Birmingham, AL 35294-0022, USA. Electronic address: Jasvinder.md@gmail.com. · Department of Medicine at School of Medicine, USA. Electronic address: jcleveland@uabmc.edu. ·Psychiatry Res · Pubmed #30551333.

ABSTRACT: We used the 5% random Medicare claims from Americans 65 years or older from 2006-2012 to examine the association of gout with the risk of developing incident (new) depression using multivariable-adjusted Cox proportional hazards model, adjusting for demographics (age, race, sex), common cardiovascular medications, allopurinol, and febuxostat and medical comorbidity. Of the 1.69 million people, 142,596 developed depression. In multivariable-adjusted analyses, gout was independently associated with 42% higher hazard of depression in older adults, confirmed in sensitivity analyses. This finding suggests the gout patients should be screened for depression and may trigger research to assess the role of inflammation and oxidative stress pathways in older people with depression.

22 Article Goals of gout treatment: a patient perspective. 2018

Singh, Jasvinder A. ·Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.com. · Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL, USA. Jasvinder.md@gmail.com. · University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. Jasvinder.md@gmail.com. ·Clin Rheumatol · Pubmed #30078087.

ABSTRACT: To assess the goals of gout treatment from a patient perspective, a convenience sample of consecutive patients with doctor-diagnosed gout seen at a community-based outpatient clinic were invited. Sex-stratified nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed, and rank-ordered by each participant. Thirty-six patients with doctor-diagnosed gout participated in 12 nominal groups: 6 male only, 5 female only, and 1 group with both. Mean age was 61.9 years (SD, 12.3); mean gout duration was 13.3 years (SD, 12.5); 53% were men, 64% African-American, 42% retired, 47% currently married, 87% were using either allopurinol and/or febuxostat, and 40% had had no gout flares in the last 6 months. The top 5 treatment goals accounted for 91% of all votes and included the following: (1) prevent and better manage flare-ups and improve function (25%), (2) eliminate flare-ups/disease remission (30%), (3) diet and activity modification/lifestyle change (13%), (4) patient education and public awareness (12%), and (5) medication management and minimization of side effects (11%). When examining the top-rated concern for each nominal group, the first two goals were nominated by four groups each, diet/activity modification and medication management by 1 group each, and patient education by 3 groups. There were no differences evident by sex in top-ranked treatment goal. People with gout identified and rank-ordered treatment goals relevant to them. Providers of gout care need to be cognizant of these goals. Disease management concordant with these treatment goals might lead to a more satisfied, informed patient.

23 Article Gout and the risk of age-related macular degeneration in the elderly. 2018

Singh, Jasvinder A / Cleveland, John D. ·Medicine Service, VA Medical Center, Birmingham, Alabama, United States of America. · Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America. · Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, United States of America. ·PLoS One · Pubmed #30001351.

ABSTRACT: OBJECTIVE: To assess whether gout is associated with incident age-related macular degeneration (AMD). METHODS: We used the 5% Medicare claims data from 2006-12 for all beneficiaries who were enrolled in Medicare fee-for-service (Parts A, B) and not enrolled in a Medicare Advantage Plan, and resided in the U.S. People were censored at the occurrence of new diagnosis of AMD, death or the end of study (12/31/2012), whichever occurred first. We used multivariable-adjusted Cox regression analyses to assess the association of gout with incident AMD, adjusted for demographics, comorbidity, and use of medications for cardiovascular disease and gout. Hazard ratios and 95% confidence intervals were calculated. RESULTS: In this observational cohort study, of the 1,684,314 eligible people, 116,097 developed incident AMD (6.9%). Incidence rates of AMD per 1,000 person-years were 20.1 for people with gout and 11.7 for people without gout. In multivariable-adjusted analyses, a diagnosis of gout was significantly associated with a higher risk of incident AMD with a hazard ratio of 1.39 (95% CI, 1.35, 1.43). This association was confirmed in sensitivity analyses that substituted Charlson-Romano comorbidity index continuous score with either a categorical Charlson-Romano comorbidity index score or individual Charlson-Romano index comorbidities plus hypertension, hyperlipidemia and coronary artery disease. Other covariates significantly associated with higher hazards of incident AMD were older age, female gender, White race/ethnicity, and higher Charlson-Romano comorbidity index score. CONCLUSIONS: We noted a novel association of gout with AMD in the elderly. Future studies should investigate the pathways that mediate this association.

24 Article Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients. 2018

Singh, Jasvinder A / Cleveland, John D. ·Medicine Service, VA Medical Center, 510, 20th Street South, FOT 805B, Birmingham, AL, 35233, USA. Jassingh@uab.edu. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. Jassingh@uab.edu. · Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. Jassingh@uab.edu. · University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA. Jassingh@uab.edu. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. ·Arthritis Res Ther · Pubmed #29859125.

ABSTRACT: BACKGROUND: Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults. METHODS: We assessed the 2006-2012 Medicare 5% claims data for the association of gout at baseline with the occurrence of a new (incident) MI during follow-up (no diagnosis of MI in the baseline period of at least 1 year), adjusting for patient demographics, medical comorbidity (Charlson-Romano index), and commonly used cardiovascular and gout medications, in a Cox proportional hazards model. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS: In a cohort of 1,733,613 eligible people, 14,279 developed incident MI: 13,029 MIs in people without gout and 1250 MIs in those with gout, with crude incident rates of 1.3 vs 4.1 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was significantly associated with a higher hazard of incident MI, with HR of 2.08 (95% CI 1.95, 2.21). Risk was minimally attenuated in sensitivity analyses that replaced the continuous Charlson-Romano index score with a categorical score or individual comorbidities, or expanding to a more sensitive diagnostic algorithm for incident MI, or additionally adjusting for obesity. CONCLUSIONS: Gout was independently associated with a higher risk of MI in the elderly, aged 65 years or older. The role of inflammatory and other pathways need to be explored as underlying mechanisms for this association.

25 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.

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