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Gout: HELP
Articles from University of British Columbia
Based on 31 articles published since 2008
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These are the 31 published articles about Gout that originated from University of British Columbia during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Treatment of toxic epidermal necrolysis by a multidisciplinary team. A review of literature and treatment results. 2018

Papp, Anthony / Sikora, Sheena / Evans, Morgan / Song, Diana / Kirchhof, Mark / Miliszewski, Monica / Dutz, Jan. ·Division of Plastic Surgery, Vancouver General Hospital, Canada. Electronic address: anthony.papp@ubc.ca. · Division of Plastic Surgery, Vancouver General Hospital, Canada. · Department of Dermatology and Skin Science, University of British Columbia, Canada. ·Burns · Pubmed #29627131.

ABSTRACT: BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are mucocutaneous hypersensitivity reactions, usually to drugs or their metabolites. TEN is the most severe involving greater than 30% of the total body surface area (TBSA). Management of these patients usually benefits from a large multidisciplinary team for both wound and medical management. Treatment of these patients varies between centers and physicians and there is lack of a standardized treatment protocol in the medical literature. OBJECTIVES: To review the literature and complete a retrospective review of patients treated at Vancouver General Hospital over a 11-year period. METHODS: A retrospective chart review of all patients diagnosed with SJS/TEN and treated at Vancouver General Hospital from 2001 to 2011 was completed. Data collected include patient demographics, time to transfer to a burn center, SCORTEN calculation, suspected cause of TEN, %TBSA involved, length of stay in hospital and ICU, medications, dressings, infections/cultures, fluids, mucosal involvement, teams involved, associated complications, morbidity and mortality. Data is reported quantitatively. RESULTS: A total of 67 patients were identified (28 SJS, 21 SJS/TEN overlap, 18 TEN). In SJS/TEN overlap and TEN patients, oral mucosa and trunk were the primary sites involved. SCORTEN calculations were highest in the TEN group. Plastic surgery was consulted in 53% of TEN cases, 52% of SJS/TEN cases and 25% of SJS cases. Patients were admitted to a burn unit in 74% of TEN cases, 57% of TEN/SJS cases and 21% of SJS cases. Time from symptoms to diagnosis and transfer to a burn unit was highest for TEN patients. Time from presentation to diagnosis was highest in SJS/TEN overlap. Triggers were identified in 67-82% of cases. Treatment varied widely. Patients were treated conservatively, with steroids, IVIg, and cyclosporine alone or in combination. Observed mortality was higher than predicted by SCORTEN for patients treated with IVIg and lower for those treated with Cyclosporin. Dressings varied greatly and were often changed throughout a patients stay. Total mortality was 20.9% being the highest in the TEN group (35%). CONCLUSIONS: SJS and TEN are a spectrum of severe mucocutaneous reactions that have unclear treatment recommendations within the literature and within our Level 1 hospital. Information gleaned from this research will help educate physicians involved in the treatment and management of patients with these diagnoses and has resulted in development of treatment guidelines in our hospital.

2 Review The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis. 2017

Campbell, Natasha K J / Saadeldin, Khalid / De Vera, Mary A. ·Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. · Collaboration for Outcomes Research and Evaluation, Vancouver, Canada. · Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. mdevera@mail.ubc.ca. · Collaboration for Outcomes Research and Evaluation, Vancouver, Canada. mdevera@mail.ubc.ca. · Arthritis Research Canada, Richmond, BC, Canada. mdevera@mail.ubc.ca. ·Curr Rheumatol Rep · Pubmed #28921409.

ABSTRACT: PURPOSE OF REVIEW: In this review, we synthesize current data on non-adherence across inflammatory arthritides and explore (1) the effects of economic factors on non-adherence and (2) the impacts of non-adherence on economic outcomes. RECENT FINDINGS: Recent evidence demonstrates medication non-adherence rates as high as 74% in ankylosing spondylitis (AS), 90% in gout, 50% in psoriatic arthritis (PsA), 75% in systemic lupus erythematosus (SLE), and 82% in rheumatoid arthritis (RA). The effects of socioeconomic factors have been studied most in RA and SLE but with inconsistent findings. Nonetheless, the evidence points to having prescription coverage and costs of treatment as important factors in RA and education as an important factor in SLE. Limited data in AS and gout, and no studies of the effects of socioeconomic factors in PsA, show knowledge gaps for future research. Finally, there is a dearth of data with respect to the impacts of non-adherence on economic outcomes.

3 Review Dual-Energy CT for the Musculoskeletal System. 2016

Mallinson, Paul I / Coupal, Tyler M / McLaughlin, Patrick D / Nicolaou, Savvas / Munk, Peter L / Ouellette, Hugue A. ·From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9. ·Radiology · Pubmed #27870622.

ABSTRACT: The principal advantages of dual-energy computed tomography (CT) over conventional CT in the musculoskeletal setting relate to the additional information provided regarding tissue composition, artifact reduction, and image optimization. This article discusses the manifestations of these in clinical practice-urate and bone marrow edema detection, metal artifact reduction, and tendon analysis, with potential in arthrography, bone densitometry, and metastases surveillance. The basic principles of dual-energy CT physics and scanner design will also be discussed.

4 Review Getting the Most From Your Dual-Energy Scanner: Recognizing, Reducing, and Eliminating Artifacts. 2016

Coupal, Tyler M / Mallinson, Paul I / Gershony, Sharon L / McLaughlin, Patrick D / Munk, Peter L / Nicolaou, Savvas / Ouellette, Hugue A. ·1 All authors: Radiology Department, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada. ·AJR Am J Roentgenol · Pubmed #26700343.

ABSTRACT: OBJECTIVE: Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT. CONCLUSION: The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.

5 Review What are the effects of medication adherence interventions in rheumatic diseases: a systematic review. 2016

Galo, Jessica S / Mehat, Pavandeep / Rai, Sharan K / Avina-Zubieta, Antonio / De Vera, Mary A. ·University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada. · University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada Arthritis Research Canada, Richmond, British Columbia, Canada. · Arthritis Research Canada, Richmond, British Columbia, Canada Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Richmond, British Columbia, Canada Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada Division of Rheumatology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. ·Ann Rheum Dis · Pubmed #25667208.

ABSTRACT: OBJECTIVES: Consistent reports of suboptimal treatment adherence among patients with inflammatory arthritis underscore the importance of understanding how adherence can be promoted and supported. Our objectives were to identify and classify adherence interventions; and assess the evidence on the effects of adherence interventions on outcomes of patients with rheumatic diseases. METHODS: We conducted a mapped search of Medline, Embase and International Pharmaceutical Abstract databases to identify studies meeting inclusion criteria of: (1) patient population with inflammatory arthritis; (2) evaluation of an intervention or programme targeting medication adherence directly or indirectly; (3) reporting of one or more measures of medication adherence and disease outcome; (4) publication in English, French or Spanish. For our first objective, we applied a structured framework to classify interventions according target (patient vs provider), focus (educational vs behavioural vs affective), implementation (generalised vs tailored), complexity (single vs multifaceted) and provider. For the second objective, we appraised the evidence of effects of interventions on adherence and disease outcomes. RESULTS: We identified 23 studies reporting adherence interventions that directly or indirectly addressed treatment adherence in rheumatic diseases and further appraised included RCTs. Interventions that were shown to impact adherence outcomes were generally interventions directed at adherence, tailored to patients and delivered by a healthcare provider. For interventions that were not shown to have impacts, reasons may be those related to the intervention itself, patient characteristics or study methodology. CONCLUSIONS: Our systematic review shows limited research on adherence interventions in rheumatic diseases with inconsistent impacts on adherence or disease outcome.

6 Review The economic burden of gout: A systematic review. 2015

Rai, Sharan K / Burns, Lindsay C / De Vera, Mary A / Haji, Aliya / Giustini, Dean / Choi, Hyon K. ·Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Psychology, York University, Toronto, Ontario, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. · School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. · Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: Choi.Hyon@mgh.harvard.edu. ·Semin Arthritis Rheum · Pubmed #25912932.

ABSTRACT: OBJECTIVE: Gout is a painful and disabling joint disease that constitutes the most common inflammatory arthritis in the US. To clarify the economic impact of gout, we systematically reviewed the literature on the direct and indirect costs associated with this disease. METHODS: We conducted a literature search of MEDLINE, EMBASE, International Pharmaceutical Abstracts, NHS Economic Evaluation, and CINAHL databases to identify studies of gout and economics. We systematically reviewed published studies that met our inclusion criteria and extracted and summarized all relevant economic parameters. Reported costs were inflation-adjusted to 2013 US dollars (USD). RESULTS: A total of 15 studies met all eligibility criteria. Three controlled studies reported all-cause total direct costs based on specific populations (i.e., $4733, $16,925, and $18,362 per capita among employed, elderly, and treatment-refractory gout populations, respectively, and $2562, $10,590, and $7188 among corresponding non-gout patients). Two additional studies, although uncontrolled, allowed for estimation of total all-cause direct costs in unselected gout populations ($11,080 and $13,170). Gout-related costs ranged from $172 to $6179, depending on population characteristics. Six studies reported positive associations of direct costs with SUA level, gout attack frequency, or presence of tophi. Four studies reported on indirect costs, which were estimated to be as high as $4341 USD. CONCLUSION: The available data suggest that gout patients incur substantially greater direct and indirect costs as compared with gout-free individuals among elderly and treatment-refractory gouty patients, whereas the costs are considerably less among younger, employed gouty patients. Further, direct costs increased with worsening disease characteristics.

7 Review Preventing attacks of acute gout when introducing urate-lowering therapy: a systematic literature review. 2014

Seth, Rakhi / Kydd, Alison S R / Falzon, Louise / Bombardier, Claire / van der Heijde, Désirée M / Edwards, Christopher J. ·From the Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, ON, Canada.D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; R. Seth, BM, MRCP, Department of Rheumatology, University Hospital Southampton NHS Foundation Trust; A.S.R. Kydd, MD, PhD, FRCPC, Clinical Assistant Professor, Division of Rheumatology, University of British Columbia; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital. ·J Rheumatol Suppl · Pubmed #25180127.

ABSTRACT: OBJECTIVE: To systematically review the evidence on treatment available to prevent an acute attack of gout when initiating a urate-lowering therapy (ULT) and for how long this treatment should be continued. To also evaluate the evidence on the optimal time to start a ULT after an acute attack of gout. METHODS: A systematic review as part of the 3e (Evidence, Expertise, Exchange) Initiative on Diagnosis and Management of Gout was performed using Medline, Embase, Cochrane Central Register of Controlled Trials (from 1950 to October 2011), and the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) 2010/2011 meeting abstracts. Two reviewers independently screened titles and abstracts for selection criteria. Included articles were reviewed in detail, and a risk of bias assessment (using the Cochrane tool) was performed. RESULTS: The search identified 8168 articles and 197 abstracts, from which 4 randomized controlled trials were included in the review. Two of these studies compared placebo with colchicine, 1 compared differing durations of colchicine, and 1 compared colchicine with canakinumab. CONCLUSION: Two randomized controlled trials have shown that colchicine prophylaxis for at least 6 months, when starting a ULT, reduces the risk of acute attacks. Canakinumab, although not currently licensed for gout, has been shown to provide prophylaxis superior to colchicine, when starting a ULT. There is no evidence on the optimum time to start a ULT after an acute gout attack.

8 Review Urate-lowering therapy for the management of gout: a summary of 2 Cochrane reviews. 2014

Kydd, Alison S / Seth, Rakhi / Buchbinder, Rachelle / Falzon, Louise / Edwards, Christopher J / van der Heijde, Désirée M / Bombardier, Claire. ·From the Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Monash Department of Clinical Epidemiology, Cabrini Hospital; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.A.S. Kydd, MD, PhD, FRCPC, Clinical Assistant Professor, Division of Rheumatology, University of British Columbia; R. Seth, BM, MRCP, Department of Rheumatology, University Hospital Southampton NHS Foundation Trust; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto Ge ·J Rheumatol Suppl · Pubmed #25180126.

ABSTRACT: OBJECTIVE: To systematically review the evidence on the efficacy, safety, and cost-effectiveness of urate-lowering therapy for gout: xanthine oxidase inhibitors (allopurinol and febuxostat), uricosuric medications (benzbromarone, probenecid and sulfinpyrazone), and uricases (pegloticase and rasburicase). METHODS: A systematic review was performed as part of the 3e (Evidence, Expertise, Exchange) Initiative on Gout. The primary efficacy outcomes were frequency of acute gout attacks, study participant withdrawal due to adverse events, and cost-effectiveness. Serum urate-lowering was a secondary outcome and was the most commonly reported outcome in the included trials. RESULTS: The search identified 17 articles for efficacy, 31 for safety, and 3 for cost-effectiveness. The main outcome described in these studies was serum urate-lowering. Allopurinol, febuxostat, and pegloticase are all effective at lowering serum urate compared to placebo and febuxostat (≥ 80 mg) was more effective at lowering serum urate than allopurinol. Compared to probenecid, benzbromarone was more effective at lowering serum urate. Regarding acute gout attacks, pegloticase and febuxostat (≥ 120 mg) resulted in more acute attacks than placebo. Regarding the primary safety outcome, more withdrawals due to adverse events were seen only when pegloticase was compared to placebo. The two trials of cost-effectiveness were inconclusive. CONCLUSION: There is currently moderate quality data supporting the efficacy and safety of allopurinol, febuxostat, benzbromarone, and probenecid in gout. Pegloticase, while efficacious, is associated with more withdrawals due to adverse events and infusion reactions. There is insufficient evidence currently with respect to the cost-effectiveness or the most optimal sequencing of urate-lowering therapy.

9 Review Medication adherence in gout: a systematic review. 2014

De Vera, Mary A / Marcotte, Greg / Rai, Sharan / Galo, Jessica S / Bhole, Vidula. ·University of British Columbia Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada. ·Arthritis Care Res (Hoboken) · Pubmed #24692321.

ABSTRACT: OBJECTIVE: Recent data suggesting the growing problem of medication nonadherence in gout have called for the need to synthesize the burden, determinants, and impacts of the problem. Our objective was to conduct a systematic review of the literature examining medication adherence among patients with gout in real-world settings. METHODS: We conducted a search of Medline, Embase, International Pharmaceutical Abstracts, PsycINFO, and CINAHL databases and selected studies of gout patients and medication adherence in real-world settings. We extracted information on study design, sample size, length of followup, data source (e.g., prescription records versus electronic monitoring versus self-report), type of nonadherence problem evaluated, adherence measures and reported estimates, and determinants of adherence reported in multivariable analyses. RESULTS: We included 16 studies that we categorized according to methods used to measure adherence, including electronic prescription records (n = 10), clinical records (n = 1), electronic monitoring devices (n = 1), and self-report (n = 4). The burden of nonadherence was reported in all studies, and among studies based on electronic prescription records, adherence rates were all below 0.80 and the proportion of adherent patients ranged from 10-46%. Six studies reported on determinants, with older age and having comorbid hypertension consistently shown to be positively associated with better adherence. One study showed the impact of adherence on achieving a serum uric acid target. CONCLUSION: With less than half of gout patients in real-world settings adherent to their treatment, this systematic review highlights the importance of health care professionals discussing adherence to medications during encounters with patients.

10 Review The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases. 2014

Mallinson, Paul I / Reagan, Adrian C / Coupal, Tyler / Munk, Peter L / Ouellette, Hugue / Nicolaou, Savvas. ·Radiology Department, Vancouver General Hospital, Jim Pattison Pavilion, 899W 12th Ave, Vancouver, Canada, V5Z 1M9, dr_pmallinson@hotmail.com. ·Skeletal Radiol · Pubmed #24337414.

ABSTRACT: OBJECTIVE: Clinical detection of gout can be difficult due to co-existent and mimicking arthropathies and asymptomatic disease. Understanding of the distribution of urate within the body can aid clinical diagnosis and further understanding of the resulting pathology. Our aim was to determine this distribution of urate within the extremities in patients with gout. MATERIALS AND METHODS: All patients who underwent a four-limb dual-energy computed tomography (DECT) scan for suspected gout over a 2-year period were identified (n = 148, 121 male, 27 female, age range, 16-92 years, mean = 61.3 years, median = 63 years). The reports of the positive cases were retrospectively analyzed and the locations of all urate deposition recorded and classified by anatomical location. RESULTS: A total of 241 cases met the inclusion criteria, of which 148 cases were positive. Of these, 101 (68.2 %) patients had gout in the foot, 81 (56.1 %) in the knee, 79 (53.4 %) in the ankle, 41 (27.7 %) in the elbow, 25 (16.9 %) in the hand, and 25 (16.9 %) in the wrist. The distribution was further subcategorized for each body part into specific bone and soft tissue structures. CONCLUSIONS: In this observational study, we provide for the first time a detailed analysis of extremity urate distribution in gout, which both supports and augments to the current understanding based on clinical and microscopic findings.

11 Article Referral Patterns for Dual-Energy Computed Tomography in Diagnosis and Management of Gout: Ten-Year Experience at a Canadian Institution. 2018

Gong, Bo / Shojania, Kamran / Khosa, Faisal / Nicolaou, Savvas. ·Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: bogong.ustc@gmail.com. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. ·Can Assoc Radiol J · Pubmed #30249410.

ABSTRACT: PURPOSE: To analyze the utilization, indications, and outcomes of dual-energy computed tomography (DECT) gout imaging in clinical practice. METHODS: This retrospective study was ethics approved. Radiology reports of DECT gout scans between 2007 and 2016 were analyzed for trends of utilization, referral pattern, indication, and diagnosis. RESULTS: DECT gout referrals increased substantially (2007: 37; 2008: 72; 2016: 385; total: 1877). The largest number of referrals were from rheumatology (1160), emergency medicine (283), and family medicine (177). Most referrals (92%) were requested to aid an initial diagnosis of gout. Other reasons included estimating the disease burden (6%) or monitoring disease progression and effectiveness of treatment (2%). Rheumatology accounted for most referrals for the latter two reasons (81% and 97%). Imaging findings of urate presence were similar in referrals from rheumatology (62%), family medicine (62%), and other medical specialties (62%). The urate positive rates were slightly lower in referrals from emergency medicine (47%) and surgical specialties (41%). The most common differential diagnoses by referring specialties were calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and other inflammatory or erosive arthritides (rheumatology, family medicine), CPPD and infections (other medical specialties), infections and fractures (emergency medicine), neoplasm and infections (surgical specialties). CONCLUSIONS: The increasing utilization of DECT for gout imaging validates its clinical value. Varying clinical presentation could explain differences of urate positive rates among specialties. Our results support a multispecialty collaborative approach to the diagnosis and management of gout, with direct access to DECT gout imaging provided to various physician specialties.

12 Article How patients with gout become engaged in disease management: a constructivist grounded theory study. 2018

Howren, Alyssa / Cox, Susan M / Shojania, Kam / Rai, Sharan K / Choi, Hyon K / De Vera, Mary A. ·Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. · Arthritis Research Canada, Richmond, BC, Canada. · Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada. · University of British Columbia, School of Population & Public Health, Vancouver, BC, Canada. · Faculty of Medicine, Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada. · Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. · Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, USA. · Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. mdevera@mail.ubc.ca. · Arthritis Research Canada, Richmond, BC, Canada. mdevera@mail.ubc.ca. · Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada. mdevera@mail.ubc.ca. ·Arthritis Res Ther · Pubmed #29859127.

ABSTRACT: BACKGROUND: Prior qualitative research on gout has focused primarily on barriers to disease management. Our objective was to use patients' perspectives to construct an explanatory framework to understand how patients become engaged in the management of their gout. METHODS: We recruited a sample of individuals with gout who were participating in a proof-of-concept study of an eHealth-supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics. Semistructured interviews were used. We analyzed transcripts using principles of constructivist grounded theory involving initial coding, focused coding and categorizing, and theoretical coding. RESULTS: Twelve participants with gout (ten males, two females; mean age, 66.5 ± 13.3 years) were interviewed. The analysis resulted in the construction of three themes as well as a framework describing the dynamically linked themes on (1) processing the diagnosis and management of gout, (2) supporting management of gout, and (3) interfering with management of gout. In this framework, patients with gout transition between each theme in the process of becoming engaged in the management of their gout and may represent potential opportunities for healthcare intervention. CONCLUSIONS: Findings derived from this study show that becoming engaged in gout management is a dynamic process whereby patients with gout experience factors that interfere with gout management, process their disease and its management, and develop the practical and perceptual skills necessary to manage their gout. By understanding this process, healthcare providers can identify points to adapt care delivery and thereby improve health outcomes.

13 Article Presence of monosodium urate crystal deposition by dual-energy CT in patients with gout treated with allopurinol. 2018

Dalbeth, Nicola / Nicolaou, Savvas / Baumgartner, Scott / Hu, Jia / Fung, Maple / Choi, Hyon K. ·Department of Medicine, University of Auckland, Auckland, New Zealand. · Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada. · Formerly Ardea Biosciences, Inc., San Diego, California, USA. · Department of Rheumatology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. ·Ann Rheum Dis · Pubmed #29146741.

ABSTRACT: OBJECTIVE: Dual-energy CT (DECT) detects and quantifies monosodium urate (MSU) crystal deposition with high precision. This DECT study assessed crystal deposition in patients with gout treated with stable-dose allopurinol, and investigated potential clinical determinants for crystal deposition. METHODS: Patients with gout treated with allopurinol ≥300 mg daily for at least 3 months were prospectively recruited from the USA and New Zealand, using monitored enrolment to include approximately 25% patients with palpable tophi and approximately 50% with serum urate (sUA) levels <6.0 mg/dL (<357µmol/L). MSU crystal deposition was measured in the hands/wrists, feet/ankles/Achilles and knees bilaterally. The presence and total volume of crystals were assessed by DECT and analysed according to sUA levels and gout characteristics. RESULTS: Among 152 patients receiving allopurinol ≥300 mg/day for 5.1 years on average, 69.1% had crystal deposition on DECT, with a median total crystal volume of 0.16 cm CONCLUSION: A substantial proportion of patients without palpable tophi have MSU crystal deposition, despite receiving allopurinol doses ≥300 mg/day for a considerable duration. Patients with higher sUA and clinical features of severe disease have a higher frequency and greater volume of MSU crystal deposition.

14 Article Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial protocol. 2017

Day, Richard O / Frensham, Lauren J / Nguyen, Amy D / Baysari, Melissa T / Aung, Eindra / Lau, Annie Y S / Zwar, Nicholas / Reath, Jennifer / Laba, Tracey / Li, Ling / McLachlan, Andrew / Runciman, William B / Buchbinder, Rachelle / Clay-Williams, Robyn / Coiera, Enrico / Braithwaite, Jeffrey / McNeil, H Patrick / Hunter, David J / Pile, Kevin D / Portek, Ian / WIlliams, Kenneth Mapson / Westbrook, Johanna I. ·Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia. · St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia. · Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. · Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. · School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia. · School of Medicine, Western Sydney University, Sydney, Australia. · The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia. · The Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, Australia. · The Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada. · Faculty of Pharmacy and Centre for Education and Research on Ageing, University of Sydney, Sydney, Australia. · School of Health Sciences, University of South Australia, Adelaide, Australia. · Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. · Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia. · Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia. · Department of Medicine, Western Sydney University, Sydney, Australia. · Department of Rheumatology, Campbelltown Hospital, Sydney, Australia. · St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia. · Department of Rheumatology, St George Hospital, Sydney, Australia. ·BMJ Open · Pubmed #29042386.

ABSTRACT: INTRODUCTION: Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate-lowering therapy (ULT) is poor, with rates of less than 50% 1 year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. We aim to evaluate the effectiveness of use of a personal, self-management, 'smartphone' application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. METHODS AND ANALYSIS: Setting and designPrimary care. A prospective, cluster randomised (by general practitioner (GP) practices), controlled trial. PARTICIPANTS: GP practices will be randomised to either intervention or control clusters with their patients allocated to the same cluster. INTERVENTION: The intervention group will have access to the Healthy.me app tailored for the self-management of gout. The control group patients will have access to the same app modified to remove all functions except the Gout Attack Diary. PRIMARY AND SECONDARY OUTCOMES: The proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes will be proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a ≥30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed 'dropout' rate 20%. ETHICS AND DISSEMINATION: This study has been approved by the University of New South Wales Human Research Ethics Committee. Study findings will be disseminated in international conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER: ACTRN12616000455460.

15 Article Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013. 2017

Moradi-Lakeh, Maziar / Forouzanfar, Mohammad H / Vollset, Stein Emil / El Bcheraoui, Charbel / Daoud, Farah / Afshin, Ashkan / Charara, Raghid / Khalil, Ibrahim / Higashi, Hideki / Abd El Razek, Mohamed Magdy / Kiadaliri, Aliasghar Ahmad / Alam, Khurshid / Akseer, Nadia / Al-Hamad, Nawal / Ali, Raghib / AlMazroa, Mohammad AbdulAziz / Alomari, Mahmoud A / Al-Rabeeah, Abdullah A / Alsharif, Ubai / Altirkawi, Khalid A / Atique, Suleman / Badawi, Alaa / Barrero, Lope H / Basulaiman, Mohammed / Bazargan-Hejazi, Shahrzad / Bedi, Neeraj / Bensenor, Isabela M / Buchbinder, Rachelle / Danawi, Hadi / Dharmaratne, Samath D / Zannad, Faiez / Farvid, Maryam S / Fereshtehnejad, Seyed-Mohammad / Farzadfar, Farshad / Fischer, Florian / Gupta, Rahul / Hamadeh, Randah Ribhi / Hamidi, Samer / Horino, Masako / Hoy, Damian G / Hsairi, Mohamed / Husseini, Abdullatif / Javanbakht, Mehdi / Jonas, Jost B / Kasaeian, Amir / Khan, Ejaz Ahmad / Khubchandani, Jagdish / Knudsen, Ann Kristin / Kopec, Jacek A / Lunevicius, Raimundas / Abd El Razek, Hassan Magdy / Majeed, Azeem / Malekzadeh, Reza / Mate, Kedar / Mehari, Alem / Meltzer, Michele / Memish, Ziad A / Mirarefin, Mojde / Mohammed, Shafiu / Naheed, Aliya / Obermeyer, Carla Makhlouf / Oh, In-Hwan / Park, Eun-Kee / Peprah, Emmanuel Kwame / Pourmalek, Farshad / Qorbani, Mostafa / Rafay, Anwar / Rahimi-Movaghar, Vafa / Shiri, Rahman / Rahman, Sajjad Ur / Rai, Rajesh Kumar / Rana, Saleem M / Sepanlou, Sadaf G / Shaikh, Masood Ali / Shiue, Ivy / Sibai, Abla Mehio / Silva, Diego Augusto Santos / Singh, Jasvinder A / Skogen, Jens Christoffer / Terkawi, Abdullah Sulieman / Ukwaja, Kingsley N / Westerman, Ronny / Yonemoto, Naohiro / Yoon, Seok-Jun / Younis, Mustafa Z / Zaidi, Zoubida / Zaki, Maysaa El Sayed / Lim, Stephen S / Wang, Haidong / Vos, Theo / Naghavi, Mohsen / Lopez, Alan D / Murray, Christopher J L / Mokdad, Ali H. ·Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA. · Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran. · Norwegian Institute of Public Health, Bergen, Norway. · Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. · Japan International Cooperation Agency, Lusaka, Zambia. · Ophthalmology resident in Aswan University Hospital, Aswan, Egypt. · Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden. · Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. · The University of Melbourne, Melbourne, Victoria, Australia. · The University of Sydney, Sydney, New South Wales, Australia. · Hospital for Sick Children, Toronto, Ontario, Canada. · University of Toronto, Toronto, Ontario, Canada. · Food and Nutrition Administration, Ministry of Health, Safat, Kuwait. · University of Oxford, Oxford, UK. · Saudi Ministry of Health, Riyadh, Saudi Arabia. · Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan. · Charité Universitätsmedizin, Berlin, Germany. · King Saud University, Riyadh, Saudi Arabia. · Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan. · Public Health Agency of Canada, Toronto, Ontario, Canada. · Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia. · Charles R. Drew University of Medicine and Science, Los Angeles, California, USA. · David Geffen School of Medicine, University of California at Los Angeles (UCLA), California, USA. · College of Public Health and Tropical Medicine, Jazan, Saudi Arabia. · University of São Paulo, São Paulo, Brazil. · Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia. · Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. · Walden University, Minneapolis, Minnesota, USA. · Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. · Clinical Investigation Centre INSERM (the National Institute for Health and Medical Research), Université de Lorraine, Vandoeuvre les Nancy, France. · Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. · Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden. · Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran. · Bielefeld University, Bielefeld, Germany. · West Virginia Bureau for Public Health, Charleston, West Virginia, USA. · Arabian Gulf University, Manama, Bahrain. · Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates. · Nevada Division of Behavior and Public Health, Carson City, Nevada, USA. · Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA. · Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia. · Salah Azaiz Institute, Tunis, Tunisia. · Institute of Community and Public Health, Birzeit University, Birzeit, Palestine. · Health Economics Research Unit, University of Aberdeen, Aberdeen, UK. · Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. · Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran. · Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. · Health Services Academy, Islamabad, Pakistan. · Ball State University, Muncie, Indiana, USA. · Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway. · University of British Columbia, Vancouver, British Columbia, Canada. · Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK. · School of Medicine, University of Liverpool, Liverpool, UK. · Mansoura Faculty of Medicine, Mansoura, Egypt. · Imperial College London, London, UK. · Digestive Disease Research Institute, Tehran Universities of Medical Sciences, Tehran, Iran. · McGill University, Montreal, Quebec, Canada. · College of Medicine, Howard University, Washington DC, USA. · Thomas Jefferson University, Philadelphia, Pennsylvania, USA. · College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. · Hunger Action Los Angeles, Los Angeles, California, USA. · Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria. · Institute of Public Health, Heidelberg University, Heidelberg, Germany. · International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. · Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon. · Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea. · Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea. · National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA. · Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. · Contech International Health Consultants, Lahore, Pakistan. · Contech School of Public Health, Lahore, Pakistan. · Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. · Finnish Institute of Occupational Health, Helsinki, Finland. · Sweidi Hospital, Riyadh, Saudi Arabia. · Society for Health and Demographic Surveillance, Suri, India. · Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. · Independent Consultant, Karachi, Pakistan. · Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK. · Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK. · Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. · Federal University of Santa Catarina, Florianópolis, Brazil. · University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA. · Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway. · Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA. · Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia. · Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria. · Federal Institute for Population Research, Wiesbaden, Germany. · German National Cohort Consortium, Heidelberg, Germany. · Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan. · Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea. · Jackson State University, Jackson, Mississippi, USA. · University Hospital, Setif, Algeria. · Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. ·Ann Rheum Dis · Pubmed #28209629.

ABSTRACT: OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

16 Article The rising prevalence and incidence of gout in British Columbia, Canada: Population-based trends from 2000 to 2012. 2017

Rai, Sharan K / Aviña-Zubieta, J Antonio / McCormick, Natalie / De Vera, Mary A / Shojania, Kam / Sayre, Eric C / Choi, Hyon K. ·Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: hchoi@partners.org. ·Semin Arthritis Rheum · Pubmed #28040245.

ABSTRACT: OBJECTIVES: Gout is increasingly recognized as the most common form of inflammatory arthritis worldwide; however, no Canadian data on the disease burden of gout are available. We estimated the prevalence, incidence, prescription patterns, and comorbidity burden of gout in an entire Canadian province [British Columbia (BC)] over the last decade. METHODS: We utilized PopulationData BC, a province-wide database, to estimate temporal trends in the prevalence and incidence of gout from 2000 to 2012, as well as according to age category. Annual estimates were age-sex-standardized using 2012 as the reference. We also examined annual trends in prescription patterns of common gout medications and assessed the comorbidity burden among gout patients in 2012. RESULTS: The 2012 prevalence of gout was 3.8% among the overall population, and the incidence rate was 2.9 per 1000 person-years. Both gout prevalence and incidence increased substantially over the study period. This burden additionally increased according to age category, affecting over 8% of those ages 60-69 years in 2012. Approximately 22% of gout patients received a prescription for urate-lowering therapy (ULT), which remained stable over the study period, while colchicine and oral glucocorticoid use both increased modestly. By 2012, 72%, 52%, and 18% of prevalent gout patients had been diagnosed with hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS: The burden of gout in BC, Canada, is substantial, and both the prevalence and incidence have increased over the past decade, while prescription of ULT remains low. These data support the need to improve gout prevention and care.

17 Article Trends in Gout and Rheumatoid Arthritis Hospitalizations in Canada From 2000 to 2011. 2017

Rai, Sharan K / Aviña-Zubieta, J Antonio / McCormick, Natalie / De Vera, Mary A / Lacaille, Diane / Sayre, Eric C / Choi, Hyon K. ·Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada. · Arthritis Research Canada, Vancouver, British Columbia, Canada, and Massachusetts General Hospital and Harvard Medical School, Boston. ·Arthritis Care Res (Hoboken) · Pubmed #27565008.

ABSTRACT: OBJECTIVE: Gout and rheumatoid arthritis (RA) are the 2 most common forms of inflammatory arthritis worldwide. As hospitalizations for both conditions lead to substantial health resource use, contemporary inpatient trends and associated costs may provide important benchmarks of disease burden. However, relevant data are limited. METHODS: We used PopulationData BC, a population-based administrative data set from Canada. We examined trends in the annual hospitalization and surgery rate of gout and RA from 2000 to 2011. Additionally, we examined annual trends in the inpatient cost burden of both conditions. We assessed annual trends in hospitalization and surgery rates using Poisson regression models and cost trends using linear regression models. RESULTS: From 2000 to 2011, the annual hospitalization rate for RA declined by 49% from 15.4 to 7.9 per 100,000 Canadian adults (P < 0.001), whereas that for gout doubled from 3.8 to 7.6 per 100,000 Canadian adults (P < 0.001). Approximately 31% of RA admissions were associated with hip or knee replacement surgery; the trend of these surgeries paralleled the declining trend in RA hospitalizations (P = 0.0097). The inpatient costs also reflected the hospitalization trends, with a 40% decrease in RA hospital costs, while gout costs more than doubled over the study period. CONCLUSION: Our findings indicate that hospitalization rates for gout have doubled over the past decade, while those for RA have decreased considerably. While these data provide an encouraging benchmark for RA care, they also highlight the critical need to improve gout management and prevention to mitigate its rising disease burden in Canada and beyond.

18 Article Gout and the risk of Alzheimer's disease: a population-based, BMI-matched cohort study. 2016

Lu, Na / Dubreuil, Maureen / Zhang, Yuqing / Neogi, Tuhina / Rai, Sharan K / Ascherio, Alberto / Hernán, Miguel A / Choi, Hyon K. ·Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. · Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA. · Arthritis Research Centre of Canada, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. · Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. ·Ann Rheum Dis · Pubmed #25739830.

ABSTRACT: OBJECTIVE: While gout is associated with cardiovascular (CV)-metabolic comorbidities and their sequelae, the antioxidant effects of uric acid may have neuroprotective benefits. We evaluated the potential impact of incident gout on the risk of developing Alzheimer's disease (AD) in a general population context. METHODS: We conducted an age-matched, sex-matched, entry-time-matched and body mass index (BMI)-matched cohort study using data from The Health Improvement Network, an electronic medical record database representative of the UK general population, from 1 January 1995 to 31 December 2013. Up to five non-gout individuals were matched to each case of incident gout by age, sex, year of enrolment and BMI. We compared incidence rates of AD between the gout and comparison cohorts, excluding individuals with prevalent gout or dementia at baseline. Multivariate hazard ratios (HRs) were calculated, while adjusting for smoking, alcohol use, physician visits, social deprivation index, comorbidities and medication use. We repeated the same analysis among patients with incident osteoarthritis (OA) as a negative control exposure. RESULTS: We identified 309 new cases of AD among 59 224 patients with gout (29% female, mean age 65 years) and 1942 cases among 238 805 in the comparison cohort over a 5-year median follow up (1.0 vs 1.5 per 1000 person-years, respectively). Univariate (age-matched, sex-matched, entry-time-matched and BMI-matched) and multivariate HRs for AD among patients with gout were 0.71 (95% CI 0.62 to 0.80) and 0.76 (95% CI 0.66 to 0.87), respectively. The inverse association persisted among subgroups stratified by sex, age group (<75 and ≥75 years), social deprivation index and history of CV disease. The association between incident OA and the risk of incident AD was null. CONCLUSIONS: These findings provide the first general population-based evidence that gout is inversely associated with the risk of developing AD, supporting the purported potential neuroprotective role of uric acid.

19 Article Multiple Cutaneous Creamy Papules and Nodules: A Case of Miliarial Gout. 2015

Kirchhof, Mark G / Collins, David / Crawford, Richard I / Au, Sheila. ·Department of Dermatology and Skin Science and Division of Rheumatology, Department of Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC kirchhof.mark@gmail.com. · Department of Dermatology and Skin Science and Division of Rheumatology, Department of Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC. ·J Cutan Med Surg · Pubmed #25775647.

ABSTRACT: BACKGROUND: Tophaceous gout is the nonarticular deposition of monosodium urate resulting from a disorder in purine metabolism that causes an elevation of serum uric acid. Cutaneous variants of tophaceous gout include papular, nodular, ulcerative, and pustular forms. OBJECTIVE: We present a case of a 67-year-old man who presented with multiple cutaneous creamy white papules and nodules. A biopsy was taken, and a diagnosis of cutaneous tophaceous gout was made. The treatment and pathophysiology are discussed. CONCLUSION: Miliarial gout is a rare form of cutaneous tophaceous gout that is treated using xanthine oxidase inhibitors such as allopurinol and febuxostat or uricosurics such as probenecid.

20 Article Uricosuric medications for chronic gout. 2014

Kydd, Alison S R / Seth, Rakhi / Buchbinder, Rachelle / Edwards, Christopher J / Bombardier, Claire. ·Division of Rheumatology, University of British Columbia, 1650 Terminal Ave, Suite 206, Nanaimo, BC, Canada, V9S 0A3. ·Cochrane Database Syst Rev · Pubmed #25392987.

ABSTRACT: BACKGROUND: Uricosuric agents have long been used in the treatment of gout but there is little evidence regarding their benefit and safety in this condition. OBJECTIVES: To assess the benefits and harms of uricosuric medications in the treatment of chronic gout. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2013), Ovid MEDLINE and Ovid EMBASE for studies to the 13 May 2013. We also searched the World Health Organization Clinical Trials Registry, ClinicalTrials.gov and the 2011 to 2012 American College of Rheumatology and European League against Rheumatism abstracts. WE considered black box warnings and searched drug safety databases to identify and describe rare adverse events. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) or quasi-randomised controlled trials (controlled clinical trials (CCTs)) that compared uricosuric medications (benzbromarone, probenecid or sulphinpyrazone) alone or in combination with another therapy (placebo or other active uric acid-lowering medication, or non-pharmacological treatment) in adults with chronic gout for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies for inclusion, extracted data and performed a risk of bias assessment. Main outcomes were frequency of acute gout attacks, serum urate normalisation, study participant withdrawal due to adverse events, total adverse events, pain reduction, function and tophus regression. MAIN RESULTS: The search identified four RCTs and one CCT that evaluated the benefit and safety of uricosurics for gout. One study (65 participants) compared benzbromarone with allopurinol for a duration of four months; one compared benzbromarone with allopurinol (36 participants) for a duration of nine to 24 months; one study (62 participants) compared benzbromarone with probenecid for two months and one study (74 participants) compared benzbromarone with probenecid. One study (37 participants) compared allopurinol with probenecid. No study was completely free from bias.Low-quality evidence from one study (55 participants) comparing benzbromarone with allopurinol indicated uncertain effects in terms of frequency of acute gout attacks (4% with benzbromarone versus 0% with allopurinol; risk ratio (RR) 3.58, 95% confidence interval (CI) 0.15 to 84.13), while moderate-quality evidence from two studies (101 participants; treated for four to nine months) indicated similar proportions of participants achieving serum urate normalisation (73.9% with benzbromarone versus 60% with allopurinol; pooled RR 1.27, 95% CI 0.90 to 1.79). Low-quality evidence indicated uncertain differences in withdrawals due to adverse events (7.1% with benzbromarone versus 6.1% with allopurinol; pooled RR 1.25, 95% CI 0.28 to 5.62), and total adverse events (20% with benzbromarone versus 6.7% with allopurinol; RR 3.00, 95% CI 0.64 to 14.16). The study did not measure pain reduction, function and tophus regression.When comparing benzbromarone with probenecid, there was moderate-quality evidence based on one study (62 participants) that participants taking benzbromarone were more likely to achieve serum urate normalisation after two months (81.5% with benzbromarone versus 57.1% with probenecid; RR 1.43, 95% CI 1.02 to 2.00). This indicated that when compared with probenecid, five participants needed to be treated with benzbromarone in order to have one additional person achieve serum urate normalisation (number needed to treat for an additional beneficial outcome (NNTB) 5). However, the second study reported no difference in the absolute decrease in serum urate between these groups after 12 weeks. Low-quality evidence from two studies (129 participants) indicated uncertain differences between treatments in the frequency of acute gout attacks (6.3% with benzbromarone versus 10.6% with probenecid; pooled RR 0.73, 95% CI 0.09 to 5.83); fewer withdrawals due to adverse events with benzbromarone (2% with benzbromarone versus 17% with probenecid; pooled RR 0.15, 95% CI 0.03 to 0.79, NNTB 7) and fewer total adverse events (21% with benzbromarone versus 47% with probenecid; pooled RR 0.43, 95% CI 0.25 to 0.74; NNTB 4). The studies did not measure pain reduction, function and tophus regression.Low-quality evidence based on one small CCT (37 participants) indicated uncertainty around the difference in the incidence of acute gout attacks between probenecid and allopurinol after 18 to 20 months' treatment (53% with probenecid versus 55% with allopurinol; RR 0.96, 95% CI 0.53 to 1.75). The study did not measure or report the proportion achieving serum urate normalisation, pain reduction, function, tophus regression, withdrawal due to adverse events and total adverse events. AUTHORS' CONCLUSIONS: There was moderate-quality evidence that there is probably no important difference between benzbromarone and allopurinol at achieving serum urate normalisation, but that benzbromarone is probably more successful than probenecid at achieving serum urate normalisation in people with gout. There is some uncertainty around the effect estimates, based on low-quality evidence from only one or two trials, on the number of acute gout attacks, the number of withdrawals due to adverse events or the total number of participants experiencing adverse events when comparing benzbromarone with allopurinol. However, when compared with probenecid, benzbromarone resulted in fewer withdrawals due to adverse events and fewer participants experiencing adverse events. Low-quality evidence from one small study indicated uncertain effects in the incidence of acute gout attacks when comparing probenecid with allopurinol therapy. We downgraded the evidence because of a possible risk of performance and other biases and imprecision.

21 Article A pilot study on dual-energy computed tomography for detection of urate deposits in renal transplant patients with asymptomatic hyperuricemia. 2014

Kimura-Hayama, Eric / Criales-Vera, Sergio / Nicolaou, Savvas / Betanzos, Jose Luis / Rivera, Yahaira / Alberú, Josefina / Rull-Gabayet, Marina / Hernández-Molina, Gabriela. ·From the *Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; †Department of Emergency/Trauma Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada; and Departments of ‡Immunology and Rheumatology and §Transplant, Instituto Nacional de Ciencias Médicas y Nutrición SZ, Mexico City, Mexico. ·J Clin Rheumatol · Pubmed #25160012.

ABSTRACT: BACKGROUND: An increasing role of dual-energy computed tomography (DECT) scan in tophaceous gout assessment is recognized, whereas its role in asymptomatic hyperuricemia is unknown. OBJECTIVE: The objective of this study was to assess the prevalence of joint and renal monosodium urate deposits by DECT in asymptomatic hyperuricemia. METHODS: Among a renal transplant population with at least 1 year of follow-up, we included 27 patients with sustained hyperuricemia and 11 with normal serum uric acid (SUA) levels. We excluded patients with gout or history of monoarthritis or oligoarthritis. We registered demographic data, drugs, hyperuricemia onset, comorbidities, renal function, and SUA. We used a 128-slice dual-source CT system, and the acquisition protocol included the pelvis and imaging of elbows, wrists, hands, knees, ankles, and feet. The reading process was performed by 2 radiologists. RESULTS: The mean age was 43.7 ± 12 years, 57.8% were males, and median follow-up was 7 years. Hyperuricemia presented after a median time of 0.61 years after transplantation and had persisted for a median of 3.2 years (0.5-16.8 years). For the hyperuricemic group, the median SUA at the DECT scan and the maximum SUA levels were 7.9 and 8.9 mg/dL, respectively. Groups were similar in most of the clinical variables. We did not find any articular or renal deposit; conversely, we demonstrated a quadriceps tendon deposition in 1 patient with hyperuricemia (prevalence of 0.03%; 95% confidence interval, 0.006%-0.17%). CONCLUSIONS: In these patients with asymptomatic hyperuricemia, the prevalence of monosodium urate deposition assessed by DECT was low; however, larger studies need to be performed for further validation.

22 Article Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. 2014

Mallinson, Paul Ian / Coupal, Tyler / Reisinger, Clemens / Chou, Hong / Munk, Peter Loren / Nicolaou, Savvas / Ouellette, Hugue. ·1 Department of Radiology, Vancouver General Hospital and University of British Columbia, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada. ·AJR Am J Roentgenol · Pubmed #24951221.

ABSTRACT: OBJECTIVE: The objective of our study was to discover the types and incidence of artifacts in dual-energy CT (DECT) using datasets of 50 consecutive patients who underwent a four-limb DECT protocol for the evaluation of suspected gout. Identification of artifacts and techniques for artifact reduction are discussed. CONCLUSION: Artifacts commonly occur in DECT performed for gout assessment but are usually readily recognizable. For 90% of the patients in our study who underwent imaging for suspected gout, DECT showed some type of artifact, with nail bed and skin artifacts being the most common.

23 Article Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. 2012

Nicolaou, Savvakis / Liang, Teresa / Murphy, Darra T / Korzan, Jeff R / Ouellette, Hugue / Munk, Peter. ·Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada. savvas.nicolaou@vch.ca ·AJR Am J Roentgenol · Pubmed #23097171.

ABSTRACT: OBJECTIVE: Dual-energy CT (DECT) characterizes the chemical composition of material according to its differential x-ray attenuation at two different energy levels. Applications of DECT in musculoskeletal imaging include imaging of bone marrow edema, tendons, and ligaments and the use of monoenergetic techniques to minimize metal prosthesis beam-attenuating artifacts. CONCLUSION: The most validated application of DECT is undoubtedly its noninvasive and highly specific ability for confirming the presence of monosodium urate deposits in the assessment of gout.

24 Article Febuxostat efficacy in allopurinol-resistant tophaceous gout. 2011

Uh, Mitchell / Reid, Graham. ·Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada. ·J Clin Rheumatol · Pubmed #21617552.

ABSTRACT: Allopurinol has been a standard hypouricemic agent for more than 40 years, but febuxostat, which is also a xanthine oxidase inhibitor, is now available. We present a case of tophaceous gout with uric acid levels that did not respond to prescription of very high doses of allopurinol or uricosuric agents. With febuxostat treatment, the patient had rapid and sustained reduction in her uric acid levels to target range. This case raises the possibility of currently unrecognized pharmacologic differences between allopurinol and febuxostat.

25 Article Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. 2010

Nicolaou, Savvakis / Yong-Hing, Charlotte Jane / Galea-Soler, Sandro / Hou, Daniel J / Louis, Luck / Munk, Peter. ·ER Radiology Division, Radiology Department, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada. savvas.nicolaou@vch.ca ·AJR Am J Roentgenol · Pubmed #20308513.

ABSTRACT: OBJECTIVE: Gout is the most common crystal deposition arthropathy currently diagnosed clinically and with arthrocentesis. Dual-energy CT is a promising new imaging technique offering potential new applications in a number of clinical areas. CONCLUSION: The ability of dual-energy CT to diagnose early gout and its use as a problem-solving tool is shown here. Diagnosis of subclinical gout could avert associated long-term complications, thereby reducing disease burden and improving overall quality of life.

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