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Gout: HELP
Articles from North Yorkshire
Based on 6 articles published since 2008
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These are the 6 published articles about Gout that originated from North Yorkshire during 2008-2019.
 
+ Citations + Abstracts
1 Review Treat to target in gout. 2018

Perez-Ruiz, Fernando / Moreno-Lledó, Aitana / Urionagüena, Irati / Dickson, Alastair J. ·Rheumatology Division, Hospital Universitario Cruces, Biocruces Health Research Institute, and University of the Basque Country. · Family physician, Las Arenas Healthcare Centre, Biscay, Spain. · Primary Care Rheumatology Society & Honorary Associate, Centre of Health Economics, University of York, UK. ·Rheumatology (Oxford) · Pubmed #29272512.

ABSTRACT: The treat-to-target (T2T) approach has been successfully implemented in a number of diseases. T2T has been proposed for rheumatic diseases such as RA, spondyloarthritis, lupus, and recently for gout. The level of evidence for such approaches differs from one condition to the other (moderate to high for hyperlipidaemia, for example). Practice is based on the best available evidence at any time, and in absence of good evidence for T2T in gout, some suggest a conservative only-treat-symptoms approach. Evidence suggests that not treating gout to target in the long term is overall associated with worsening outcomes, such as flares, tophi and structural damage, which is associated to loss of quality of life and mortality. Different targets have been proposed for hyperuricaemia in gout; lower than 6 mg/dl (0.36 mmol/l) for all patients, at least <5 mg/dl (0.30 mmol/l) for patients with severe-polyarticular or tophaceous-gout.

2 Review Interventions for tophi in gout: a Cochrane systematic literature review. 2014

Sriranganathan, Melonie K / Vinik, Ophir / Falzon, Louise / Bombardier, Claire / van der Heijde, Desiree M / Edwards, Christopher J. ·From the Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Division of Rheumatology, University of Toronto, Toronto, Ontario, 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, Ontario, Canada; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and the Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; 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; 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. ·J Rheumatol Suppl · Pubmed #25180130.

ABSTRACT: OBJECTIVE: To systematically review the available literature on the management of tophi in gout. This article is based on the Cochrane Review Interventions for Tophi in Gout published in the Cochrane Database of Systematic Reviews. METHODS: Medline, Embase, and The Cochrane Library were searched using a strategy developed with an experienced librarian. We also searched American College of Rheumatology and European League Against Rheumatism conference abstracts from 2010-2011. Included articles were reviewed in detail and a risk of bias (using the Cochrane tool) and quality assessment were performed. RESULTS: In total, 3206 references were recovered. Of these, 72 articles were selected based on our inclusion criteria. This included 1 report of 2 randomized controlled trials, 2 nonrandomized studies, and 69 case series and reports. The study with 2 randomized controlled trials looked at pegloticase. This showed improvement in tophi with treatment. One observational prospective trial looked at allopurinol and benzbromarone individually and in combination. It noted that achieving lower serum urate levels was associated with a faster reduction of tophi. An open-label extension trial noted that longterm maintenance of serum uric acid < 6.0 mg/dl with febuxostat led to a reduction in tophi. The case series and reports looked at surgical, pharmacological, and other interventions, as well as combination therapies. All surgical interventions reported improvement in pain and/or function. No report had objective measures of outcome. CONCLUSION: Treatment with urate-lowering therapy such as allopurinol, benzbromarone, allopurinol + benzbromarone in combination, febuxostat, or pegloticase can lead to reduction in tophi. There is some evidence that achieving a lower serum urate level leads to a faster rate of tophi reduction.

3 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.

4 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.

5 Review Lifestyle interventions for the treatment of gout: a summary of 2 Cochrane systematic reviews. 2014

Moi, John H Y / Sriranganathan, Melonie K / Falzon, Louise / Edwards, Christopher J / van der Heijde, Désirée M / Buchbinder, Rachelle. ·From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; 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; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, 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; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University. ·J Rheumatol Suppl · Pubmed #25180125.

ABSTRACT: OBJECTIVE: To determine the efficacy and safety of lifestyle interventions for treating gout. METHODS: Two Cochrane systematic reviews assessed the efficacy and safety of lifestyle interventions for the treatment of acute and chronic gout. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to September 2011, and the 2010-2011 American College of Rheumatology and European League Against Rheumatism conference abstracts. Primary outcomes of interest were joint pain for acute gout, frequency of gout attacks for chronic gout, and withdrawals due to adverse events for both reviews. RESULTS: One trial met inclusion criteria for each review. An unblinded trial (19 participants), at high risk of bias, found that topical ice added to prednisolone and colchicine for acute gout resulted in significantly greater pain reduction at 1 week [mean difference (MD) -3.33 cm, 95% confidence interval (95% CI) -5.84 to -0.82 on 10 cm visual analog scale]. Adverse events were not described. The second trial (120 participants), at moderate risk of bias, compared enriched skim milk powder (glycomacropeptide and G600 milk fat extract) to non-enriched skim milk and lactose powders for treating chronic gout. There were no between-group differences in gout attack frequency over 3 months [MD -0.21 (95% CI -0.76 to 0.34)] or withdrawals due to adverse events [relative risk 1.27 (95% CI 0.53 to 3.03)]. CONCLUSION: While there is observational evidence for an association between lifestyle risk factors and gout development, there are no high quality trials to support or refute the use of lifestyle interventions for treating acute or chronic gout.

6 Review How to interpret plain radiographs in clinical practice. 2013

Brown, Andrew K. ·Senior Lecturer in Medical Education & Rheumatology, Hull York Medical School, University of York, United Kingdom. andrew.brown@hyms.ac.uk ·Best Pract Res Clin Rheumatol · Pubmed #23731934.

ABSTRACT: In this article I will consider the basic principles of requesting, acquiring, interpreting and reporting plain radiographs of joints, including assessment of the distribution of joint abnormalities, and specific pathological changes that may occur in bone, cartilage and soft tissues. I will then move on to a more specific discussion of the major arthropathies and the role of radiographs in the diagnosis and assessment in each condition as well as reviewing the combined abnormalities that may be visible on radiographs and how these relate to underlying pathological processes.