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Gout: HELP
Articles from Nebraska
Based on 23 articles published since 2009
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These are the 23 published articles about Gout that originated from Nebraska during 2009-2019.
 
+ Citations + Abstracts
1 Editorial To Treat or Not to Treat (to Target) in Gout. 2017

Neogi, Tuhina / Mikuls, Ted R. ·From Boston University School of Medicine, Boston, Massachusetts · University of Nebraska Medical Center, Omaha, Nebraska. ·Ann Intern Med · Pubmed #27802507.

ABSTRACT: -- No abstract --

2 Editorial The Problem with Gout Is That It's Still Such a Problem. 2016

Coburn, Brian W / Mikuls, Ted R. ·Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center and the Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA; · Umbach Professor of Rheumatology, Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center and the Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA tmikuls@unmc.edu. ·J Rheumatol · Pubmed #27481987.

ABSTRACT: -- No abstract --

3 Article Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. 2019

Bursill, David / Taylor, William J / Terkeltaub, Robert / Abhishek, Abhishek / So, Alexander K / Vargas-Santos, Ana Beatriz / Gaffo, Angelo Lino / Rosenthal, Ann / Tausche, Anne-Kathrin / Reginato, Anthony / Manger, Bernhard / Sciré, Carlo / Pineda, Carlos / van Durme, Caroline / Lin, Ching-Tsai / Yin, Congcong / Albert, Daniel Arthur / Biernat-Kaluza, Edyta / Roddy, Edward / Pascual, Eliseo / Becce, Fabio / Perez-Ruiz, Fernando / Sivera, Francisca / Lioté, Frédéric / Schett, Georg / Nuki, George / Filippou, Georgios / McCarthy, Geraldine / da Rocha Castelar Pinheiro, Geraldo / Ea, Hang-Korng / Tupinambá, Helena De Almeida / Yamanaka, Hisashi / Choi, Hyon K / Mackay, James / ODell, James R / Vázquez Mellado, Janitzia / Singh, Jasvinder A / Fitzgerald, John D / Jacobsson, Lennart T H / Joosten, Leo / Harrold, Leslie R / Stamp, Lisa / Andrés, Mariano / Gutierrez, Marwin / Kuwabara, Masanari / Dehlin, Mats / Janssen, Matthijs / Doherty, Michael / Hershfield, Michael S / Pillinger, Michael / Edwards, N Lawrence / Schlesinger, Naomi / Kumar, Nitin / Slot, Ole / Ottaviani, Sebastien / Richette, Pascal / MacMullan, Paul A / Chapman, Peter T / Lipsky, Peter E / Robinson, Philip / Khanna, Puja P / Gancheva, Rada N / Grainger, Rebecca / Johnson, Richard J / Te Kampe, Ritch / Keenan, Robert T / Tedeschi, Sara K / Kim, Seoyoung / Choi, Sung Jae / Fields, Theodore R / Bardin, Thomas / Uhlig, Till / Jansen, Tim / Merriman, Tony / Pascart, Tristan / Neogi, Tuhina / Klück, Viola / Louthrenoo, Worawit / Dalbeth, Nicola. ·Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia davebursill@bigpond.com. · Department of Medicine, University of Otago, Wellington, New Zealand. · Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand. · Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA. · Department of Academic Rheumatology, University of Nottingham, Nottingham, UK. · Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland. · Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. · Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA. · Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany. · Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA. · Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany. · Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy. · Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy. · Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico. · Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands. · Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. · Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA. · Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA. · Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK. · Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain. · Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. · Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland. · Rheumatology Division, Cruces University Hospital, Baracaldo, Spain. · Department of Medicine, University of the Basque Country, Biscay, Spain. · Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain. · Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain. · Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France. · Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France. · Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany. · Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. · Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland. · School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. · Department of Rheumatology, Hôpital Lariboisière, Paris, France. · Rheumatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. · Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan. · School of Medicine, Tokyo Women's Medical University, Tokyo, Japan. · Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. · President and CEO, Aristea Therapeutics, San Diego, California, USA. · Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA. · Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico. · Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA. · Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA. · Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. · Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. · Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA. · Department of Medicine, Otago University, Christchurch, New Zealand. · Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain. · Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México. · Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. · Department of Cardiology, Toranomon Hospital, Minato-ku, Japan. · Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden. · Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands. · Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA. · Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA. · College of Medicine, University of Florida, Gainesville, Florida, USA. · Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. · Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA. · Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark. · Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France. · Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France. · Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada. · Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand. · CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA. · School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. · Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA. · Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria. · Department of Medicine, University of Otago, Wellington, Wellington, New Zealand. · Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA. · Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA. · Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA. · Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea. · Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA. · Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Biochemistry, University of Otago, Dunedin, New Zealand. · Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France. · Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ·Ann Rheum Dis · Pubmed #31501138.

ABSTRACT: OBJECTIVE: There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS: A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS: The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION: Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.

4 Article Comparison of an interactive voice response system and smartphone application in the identification of gout flares. 2019

Elmagboul, Nada / Coburn, Brian W / Foster, Jeffrey / Mudano, Amy / Melnick, Joshua / Bergman, Debra / Yang, Shuo / Redden, David / Chen, Lang / Filby, Cooper / Curtis, Jeffrey R / Mikuls, Ted R / Saag, Kenneth G. ·University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA. · University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA. · University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA. ksaag@uabmc.edu. ·Arthritis Res Ther · Pubmed #31255174.

ABSTRACT: OBJECTIVE: To examine the feasibility, preference, and satisfaction of an interactive voice response (IVR) system versus a customized smartphone application (StudyBuddy) to capture gout flares METHODS: In this 24-week prospective, randomized, crossover, open-label pilot study, 44 gout patients were randomized to IVR vs. StudyBuddy and were crossed over to the other technology after 12 weeks. Flares were reported via weekly (and later daily) scheduled StudyBuddy or IVR queries. Feasibility was ascertained via response rate to scheduled queries. At 12 and 24 weeks, participants completed preference/satisfaction surveys. Preference and satisfaction were assessed using dichotomous or ordinal questions. Sensitivity was assessed by the frequency of flare reporting with each approach. RESULTS: Thirty-eight of 44 participants completed the study. Among completers, feasibility was similar for IVR (81%) and StudyBuddy (80%). Conversely, most (74%) preferred StudyBuddy. Measures of satisfaction (ease of use, preference over in-person clinic visits, and willingness for future use) were similar between the IVR and StudyBuddy; however, more participants deemed the StudyBuddy as convenient (95% vs. 73%, P = 0.01) and less disruptive (97% vs. 82%, P = 0.03). Although the per patient number of weeks in flare was not significantly different (mean 3.4 vs. 2.6 weeks/patient, P = 0.15), the StudyBuddy captured more of the total flare weeks (35%) than IVR (27%, P = 0.02). CONCLUSION: A smartphone application and IVR demonstrated similar feasibility but overall sensitivity to capture gout flares and participant preference were greater for the smartphone application. Participant preference for the smartphone application appeared to relate to perceptions of greater convenience and lower disruption. TRIAL REGISTRATION: NCT, NCT02855437 . Registered 4 August 2016.

5 Article Coexistent Hyperuricemia and Gout in Rheumatoid Arthritis: Associations with Comorbidities, Disease Activity and Mortality. 2019

Chiou, Andrew / England, Bryant R / Sayles, Harlan / Thiele, Geoffrey M / Duryee, Michael J / Baker, Joshua F / Singh, Namrata / Cannon, Grant W / Kerr, Gail S / Reimold, Andreas / Gaffo, Angelo / Mikuls, Ted R. ·Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. · Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE. · Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE. · Corporal Michael J. Crescenz Veterans Affairs Medical Center (VAMC), University of Pennsylvania, Philadelphia, PA. · Iowa City VAMC and University of Iowa, Iowa City, IA. · VAMC and University of Utah, Salt Lake City, UT. · DC VAMC, Georgetown & Howard University, Washington, DC. · Dallas VAMC, University of Texas Southwestern, Dallas, TX. · Birmingham VAMC, University of Alabama at Birmingham, Birmingham, AL. ·Arthritis Care Res (Hoboken) · Pubmed #31074584.

ABSTRACT: OBJECTIVE: Although hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes in RA is unclear. We examined associations of coexistent hyperuricemia and gout with RA disease measures, RA treatments, and survival. METHODS: Participants from a longitudinal RA study were categorized by the presence of gout and serum urate (sUA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline sUA levels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses. RESULTS: Of 1,999 participants with RA, 341 (17%) had sUA concentrations >6.8 mg/dl and 121 (6.1%) were diagnosed with gout. There were no significant associations of enrollment sUA or gout with RA disease activity or treatment with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving NSAIDs. After age- and sex-adjustment, moderate hyperuricemia (sUA >6.8-8 mg/dl) was associated with an increased risk of CVD-related mortality (HR 1.56; 95% CI 1.11-2.21). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompanied hyperuricemia. Results corresponding with sUA >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline sUA with all-cause mortality. CONCLUSION: Our study reports the frequency of hyperuricemia and gout in patients with RA. These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity. This article is protected by copyright. All rights reserved.

6 Article Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial. 2019

Mikuls, Ted R / Cheetham, T Craig / Levy, Gerald D / Rashid, Nazia / Kerimian, Artak / Low, Kimberly J / Coburn, Brian W / Redden, David T / Saag, Kenneth G / Foster, P Jeffrey / Chen, Lang / Curtis, Jeffrey R. ·Division of Rheumatology, University of Nebraska Medical Center and Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb. Electronic address: tmikuls@unmc.edu. · Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif; Western University of Health Sciences, College of Pharmacy, Pomona, Calif. · Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif. · Drug Information Services, Kaiser Permanente Southern California, Downey, Calif. · Division of Rheumatology, University of Nebraska Medical Center and Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb. · Department of Biostatistics, University of Alabama at Birmingham. · Division of Rheumatology, University of Alabama at Birmingham. ·Am J Med · Pubmed #30503879.

ABSTRACT: PURPOSE: The purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes. METHODS: We conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at 1 year. Outcomes were reassessed at year 2. RESULTS: Patients who underwent intervention were more likely than patients of usual care to be adherent (50% vs 37%; odds ratio [OR] 1.68; 95% confidence interval [CI] 1.30, 2.17) and reach serum urate goal (30% vs 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (1 year after the intervention ended), differences were attenuated, remaining significant for urate goal but not for adherence. The intervention was associated with a 6%-16% lower gout flare rate during year 2, but the differences did not reach statistical significance. CONCLUSIONS: A pharmacist-led intervention incorporating automated telephone technology improved adherence and serum urate goal in patients with gout initiating allopurinol. Although this light-touch, low-tech intervention was efficacious, additional efforts are needed to enhance patient engagement in gout management and ultimately to improve outcomes.

7 Article Antioxidant properties of citric acid interfere with the uricase-based measurement of circulating uric acid. 2019

Ryan, Evan M / Duryee, Michael J / Hollins, Andrew / Dover, Susan K / Pirruccello, Samuel / Sayles, Harlan / Real, Kevin D / Hunter, Carlos D / Thiele, Geoffrey M / Mikuls, Ted R. ·Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA. · Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA; Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA. Electronic address: mduryee@unmc.edu. · Department of Clinical Sciences, Surgery, Duke University, Durham, NC, USA. · Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA. · Department of Clinical Pathology, University of Nebraska Medical Center, Omaha, NE, USA. · Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA; Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA. ·J Pharm Biomed Anal · Pubmed #30447534.

ABSTRACT: BACKGROUND: Circulating uric acid (UA) is an important biomarker, not only in the detection and management of gout, but also in assessing the risk of related comorbidity. The impact of collection methods on clinical UA measurements has been the subject of limited study. After observing significant differences between UA concentrations of blood samples obtained by different collection tubes, we began examining the effects of exogenous tube components on measured UA concentrations. We aimed to: (1) demonstrate the variability in uricase-based UA measurements attributable to different collection methods and (2) identify factors influencing this variability. METHODS: Blood samples from human subjects were collected using Serum Separator Tubes (SST tubes), Acid Citrate Dextrose (ACD) tubes, and Sodium Citrate (SC) tubes. Circulating UA concentrations were measured by chemistry analyzers utilizing the uricase method. Absorbance assays were run in order to determine the effects of citric acid, sodium citrate, and dextrose on measured absorbance in the presence of leuco crystal violet dye, hydrogen peroxide, and peroxidase. Statistical analyses-including Student's T tests and ANOVA-were used to compare results. RESULTS: UA concentrations of blood samples collected in ACD tubes were significantly lower than those collected in SST tubes (P < 0.01). Samples collected in SC tubes trended towards lower UA measurements than samples collected in SST tubes, although this difference did not reach statistical significance (P = 0.06). Blood samples spiked with separate concentrations of sodium citrate (3.2 and 22.0 g/L), citric acid (8.0 g/L), and dextrose (24.5 g/L) demonstrated significantly lower UA measurements compared to controls (P < 0.01). Absorbance assays demonstrated that increasing concentrations of citric acid and sodium citrate-in the presence of leuco crystal violet, hydrogen peroxide, and peroxidase-decreased the amount of oxidized dye in the uricase method of UA measurement in a dose-dependent manner (P < 0.01). In contrast, dextrose did not significantly alter the amount of oxidized dye available. DISCUSSION: Our results indicate that citric acid obstructs accurate uricase-based UA measurement, providing falsely low values. Citric acid, a known antioxidant, scavenges hydrogen peroxide, a key intermediate using the uricase method. By scavenging hydrogen peroxide, citric acid decreases the amount of oxidized leuco dye leading to falsely low UA measurements. Therefore, collection tubes, like ACD and SC tubes, which contain concentrations of citric acid or its conjugate base sodium citrate should not be used to measure circulating UA levels when utilizing uricase-based measurement methods.

8 Article Towards standardized patient reported physical function outcome reporting: linking ten commonly used questionnaires to a common metric. 2019

Oude Voshaar, M A H / Vonkeman, H E / Courvoisier, D / Finckh, A / Gossec, L / Leung, Y Y / Michaud, K / Pinheiro, G / Soriano, E / Wulfraat, N / Zink, A / van de Laar, M A F J. ·Department of Psychology, Health and Technology, University of Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands. A.H.Oudevoshaar@utwente.nl. · Department of Psychology, Health and Technology, University of Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands. · Arthritis Center Twente and Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands. · Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland. · UPMC Univ Paris 06, GRC-UPMC 08, Paris, France. · Rheumatology Department, Pitié Salpêtrière Hospital, APHP, Paris, France. · Department of Rheumatology and Immunology, Singapore General Hosptial, Singapore, Singapore. · Duke-NUS Medical School, Singapore, Singapore. · The National Databank for Rheumatic Diseases, Wichita, KS and University of Nebraska Medical Center, Omaha, NE, USA. · Discipline of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Rheumatology Unit, Internal Medical Services, Hospital Italiano de Buenos Aires, and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · Wilhelmina Children's Hospital, Utrecht, The Netherlands. · German Rheumatism Research Centre, Epidemiology Unit, and Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany. ·Qual Life Res · Pubmed #30317425.

ABSTRACT: OBJECTIVES: Outcomes obtained using different physical function patient reported outcome measures (PROMs) are difficult to compare. To facilitate standardization of physical function outcome measurement and reporting we developed an item response theory (IRT) based standardized physical function score metric for ten commonly used physical function PROMs. METHODS: Data of a total of 16,386 respondents from representative cohorts of patients with rheumatic diseases as well as the Dutch general population were used to map the items of ten commonly used physical function PROMs on a continuous latent physical function variable. The resulting IRT based common metric was cross-validated in an independent dataset of 243 patients with gout, osteoarthritis or polymyalgia in which four of the linked PROMs were administered. RESULTS: Our analyses supported that all 97 items of the ten included PROMs relate to a single underlying physical function variable and that responses to each item could be described by the generalized partial credit IRT model. In the cross-validation analyses we found congruent mean scores for four different PROMs when the IRT based scoring procedures were used. CONCLUSIONS: We showed that the standardized physical function score metric developed in this study can be used to facilitate standardized reporting of physical function outcomes for ten commonly used make physical function PROMs.

9 Article Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout. 2018

FitzGerald, John D / Mikuls, Ted R / Neogi, Tuhina / Singh, Jasvinder A / Robbins, Mark / Khanna, Puja P / Turner, Amy S / Myslinski, Rachel / Suter, Lisa G. ·David Geffen School of Medicine, University of California, Los Angeles. · VA Nebraska-Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha. · Boston University School of Medicine, Boston, Massachusetts. · Birmingham Veterans Affairs Medical Center, and University of Alabama at Birmingham. · Harvard Vanguard Medical Association, Somerville, Massachusetts. · University of Michigan, and VA Ann Arbor Healthcare System, Ann Arbor, Michigan. · American College of Rheumatology, Atlanta, Georgia. · Yale University, New Haven, Connecticut, and West Haven Veterans Affairs Medical Center, West Haven, Connecticut. ·Arthritis Care Res (Hoboken) · Pubmed #29649348.

ABSTRACT: OBJECTIVE: Electronic clinical quality measures (eCQMs) are increasingly used by health registries and third parties to evaluate and improve the quality of health care. To complete these eCQMs, data are extracted from electronic health records (EHRs). The treatment of gout has been an area identified with gaps in quality of care. On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs to evaluate gout care. METHODS: Drawing from the 2012 ACR gout guidelines, a working group developed candidate gout process measures that were evaluated by an interdisciplinary panel of health care stakeholders, the ACR Quality Measures Subcommittee (QMS), and ultimately the ACR Board of Directors for formal validity testing. For each of the selected gout eCQMs, 3 clinical sites using different EHR systems tested the scientific feasibility and validity of the measures. Measures appropriate for accountability were presented for national endorsement. RESULTS: Of the 10 proposed eCQMs, 4 were endorsed by the ACR QMS, 3 were incorporated into the ACR's Rheumatology Informatics System for Effectiveness (RISE) Registry, and 2 were endorsed by the National Quality Forum. The 3 eCQMs incorporated into RISE (evaluating indications for urate-lowering therapy [ULT]), monitoring serum urate, and treat-to-target outcome) demonstrated high validity and reliability. Proportions of patients passing these 3 eCQMs in RISE and at the 3 clinical testing sites ranged between 32% and 58%, indicating significant room for improvement in care. CONCLUSION: Three eCQMs have been validated and implemented into RISE. Two of these measures (evaluating indications for ULT and monitoring serum urate) are available for use in federal quality reporting programs. Performance on these measures suggests there is significant room for improvement in the management of gout.

10 Article Design and Rationale for the Veterans Affairs "Cooperative Study Program 594 Comparative Effectiveness in Gout: Allopurinol vs. Febuxostat" Trial. 2018

Timilsina, S / Brittan, K / O'Dell, J R / Brophy, M / Davis-Karim, A / Henrie, A M / Neogi, T / Newcomb, J / Palevsky, P M / Pillinger, M H / Pittman, D / Taylor, T H / Wu, H / Mikuls, T R. ·VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States. · Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Cooperative Study Program Coordinating Center, Boston, MA, United States. · VA Cooperative Study Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, United States. · Boston University School of Medicine, Boston, MA, United States. · VA Pittsburgh Healthcare System, Pittsburgh, PA, United States. · New York University Langone Medical Center, New York, NY, United States. · White River Junction VA Hospital, White River Junction, VT, United States. · VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States. Electronic address: Ted.Mikuls@va.gov. ·Contemp Clin Trials · Pubmed #29597007.

ABSTRACT: BACKGROUND: Gout patients do not routinely achieve optimal outcomes related in part to suboptimal administration of urate lowering therapy (ULT) including first-line xanthine oxidase inhibitors allopurinol or febuxostat. Studies leading to the approval of febuxostat compared this agent to allopurinol in inappropriately low, fixed doses. We will compare allopurinol with febuxostat in gout using appropriately titrated doses of both agents and a "treat-to-target" strategy congruent with specialty guidelines. METHODS: We have planned and initiated the Veterans Affairs (VA) Cooperative Study Program (CSP) 594, Comparative Effectiveness in Gout: Allopurinol vs Febuxostat study. This large double-blind, non-inferiority trial will enroll 950 gout patients randomized to receive allopurinol or febuxostat. Patients will be followed for a total of 72 weeks encompassing 3 distinct 24-week study phases. During Phase I (0-24 weeks), participants will undergo gradual dose titration of ULT until achievement of serum uric acid (sUA) <6.0 mg/dL or <5.0 mg/dL if tophi are present. Dose escalation will not be allowed during final three study visits of Phase 2 (24-48 weeks) and during Phase 3 (48-72 weeks). The primary study outcome is the proportion of participants experiencing at least one gout flare during Phase 3. Subsequent to the 72-week study, participants will be followed passively for up to 10 years after the study to assess long-term health outcomes. CONCLUSION: With its completion, the VA Comparative Effectiveness in Gout: Allopurinol vs Febuxostat study will demonstrate the central role of gradual ULT dose escalation and a treat-to-target strategy in gout management.

11 Article Allopurinol Dose Escalation and Mortality Among Patients With Gout: A National Propensity-Matched Cohort Study. 2018

Coburn, Brian W / Michaud, Kaleb / Bergman, Debra A / Mikuls, Ted R. ·Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas. · University of Nebraska Medical Center, Omaha. ·Arthritis Rheumatol · Pubmed #29513934.

ABSTRACT: OBJECTIVE: Observational data suggest that hyperuricemia and gout are associated with increased mortality, while allopurinol use is associated with reduced mortality. In addition, the protective effect of allopurinol may be dose dependent. The aim of the current study was to determine whether allopurinol dose escalation is associated with cause-specific mortality in patients with gout. METHODS: In this 10-year observational, active-comparator study of US Veterans with gout who initiated treatment with allopurinol, propensity score matching, Cox proportional hazards models, and competing risks regression analyses were used to assess differences in cause-specific mortality between patients whose allopurinol dose was escalated (dose escalators) and those whose allopurinol dose was not escalated or was reduced (non-escalators) over a 2-year period. RESULTS: Among the 6,428 dose escalators and 6,428 matched non-escalators, there were 2,867 deaths during the observation period (40.4 deaths per 1,000 person-years). Dose escalators experienced an increase in all-cause mortality (hazard ratio [HR] 1.08, 95% confidence interval [95% CI] 1.01-1.17), with the effect sizes being similar for incidence of cardiovascular-related deaths (HR 1.08, 95% CI 0.97-1.21) and cancer-related deaths (HR 1.06, 95% CI 0.88-1.27), although neither reached statistical significance. Dose escalation to achieve the goal of lowering the serum urate (SU) level to <6.0 mg/dl was infrequent. At 2 years, 10% of dose escalators were receiving a final daily dose of >300 mg and 31% had achieved the SU goal. In a sensitivity analysis limited to dose escalators achieving the SU goal, there was a nonsignificant reduction of 7% in the hazard of cardiovascular-related mortality (HR 0.93, 95% CI 0.76-1.14). CONCLUSION: This is the largest study to date to investigate the effects of allopurinol use on mortality and is the first to use a rigorous active-comparator design. Dose escalation was associated with a small (<10%) increase in all-cause mortality, thus showing that a strategy of allopurinol dose escalation, which in current real-life practice is characterized by limited dose increases, is unlikely to improve the survival of patients with gout.

12 Article Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management. 2017

Coburn, Brian W / Bendlin, Kayli A / Sayles, Harlan / Meza, Jane / Russell, Cynthia L / Mikuls, Ted R. ·From the *Medicine Service, Veterans Affairs Nebraska-Western Iowa Health Care System; †Division of Rheumatology, University of Nebraska Medical Center; ‡Pharmacy Service, Veterans Affairs Nebraska-Western Iowa Health Care System; and §Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE; and ∥School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO. ·J Clin Rheumatol · Pubmed #28816767.

ABSTRACT: BACKGROUND: Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. OBJECTIVES: The aim of this study was to examine associations of patient and provider factors with optimal gout management. METHODS: Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. RESULTS: A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). CONCLUSIONS: Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.

13 Article Treatment Options for Acute Gout. 2016

Coburn, Brian W / Mikuls, Ted R. ·is a staff rheumatologist and research scientist at the VA Nebraska Western-Iowa Health Care System. is a MD-PhD student and Dr. Mikuls is the Umbach Professor of Rheumatology at the University of Nebraska Medical Center, all in Omaha. ·Fed Pract · Pubmed #30766136.

ABSTRACT: Careful consideration of comorbidities and contraindications are important when determining the appropriate treatment of patients with gout.

14 Article Rationale and design of the randomized evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) Study. 2016

Coburn, Brian W / Cheetham, T Craig / Rashid, Nazia / Chang, John M / Levy, Gerald D / Kerimian, Artak / Low, Kimberly J / Redden, David T / Bridges, S Louis / Saag, Kenneth G / Curtis, Jeffrey R / Mikuls, Ted R. ·Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States. · Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States. · Drug Information Services, Kaiser Permanente Southern California, Downey, CA, United States. · Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States. · Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States. · Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States; Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States. Electronic address: tmikuls@unmc.edu. ·Contemp Clin Trials · Pubmed #27449546.

ABSTRACT: BACKGROUND: Despite the availability of effective therapies, most gout patients achieve suboptimal treatment outcomes. Current best practices suggest gradual dose-escalation of urate lowering therapy and serial serum urate (sUA) measurement to achieve sUA<6.0mg/dl. However, this strategy is not routinely used. Here we present the study design rationale and development for a pharmacist-led intervention to promote sUA goal attainment. METHODS: To overcome barriers in achieving optimal outcomes, we planned and implemented the Randomized Evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) study. This is a large pragmatic cluster-randomized trial designed to assess a highly automated, pharmacist-led intervention to optimize allopurinol treatment in gout. Ambulatory clinics (n=101) from a large health system were randomized to deliver either the pharmacist-led intervention or usual care to gout patients over the age of 18years newly initiating allopurinol. All participants received educational materials and could opt-out of the study. For intervention sites, pharmacists conducted outreach primarily via an automated telephone interactive voice recognition system. The outreach, guided by a gout care algorithm developed for this study, systematically promoted adherence assessment, facilitated sUA testing, provided education, and adjusted allopurinol dosing. The primary study outcomes are achievement of sUA<6.0mg/dl and treatment adherence determined after one year. With follow-up ongoing, study results will be reported subsequently. CONCLUSION: Ambulatory care pharmacists and automated calling technology represent potentially important, underutilized resources for improving health outcomes for gout patients.

15 Article Increasing Public Health Burden of Arthritis and Other Rheumatic Conditions and Comorbidity: Results From a Statewide Health Surveillance System, 2007-2012. 2016

Han, Guang-Ming / Michaud, Kaleb / Yu, Fang / Watanabe-Galloway, Shinobu / Mikuls, Ted R. ·University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas. · University of Nebraska Medical Center, Omaha. tmikuls@unmc.edu. · Omaha Veterans Affairs Medical Center and University of Nebraska Medical Center, Omaha. ·Arthritis Care Res (Hoboken) · Pubmed #26866827.

ABSTRACT: OBJECTIVE: To describe the burden and changing trends of arthritis and other rheumatic conditions (AORCs) on health care and public health by estimating annual rates of emergency department (ED) visits, hospitalizations, and mortality, in addition to medical charges related to AORCs and their comorbidities in Nebraska from 2007 to 2012. METHODS: Nebraska state ED discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to estimate disease burden. AORCs were defined using the standard International Classification of Diseases specified by the National Arthritis Data Workgroup. AORC conditions were defined by the presence of a diagnostic code anywhere on the corresponding record. To identify potential disparities in AORC burden, health care utilization was examined separately across 4 urban/rural categories. RESULTS: Rates of annual ED visits (34% increase), hospitalizations (22% increase) and mean charges (an approximate 30% to 70% increase) from visits involving AORCs increased significantly from 2007 to 2012. Annual rates of ED visits and hospitalizations involving AORCs were lower in urban metropolitan areas compared to other urban/rural designations. AORC-related mortality was highest in small rural communities. Disease profiles revealed that ED visits and hospitalizations involving gout and other crystal arthropathies increased disproportionately compared to other AORCs. CONCLUSION: The public health burden of AORCs increased significantly over the 6-year period studied, posing a growing challenge for patients, families, and the public health system, and AORCs appear to disproportionately impact nonmetropolitan and other rural communities.

16 Article Target Serum Urate: Do Gout Patients Know Their Goal? 2016

Coburn, Brian W / Bendlin, Kayli A / Sayles, Harlan / Hentzen, Kathryn S / Hrdy, Michaela M / Mikuls, Ted R. ·Veterans Affairs Nebraska, Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha, Nebraska. · Veterans Affairs Nebraska, Western Iowa Health Care System, Omaha, Nebraska. ·Arthritis Care Res (Hoboken) · Pubmed #26784147.

ABSTRACT: OBJECTIVE: To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT). METHODS: This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included gout-specific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. RESULTS: The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. CONCLUSION: There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

17 Article Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. 2016

de Lautour, Hugh / Taylor, William J / Adebajo, Ade / Alten, Rieke / Burgos-Vargas, Ruben / Chapman, Peter / Cimmino, Marco A / da Rocha Castelar Pinheiro, Geraldo / Day, Ric / Harrold, Leslie R / Helliwell, Philip / Janssen, Matthijs / Kerr, Gail / Kavanaugh, Arthur / Khanna, Dinesh / Khanna, Puja P / Lin, Chingtsai / Louthrenoo, Worawit / McCarthy, Geraldine / Vazquez-Mellado, Janitzia / Mikuls, Ted R / Neogi, Tuhina / Ogdie, Alexis / Perez-Ruiz, Fernando / Schlesinger, Naomi / Ralph Schumacher, H / Scirè, Carlo A / Singh, Jasvinder A / Sivera, Francisca / Slot, Ole / Stamp, Lisa K / Tausche, Anne-Kathrin / Terkeltaub, Robert / Uhlig, Till / van de Laar, Mart / White, Douglas / Yamanaka, Hisashi / Zeng, Xuejun / Dalbeth, Nicola. ·Auckland District Health Board, Auckland, New Zealand. · University of Otago, Wellington, New Zealand. · University of Sheffield, Sheffield, UK. · Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany. · Hospital General de México, Mexico City, Mexico. · Christchurch Hospital, Christchurch, New Zealand. · Università di Genova, Genova, Italy. · Pedro Ernesto University Hospital, Rio de Janeiro, Brazil. · University of New South Wales and St Vincent's Hospital, Sydney, Australia. · University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Rijnstate Hospital, Arnhem, The Netherlands. · Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC. · University of California School of Medicine, San Diego. · University of Michigan, Ann Arbor. · University of Michigan and Ann Arbor VA Medical Center, Ann Arbor. · Taichung Veteran's General Hospital, Taichung, Taiwan. · Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Mater Misericordiae University Hospital and University College, Dublin, Ireland. · Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha. · Boston University School of Medicine, Boston, Massachusetts. · University of Pennsylvania, Philadelphia. · Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain. · Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. · IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy. · University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham. · Hospital General Universitario Elda, Elda, Spain. · Copenhagen University Hospital Glostrup, Glostrup, Denmark. · University of Otago, Christchurch, New Zealand. · University Hospital Carl Gustav Carus, Dresden, Germany. · University of California San Diego VA Medical Center, La Jolla. · National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Universiteit Twente, Erschede, The Netherlands. · Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand. · Tokyo Women's Medical University, Tokyo, Japan. · Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China. · University of Auckland and Auckland District Health Board, Auckland, New Zealand. ·Arthritis Care Res (Hoboken) · Pubmed #26414176.

ABSTRACT: OBJECTIVE: To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS: Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS: There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION: These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.

18 Article Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system. 2015

Rashid, Nazia / Coburn, Brian W / Wu, Yi-Lin / Cheetham, T Craig / Curtis, Jeffrey R / Saag, Kenneth G / Mikuls, Ted R. ·From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center. ·J Rheumatol · Pubmed #25512479.

ABSTRACT: OBJECTIVE: To identify modifiable patient and provider factors associated with allopurinol adherence and the achievement of a serum urate acid (SUA) goal in gout. METHODS: We identified a retrospective cohort of patients with gout, newly treated with allopurinol. All patient data came from administrative datasets at a large integrated health delivery system. Patients were ≥ 18 years old at time of initial allopurinol dispensing, and had 12 months or more of membership and drug eligibility prior to the index date. Allopurinol adherence was defined as a proportion of days covered ≥ 0.80, evaluated during the first 12 months of observation after the initial dispensing. Multivariable logistic regression was used to examine factors associated with allopurinol nonadherence and attaining an SUA concentration < 6.0 mg/dl. RESULTS: We identified 13,341 patients with gout with incident allopurinol use (mean age 60 yrs, 78% men). Of these, 9581 patients (72%) had SUA measured both at baseline and during followup. Only 3078 patients (32%) attained an SUA target of < 6.0 mg/dl during followup. Potentially modifiable factors associated with treatment adherence and obtaining the SUA goal in the multivariable analysis included concomitant diuretic use, prescriber specialty, and allopurinol dosing practices. Adherent patients were 2.5-fold more likely than nonadherent patients to achieve an SUA < 6.0 mg/dl during observation. CONCLUSION: Among patients with gout initiating allopurinol in our study, 68% did not reach the SUA goal and 57% of patients were nonadherent. Modifiable factors, including allopurinol dose escalation, treatment adherence, rheumatology referral, and concomitant medication use, could be important factors to consider in efforts aimed at optimizing gout treatment outcomes.

19 Article Gout as a manifestation of familial juvenile hyperuricemic nephropathy. 2014

Spain, Heather / Plumb, Troy / Mikuls, Ted R. ·From the *Department of Medicine, University of Nebraska Medical Center; and †Omaha Veterans Affairs Medical Center, Omaha, NE. ·J Clin Rheumatol · Pubmed #25417683.

ABSTRACT: We report 2 cases of familial juvenile hyperuricemic nephropathy, a rare autosomal dominant disorder characterized by uromodulin gene mutations leading to hyperuricemia secondary to profound renal uric acid underexcretion, gout, and chronic renal disease. Case 1 involves a 56-year-old woman who underwent a kidney transplant after steady decline in kidney function since the age of 19 years. Her gout had been successfully controlled with varying doses of daily allopurinol. Case 2, the son of case 1, presented with already progressive and debilitating arthritis at the age of 34 years with relatively stable chronic renal failure that was also subsequently managed with daily allopurinol and judicious anti-inflammatory prophylaxis.

20 Article Gout-related health care utilization in US emergency departments, 2006 through 2008. 2013

Garg, Rohini / Sayles, Harlan R / Yu, Fang / Michaud, Kaleb / Singh, Jasvinder / Saag, Kenneth G / Mikuls, Ted R. ·Creighton University, Omaha, Nebraska. ·Arthritis Care Res (Hoboken) · Pubmed #22949176.

ABSTRACT: OBJECTIVE: To characterize gout-related emergency department (ED) utilization using a nationally representative sample and to examine factors associated with the frequency and charges of gout-related ED visits. METHODS: Using the National Emergency Department Sample data from 2006-2008, the weighted national frequency of gout visits was calculated along with the median ED charge and total national ED-related charges. Associations of several patient- and facility-level factors were examined with the occurrence of gout visits using multivariable logistic regression and with ED-related charges using multivariable linear regression. RESULTS: Gout was the primary indication for 168,410 ED visits in 2006, 171,743 visits in 2007, and 174,823 visits in 2008, accounting for ∼0.2% of all visits annually and generating ED charges of more than $128 million in 2006, $144 million in 2007, and $166 million in 2008. Age, male sex, household income <$39,000, private insurance, and hospital locations in nonmetropolitan areas and the southern US were associated with an increased propensity for ED utilization in gout. Higher ED-related charges for gout were associated with female sex, age, a higher number of coded diagnoses, and a metropolitan residence. CONCLUSION: Gout accounts for a substantial proportion of ED visits, leading to significant health care charges. Effective strategies to reduce gout burden in EDs could potentially benefit by targeting groups characterized by factors demonstrated to be related to a higher ED utilization in gout as identified by our study.

21 Minor Reply. 2018

Coburn, Brian W / Michaud, Kaleb / Bergman, Debra A / Mikuls, Ted R. ·Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE. · University of Nebraska Medical Center Omaha, NE and National Data Bank for Rheumatic Diseases, Wichita, KS. · University of Nebraska Medical Center, Omaha, NE. ·Arthritis Rheumatol · Pubmed #29740984.

ABSTRACT: -- No abstract --

22 Minor Renal dosing of allopurinol results in suboptimal gout care. 2017

Neogi, Tuhina / Dalbeth, Nicola / Stamp, Lisa / Castelar, Geraldo / Fitzgerald, John / Gaffo, Angelo / Mikuls, Ted R / Singh, Jasvinder / Vázquez-Mellado, Janitzia / Edwards, N Lawrence. ·Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA. · Department of Immunology, University of Auckland, Auckland, New Zealand. · Department of Medicine, Otago University, Christchurch, Canterbury, New Zealand. · Department of Rheumatology, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil. · Medicine/Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. · Department of Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA. · Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. · Servicio de Reumatologia, Hospital General de Mexico, Mexico City, Mexico. · Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA. ·Ann Rheum Dis · Pubmed #27582422.

ABSTRACT: -- No abstract --

23 Minor Allopurinol Dose Reductions Based on Creatinine Alert Redesign System. 2016

Gaffo, Angelo L / Mikuls, Ted R / Stamp, Lisa K / Neogi, Tuhina. ·Department of Medicine, University of Alabama at Birmingham, Birmingham Veterans Affairs Medical Center. · Division of Rheumatology, University of Nebraska Medical Center, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha. · Department of Medicine, University of Otago, Christchurch, New Zealand. · Department of Medicine, Boston University School of Medicine, Mass. ·Am J Med · Pubmed #27320718.

ABSTRACT: -- No abstract --