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Gout: HELP
Articles from New York area
Based on 131 articles published since 2008
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These are the 131 published articles about Gout that originated from New York area during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Autosomal dominant tubulointerstitial kidney disease: diagnosis, classification, and management--A KDIGO consensus report. 2015

Eckardt, Kai-Uwe / Alper, Seth L / Antignac, Corinne / Bleyer, Anthony J / Chauveau, Dominique / Dahan, Karin / Deltas, Constantinos / Hosking, Andrew / Kmoch, Stanislav / Rampoldi, Luca / Wiesener, Michael / Wolf, Matthias T / Devuyst, Olivier / Anonymous4640822. ·Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. · Divisions of Nephrology and Molecular and Vascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. · INSERM U1163, Laboratory of Hereditary Kidney Diseases, Paris, France. · Paris Descartes University, Imagine Institute, Paris, France. · Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. · Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France. · Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium. · Department of Biological Sciences, Molecular Medicine Research Center and Laboratory of Molecular and Medical Genetics, University of Cyprus, Nicosia, Cyprus. · UKD Foundation, New York, New York, USA. · Institute for Inherited Metabolic Disorders, Charles University in Prague, Prague, Czech Republic. · Molecular Genetics of Renal Disorders Unit, Division of Genetics and Cell Biology, Dulbecco Telethon Institute c/o IRCCS San Raffaele Scientific Institute, Milan, Italy. · Division of Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. · Institute of Physiology, University of Zurich, Zurich, Switzerland. ·Kidney Int · Pubmed #25738250.

ABSTRACT: Rare autosomal dominant tubulointerstitial kidney disease is caused by mutations in the genes encoding uromodulin (UMOD), hepatocyte nuclear factor-1β (HNF1B), renin (REN), and mucin-1 (MUC1). Multiple names have been proposed for these disorders, including 'Medullary Cystic Kidney Disease (MCKD) type 2', 'Familial Juvenile Hyperuricemic Nephropathy (FJHN)', or 'Uromodulin-Associated Kidney Disease (UAKD)' for UMOD-related diseases and 'MCKD type 1' for the disease caused by MUC1 mutations. The multiplicity of these terms, and the fact that cysts are not pathognomonic, creates confusion. Kidney Disease: Improving Global Outcomes (KDIGO) proposes adoption of a new terminology for this group of diseases using the term 'Autosomal Dominant Tubulointerstitial Kidney Disease' (ADTKD) appended by a gene-based subclassification, and suggests diagnostic criteria. Implementation of these recommendations is anticipated to facilitate recognition and characterization of these monogenic diseases. A better understanding of these rare disorders may be relevant for the tubulointerstitial fibrosis component in many forms of chronic kidney disease.

2 Editorial Editorial: The Sound and the Fury: Musculoskeletal Ultrasound in the Diagnosis of Gout. 2017

Kissin, Eugene Y / Pillinger, Michael H. ·Boston University School of Medicine, Boston, Massachusetts. · New York University School of Medicine, New York, New York. ·Arthritis Rheumatol · Pubmed #27748075.

ABSTRACT: -- No abstract --

3 Review How Can We Improve Disease Education in People with Gout? 2018

Fields, Theodore R / Batterman, Adena. ·Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St., Suite 848-West, New York, NY, 10021, USA. fieldst@hss.edu. · Weill Cornell College of Medicine, New York, NY, USA. fieldst@hss.edu. · Department of Social Work Programs, Hospital for Special Surgery, New York, NY, USA. ·Curr Rheumatol Rep · Pubmed #29516200.

ABSTRACT: PURPOSE OF REVIEW: Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts. RECENT FINDINGS: Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education. An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

4 Review Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature. 2018

Bieber, Amir / Schlesinger, Naomi / Fawaz, Abdallah / Mader, Reuven. ·Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. Electronic address: amir.bieber@gmail.com. · Division of Rheumatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ. · Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. · Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel; The Technicon Institute of Technology, Haifa, Israel. ·Semin Arthritis Rheum · Pubmed #29275830.

ABSTRACT: OBJECTIVES: Acute gout is a common arthritis that may eventually develop into chronic tophaceous gout (CTG). CTG usually is manifested by recurrent gout attacks. The diagnosis and treatment of CTG is challenging. Although the emergence of CTG without previous gout attacks is uncommon, it is important to recognize this unusual gout presentation. METHODS: Herein, we present two cases of CTG, occurring in elderly patients with chronic kidney disease (CKD) on diuretics, who presented without a prior history of acute gout attacks. We also searched PUBMED, Ovid MEDLINE, and Google scholar (1970-2017), for "tophi as the initial manifestation of gout" and "chronic gout without previous attacks", and extracted relevant data. RESULTS: The search disclosed one retrospective study and several case reports and case series describing 96 patients. Clinical and laboratory data was extracted from 34 patients. We found that a specific group of patients, e.g., elderly patients, most often female patients, suffering from CKD, and treated with diuretics, are specifically reported in the English medical literature to present with CTG as their first manifestation of gout. CONCLUSION: The two cases and our literature review try to emphasize the many faces of chronic gout, in particular, its presentation without previous gout attacks.

5 Review Update on colchicine, 2017. 2018

Slobodnick, Anastasia / Shah, Binita / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine. · Rheumatology and Cardiology Sections, VA New York Harbor Health Care System, U.S. Department of Veterans Affairs. · Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA. ·Rheumatology (Oxford) · Pubmed #29272515.

ABSTRACT: Colchicine is an ancient medication that is currently approved for the treatment of gout and FMF. However, colchicine has a wide range of anti-inflammatory activities, and studies indicate that it may be beneficial in a variety of other conditions. This paper reviews the evidence for the well-established use of colchicine in gout, as well as several other rheumatic diseases. In addition, we highlight the potential benefit of colchicine in cardiac disease, including coronary artery disease in patients both with and without gout.

6 Review Gout Keratitis: A Case of Peripheral Ulcerative Keratitis Secondary to Gout With a Review of the Literature. 2018

Yazdanyar, Amirfarbod / Rizzuti, Allison E / Mechel, Elzbieta / Denisova, Ksenia / Lazzaro, Douglas R. ·Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY. ·Cornea · Pubmed #29053564.

ABSTRACT: PURPOSE: To report a case of peripheral ulcerative keratitis secondary to gout. METHODS: A 41-year-old man with a history of severe gout disease presented with pain and redness of the right eye. Physical examination revealed 2 areas of peripheral corneal thinning with overlying epithelial defects. Adjacent to these areas, reflective crystals were identified in the corneal stroma. Anterior segment optical coherence tomography demonstrated stromal corneal deposits. RESULTS: Systemic workup was negative aside from an elevated serum uric acid level. The patient was administered oral prednisone, allopurinol, and colchicine. At his 2-month follow-up visit, the patient was asymptomatic and his corneal thinning had significantly improved. CONCLUSIONS: Gout is the most common type of inflammatory arthritis in adults with rising incidence and prevalence. Ocular findings in gout are common, but patients are usually asymptomatic. Monosodium urate crystal deposition has been reported to occur in various parts of the eye, with and without ocular inflammation. Crystal deposition in the cornea is extremely rare and may be a cause of peripheral ulcerative keratitis.

7 Review Gout and Metabolic Syndrome: a Tangled Web. 2017

Thottam, Gabrielle E / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Department of Medicine, Roger Williams Medical Center, Providence, RI, USA. · Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. · Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA. · Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. michael.pillinger@nyumc.org. · Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA. michael.pillinger@nyumc.org. ·Curr Rheumatol Rep · Pubmed #28844079.

ABSTRACT: PURPOSE OF REVIEW: The complexity of gout continues to unravel with each new investigation. Gout sits at the intersection of multiple intrinsically complex processes, and its prevalence, impact on healthcare costs, and association with important co-morbidities make it increasingly relevant. The association between gout and type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, renal disease, and obesity suggest that either gout, or its necessary precursor hyperuricemia, may play an important role in the manifestations of the metabolic syndrome. In this review, we analyze the complex interconnections between gout and metabolic syndrome, by reviewing gout's physiologic and epidemiologic relationships with its major co-morbidities. RECENT FINDINGS: Increasing evidence supports gout's association with metabolic syndrome. More specifically, both human studies and animal models suggest that hyperuricemia may play a role in promoting inflammation, hypertension and cardiovascular disease, adipogenesis and lipogenesis, insulin and glucose dysregulation, and liver disease. Fructose ingestion is associated with increased rates of hypertension, weight gain, impaired glucose tolerance, and dyslipidemia and is a key driver of urate biosynthesis. AMP kinase (AMPK) is a central regulator of processes that tend to mitigate against the metabolic syndrome. Within hepatocytes, leukocytes, and other cells, a fructose/urate metabolic loop drives key inhibitors of AMPK, including AMP deaminase and fructokinase, that may tilt the balance toward metabolic syndrome progression. Preliminary evidence suggests that agents that block the intracellular synthesis of urate may restore AMPK activity and help maintain metabolic homeostasis. Gout is both an inflammatory and a metabolic disease. With further investigation of urate's role, the possibility of proper gout management additionally mitigating metabolic syndrome is an evolving and important question.

8 Review Updates on the treatment of gout, including a review of updated treatment guidelines and use of small molecule therapies for difficult-to-treat gout and gout flares. 2017

Soskind, Rose / Abazia, Daniel T / Bridgeman, Mary Barna. ·a Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers , The State University of New Jersey , Piscataway , NJ , USA. · b Department of Pharmacy Practice and Administration , Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , Piscataway , NJ , USA. · c Department of Pharmacy , Capital Health Regional Medical Center , Trenton , NJ , USA. · d Department of Pharmacy , Robert Wood Johnson University Hospital , New Brunswick , NJ , USA. ·Expert Opin Pharmacother · Pubmed #28658988.

ABSTRACT: INTRODUCTION: Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues. Areas covered: In this article, we describe the role of currently available drug therapies for managing acute gout flares and used in reducing serum urate levels. Further, we explore the role of novel small molecular therapies and biologic agents in the treatment of refractory or severe gout symptoms. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-June 2017) was conducted utilizing the key words 'gout', 'interleukin-1 inhibitors', 'acute gout', 'gout treatment', 'urate lowering therapies', 'hyperuricemia', 'colchicine', 'pegloticase', 'lesinurad', 'xanthine oxidase', 'xanthine oxidase inhibitors', 'allopurinol', 'febuxostat', 'uricosurics', 'probenecid', and 'benzbromarone'. All published articles regarding therapeutic management of gout and hyperuricemia were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. Expert opinion: Numerous therapies are currently available to managing acute gout flares and for lowering serum urate levels; advances in the understanding of the pathophysiology of this disorder has led to the emergence of targeted therapies and novel biologic preparations currently in development which may improve the clinical management of severe or refractory cases of disease that fail to respond to traditional therapies.

9 Review Nonhealing Ulcers in Patients with Tophaceous Gout: A Systematic Review. 2017

Lam, Gretl / Ross, Frank L / Chiu, Ernest S. ·Gretl Lam, BA • Fourth-year Medical Student (graduates to MD in May 2017) • New York University School of Medicine • New York, New York Frank L. Ross, MD • Associate Professor • Department of Surgery • New York University School of Medicine • New York, New York • Associate Director • Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center • New York, New York Ernest S. Chiu, MD • Associate Professor • Department of Surgery • New York University School of Medicine • New York, New York • Director • Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center • New York, New York. ·Adv Skin Wound Care · Pubmed #28426572.

ABSTRACT: GENERAL PURPOSE: To provide information from a review of the literature about chronic ulcers associated with tophaceous gout. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Identify the pathophysiology of tophaceous gout, its presentation, phases, and common comorbidities.2. Evaluate the findings in this review regarding effectiveness of interventions for chronic tophaceous ulcers. ABSTRACT: OBJECTIVE: Treating chronic ulcers associated with tophaceous gout is an uncommon but important clinical challenge. However, treatments vary greatly from topical therapies, to debridements, to free flap wound coverage. To the authors' knowledge, this is the first study to assemble and compare these different approaches in order to guide effective treatment. DATA SOURCES: An electronic search of MEDLINE (PubMed) was conducted. Search terms included (gout and ulcer) not "peptic ulcer," and (gout, chronic wound) or (gout, nonhealing wound). STUDY SELECTION: Studies that discussed the presentation, characterization, or treatment of gout-associated wounds were included. The literature search yielded 9 case reports and case series; there were no randomized controlled studies or reviews. DATA EXTRACTION: Patient and wound characteristics, treatment approaches, and outcomes were noted. DATA SYNTHESIS: The 82% of 22 patients were male, aged 36 to 95 years. Three patients had not been previously diagnosed with gout, whereas others had received a diagnosis 2 to 35 years prior to presentation with an ulcer. Many patients had comorbidities including diabetes and peripheral vascular disease. Most of the 43 total ulcers occurred on the feet. Treatments included topical 3% citric acid in petroleum jelly, allogeneic culture dermal substitute, silver-containing dressing and heterologous lyophilized collagen, debridements, and free flap coverage. CONCLUSIONS: Chronic tophaceous wounds are a worldwide problem. Although physicians report some successes with different treatments, controlled studies are needed to determine the most effective approach and to identify risk factors and preventive strategies.

10 Review The safety of treatment options available for gout. 2017

Schlesinger, Naomi. ·a Department of Medicine Rutgers , Robert Wood Johnson Medical School , New Brunswick , NJ , USA. ·Expert Opin Drug Saf · Pubmed #28095258.

ABSTRACT: INTRODUCTION: Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis. Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout. Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs. The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.

11 Review Gout and Osteoarthritis: Associations, Pathophysiology, and Therapeutic Implications. 2016

Yokose, Chio / Chen, Meng / Berhanu, Adey / Pillinger, Michael H / Krasnokutsky, Svetlana. ·From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. · From the Crystal Disease Study Group, Division of Rheumatology, New York University School of Medicine, New York, USA. Svetlana.KrasnokutskySamuels@nyumc.org. · NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. Svetlana.KrasnokutskySamuels@nyumc.org. ·Curr Rheumatol Rep · Pubmed #27686950.

ABSTRACT: Osteoarthritis (OA), the most common type of arthritis worldwide, is a degenerative disease of diarthrodial joints resulting in pain, reduced quality of life, and socioeconomic burden. Gout, the most common form of inflammatory arthritis, is a consequence of persistently elevated levels of urate and the formation of proinflammatory monosodium urate crystals in joints. Clinicians have long noted a predilection for both diseases to occur in the same joints. In this review, we provide an overview into research elucidating possible biochemical, mechanical, and immunological relationships between gout and OA. We additionally consider the potential implications of these relationships for OA treatment.

12 Review Beyond Joints: a Review of Ocular Abnormalities in Gout and Hyperuricemia. 2016

Sharon, Yael / Schlesinger, Naomi. ·Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, 39 Jabotinsky St., Petach Tikva, 494149, Israel. yaelpauker@gmail.com. · Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, 08903-0019, NJ, USA. ·Curr Rheumatol Rep · Pubmed #27138165.

ABSTRACT: Gout is a common inflammatory arthritis among middle-aged men and postmenopausal women and can be a debilitating disease. Gout results from an elevated body uric acid pool, which leads to deposition of monosodium urate (MSU) crystals, mainly in and around the joints. The MSU crystals trigger release of proinflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. Ocular manifestations have been uncommonly reported in patients with gout. These include descriptions of tophaceous deposits in different locations of the eye including the eyelids, conjunctiva, cornea, iris, sclera, and orbit. Some depositions were coincidentally diagnosed in asymptomatic patients, while the majority were symptomatic. Other ocular abnormalities include dry eye syndrome, red eye, uveitis, intraocular hypertension, glaucoma, and cataracts. Herein, we review the medical literature pertaining to ocular manifestations in gout and hyperuricemia and propose a possible association between ocular abnormalities, hyperuricemia, and gout, including their common risk factors and comorbidities.

13 Review New and Pipeline Drugs for Gout. 2016

Keenan, Robert T / Schlesinger, Naomi. ·Department of Medicine, Duke University School of Medicine, Durham, NC, USA. robert.keenan@duke.edu. · Division of Rheumatology, Duke University Medical Center, 200 Trent Drive DUMC 3544, Durham, NC, USA. robert.keenan@duke.edu. · Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. ·Curr Rheumatol Rep · Pubmed #27097819.

ABSTRACT: Gout is the most common inflammatory arthropathy in the western world. Affecting millions and accounting for lost wages, increased health care costs, and significant disability, it remains a burden for those afflicted, their families, and the health care system. Despite the availability of a number of effective therapies, gout is often inadequately treated, and its impact on the patients overall health and well-being is underestimated by physicians and patients alike. For many decades, controlling acute flares was the priority in the management of gout. More recently, however, a deeper understanding of gout pathophysiology has resulted in a new appreciation that gout impacts the patient with consequences well beyond the episodes of acute inflammatory arthritis. Reflecting the chronic nature of the disease, gout treatment needs to be chronic as well, and aimed at reducing the underlying cause of gout-hyperuricemia-as well as the symptom of acute attacks. Therapy therefore requires both urate lowering and anti-inflammatory strategies. Unfortunately, the most commonly used urate lowering and anti-inflammatory treatments may be problematic in some gout patients, who often have multiple comorbidities that establish relative contraindications. Novel urate lowering therapies, and new medications to treat and prevent acute gouty flares, can not only improve care of the individual; they can also lead to a better discourse for the edification of those who manage and are managed for this underestimated disease. In this paper, we discuss new and pipeline drugs for acute gout, prophylactic anti-inflammatory therapies as well as urate lowering therapies.

14 Review Repositioning of drugs using open-access data portal DTome: A test case with probenecid (Review). 2016

Ahmed, Mohammad U / Bennett, Dylan J / Hsieh, Tze-Chen / Doonan, Barbara B / Ahmed, Saba / Wu, Joseph M. ·Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, NY 10595, USA. ·Int J Mol Med · Pubmed #26572802.

ABSTRACT: The one gene-one enzyme hypothesis, first introduced by Beadle and Tatum in the 1940s and based on their genetic analysis and observation of phenotype changes in Neurospora crassa challenged by various experimental conditions, has witnessed significant advances in recent decades. Much of our understanding of the association between genes and their phenotype expression has benefited from the completion of the human genome project, and has shown continual transformation guided by the effort directed at the annotation and characterization of human genes. Similarly, the idea of one drug‑one primary disease indication that traditionally has been the benchmark for the labeling and usage of drugs has also undergone evident progressive refinements; in recent years the science and practice of pharmaceutical development has notable success in the strategy of drug repurposing. Drug repurposing is an innovative approach where, instead of de novo synthesis and discovery of new drugs with novel indications, drug candidates with the desired usage are identified by a process of re‑profiling using an open‑source database or knowledge of known or failed drugs already in existence. In the present study, the repurposing drug strategy employing open‑access data portal drug‑target interactome (DTome) is applied to the uncovering of new clinical usage for probenecid.

15 Review Gout in the Spine: Imaging, Diagnosis, and Outcomes. 2015

Toprover, Michael / Krasnokutsky, Svetlana / Pillinger, Michael H. ·Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. · Rheumatology Section, Department of Medicine, VA New York Harbor Health Care System, New York Campus, New York, NY, 10010, USA. · Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. Michael.Pillinger@nyumc.org. · Rheumatology Section, Department of Medicine, VA New York Harbor Health Care System, New York Campus, New York, NY, 10010, USA. Michael.Pillinger@nyumc.org. ·Curr Rheumatol Rep · Pubmed #26490179.

ABSTRACT: Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.

16 Review Hyperuricemia and gout in solid-organ transplant: update in pharmacological management. 2015

Sullivan, Peter M / William, Asch / Tichy, Eric M. ·Memorial Sloan-Kettering Cancer Center, New York, New York (PMS), Yale University School of Medicine (AW), Yale-New Haven Hospital (EMT), New Haven, Connecticut. ·Prog Transplant · Pubmed #26308787.

ABSTRACT: Hyperuricemia is a common comorbid condition experienced by up to 28% of kidney transplant recipients. These patients are at elevated risk of acute flare-ups of gout because of transplant-specific risk factors such as impaired renal function, chronic contributing pharmacotherapy (eg, calcineurin inhibitors, diuretics), and associated comorbid conditions. After transplant, treatment is often complicated by drug-drug interactions, renal impairment, and toxic effects of drugs with the use of first-line recommended agents. A number of therapeutic options remain available for transplant recipients, including dose modifications of historic agents and newer pharmacotherapeutic options. Notably, the Kidney Disease Improving Global Outcomes guidelines address the management of hyperuricemia and gout, but these guidelines were last published in 2009, and new data and treatment options have emerged since then. The management of hyperuricemia and acute and chronic gout is described, including the use of novel agents including urate oxidases, interleukin 1 inhibitors, and human urate transporter 1 inhibitors and alternative immunosuppressive therapy strategies.

17 Review Febuxostat for the treatment of gout. 2015

Bridgeman, Mary Barna / Chavez, Benjamin. ·Rutgers, The State University of New Jersey, Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration , 160 Frelinghuysen Road, Piscataway, NJ 08854 , USA +1 848 445 6815 ; +1 732 445 2533 ; mary.bridgeman@pharmacy.rutgers.edu. ·Expert Opin Pharmacother · Pubmed #25556668.

ABSTRACT: INTRODUCTION: Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues. The xanthine oxidase inhibitor, allopurinol, has historically been the principle agent utilized for reducing elevated uric acid levels and treating underlying cause of gout symptoms; the availability of febuxostat, a newer non-purine selective xanthine oxidase inhibitor, represents an alternative therapy for those patients with contraindications or intolerance to allopurinol. AREAS COVERED: This article reviews the published literature on the pharmacologic characteristics and clinical safety and efficacy data on the use of febuxostat in the treatment of gout. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-November 2014) was conducted utilizing the key words 'febuxostat', 'allopurinol', and 'gout'. All published articles regarding febuxostat were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. EXPERT OPINION: Febuxostat has shown benefit with respect to symptomatic relief and uric acid level reduction. The safety profile of this agent makes it an ideal alternative in those patients with contraindications to or who are intolerant of allopurinol.

18 Review Outcomes assessed in trials of gout and accordance with OMERACT-proposed domains: a systematic literature review. 2015

Araújo, Filipe / Cordeiro, Inês / Ramiro, Sofia / Falzon, Louise / Branco, Jaime C / Buchbinder, Rachelle. ·Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia flipar@msn.com. · Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia. · Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal, Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia. ·Rheumatology (Oxford) · Pubmed #25398382.

ABSTRACT: OBJECTIVE: The aim of this study was to systematically review outcome domains and measurement tools used in gout trials and their accordance with the preliminary OMERACT gout recommendations published in 2005. METHODS: Randomized controlled trials (RCTs) and quasi-RCTs investigating any intervention for gout published up to February 2013 were included. Recruitment start dates and all measured outcomes were extracted. Risk of bias (RoB) was assessed with the Cochrane Collaboration tool. Numbers of OMERACT domains were compared for trials at low vs unclear/high RoB and for recruitment start date before 2005 or 2005 and later. RESULTS: Of 9784 articles screened, 38 acute and 30 chronic gout trials were included. Mean (s.d.) number of OMERACT outcomes was 2.9 (1.1) (out of 5) and 2.5 (1.2) (out of 9) for acute and chronic gout trials, respectively. Health-related quality of life, participation and joint damage imaging were not assessed in any trial. Tools used to measure individual domains varied widely. There were no differences in the number of OMERACT outcomes reported in acute or chronic gout trials recruiting before 2005 vs 2005 or later [mean (s.d.): 3.0 (1.1) vs 3.5 (1.3), P = 0.859 and 2.7 (1.1) vs 2.8 (1.4), P = 0.960, respectively]. While both acute and chronic trials at low RoB reported more OMERACT domains than trials at unclear/high RoB, these differences were not significant. Industry-funded trials and trials performed by OMERACT investigators reported more OMERACT outcome domains. CONCLUSION: We found no appreciable impact of the OMERACT recommendations for gout trials to date.

19 Review Infusion-related reactions with pegloticase, a recombinant uricase for the treatment of chronic gout refractory to conventional therapy. 2014

Baraf, Herbert S B / Yood, Robert A / Ottery, Faith D / Sundy, John S / Becker, Michael A. ·From the *Center for Rheumatology & Bone Research, Wheaton, MD; †Reliant Medical Group, Worcester, MA; ‡Savient Pharmaceuticals, Inc, Bridgewater, NJ; §Duke University Medical Center, Durham, NC; and ║The University of Chicago, Chicago, IL. ·J Clin Rheumatol · Pubmed #25417679.

ABSTRACT: BACKGROUND: In clinical trials of pegloticase, a PEGylated uricase developed for treatment of gout refractory to conventional therapy, infusion-related reactions (IRs) were the second most frequent adverse event reported. OBJECTIVE: The objective of this study was to provide a detailed account of IRs with pegloticase therapy. METHODS: Data from 2 replicate, 6-month randomized trials and an open-label extension study were pooled. Infusions of pegloticase (8 mg) were administered biweekly or monthly; all patients received prophylaxis (antihistamine, acetaminophen, and corticosteroid) and were tested for urate levels prior to each infusion. An IR was defined by protocol as any otherwise unexplained adverse event or cluster of temporally related events occurring during or within 2 hours of infusion. RESULTS: Infusion-related reactions occurred in 94 (45%) of 208 patients receiving pegloticase; 10 patients reported IRs at first infusion and 84 during subsequent infusions. Chest discomfort (15%), flushing (12%), and dyspnea (11%) were the most common symptoms. Most IRs were rated mild or moderate; 7% were rated severe. All IRs resolved with slowing, interrupting, or stopping the infusion. No patient required blood pressure or ventilatory support. Infusion-related reactions were associated with loss of pegloticase urate-lowering efficacy: 91% of all IRs occurred in patients with preinfusion serum uric acid concentrations (sUA) greater than 6 mg/dL. For patients sustaining preinfusion sUA of less than 6 mg/dL, IRs occurred in fewer than 1 per 100 infusions. CONCLUSIONS: Phase 3 trial data combined with post hoc analyses demonstrated that knowledge of sUA preceding each pegloticase infusion and cessation of therapy when urate-lowering efficacy is lost provide a means to optimize the safety of pegloticase in clinical practice.

20 Review Treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease, and cardiovascular events: a systematic literature review. 2014

Vinik, Ophir / Wechalekar, Mihir D / Falzon, Louise / Buchbinder, Rachelle / van der Heijde, Désirée M / Bombardier, Claire. ·From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; 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; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; 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; 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 General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital. ·J Rheumatol Suppl · Pubmed #25180131.

ABSTRACT: OBJECTIVE: To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients. METHODS: A systematic literature search was conducted in the Cochrane Library, Medline, Embase, clinical trials registries of the World Health Organization and the US National Institutes of Health, and abstracts from American College of Rheumatology/European League Against Rheumatism meetings, for interventional studies involving adults with no history of gouty arthritis, who were treated for HU. Outcomes of interest included gouty arthritis, renal disease (i.e., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke). RESULTS: A total of 3 studies met the inclusion criteria, 2 studies assessing the prevention of renal disease and 1 study evaluating the potential for delaying progression of preexisting renal disease. In hyperuricemic patients without renal disease, treatment resulted in increased estimated glomerular filtration rate. In hyperuricemic patients with preexisting renal disease, treatment resulted in no significant elevation of serum creatinine over a 1-year followup. However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies. CONCLUSION: Very limited data are available on the treatment of HU in asymptomatic patients. There is currently insufficient empiric evidence to suggest that lowering serum uric acid level in asymptomatic patients with HU can prevent gouty arthritis, renal disease, or cardiovascular events.

21 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.

22 Review Treatment target and followup measures for patients with gout: a systematic literature review. 2014

Andrés, Mariano / Sivera, Francisca / Falzon, Louise / van der Heijde, Désirée M / Carmona, Loreto. ·From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética. ·J Rheumatol Suppl · Pubmed #25180129.

ABSTRACT: OBJECTIVE: To systematically review the validity of serum uric acid (SUA) as a treatment target for patients with gout, and the clinimetric properties of the potential tools for monitoring these patients. METHODS: A search was performed in Medline, Embase and the Cochrane Library from inception to October 2011, and the 2010-2011 American College of Rheumatology and European League Against Rheumatism meeting abstracts. Studies evaluating different SUA levels or SUA reduction with the achievement of outcomes, and studies assessing clinimetric properties of instruments used to follow patients with gout were selected. Intervention studies were also included in order to estimate responsiveness. Titles and abstracts of the identified references were screened, and included articles were reviewed in detail and data collected using ad hoc standard forms. RESULTS: In total, 4575 articles were retrieved, 120 articles reviewed in detail, and 54 articles were included in the systematic literature review. SUA reduction was significantly associated with a reduction in acute attacks (6 studies), tophi regression (2 studies), and crystal clearance (3 studies). SUA 6.0 mg/dl was used as cutoff point in most of studies, but this level was found to be arbitrary. For followup of patients with gout, tophus measurement by caliper and ultrasound, the physical component of the Medical Outcomes Study Short Form-36 Survey, and Health Assessment Questionnaire have shown excellent clinimetric properties for this purpose. CONCLUSION: Reducing SUA is a valid treatment target for patients with gout, but the target level of reduction (cutoff point) is not clear. Some tools were found suitable for following patients with gout.

23 Review Treatment of gout patients with impairment of renal function: a systematic literature review. 2014

van Echteld, Irene A / van Durme, Caroline / Falzon, Louise / Landewé, Robert B / van der Heijde, Désirée M / Aletaha, Daniel. ·From the Rheumatology Department, St. Elisabeth Hospital, Tilburg; the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; Atrium Medical Center, Heerlen; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria.I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre, and Rheumatology Department, Centre Hospitalier Universitaire; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; and Atrium Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna. ·J Rheumatol Suppl · Pubmed #25180128.

ABSTRACT: OBJECTIVE: To assess the efficacy and safety of gout-specific medications in gout patients with a comorbidity and/or comedication. METHODS: A systematic literature search for gout, its medication, and the most common comorbidities and comedications, using serum uric acid (SUA) levels as the primary, and adverse events as the secondary outcomes. RESULTS: Eight trials met inclusion criteria. Trials covered treatment with allopurinol, benzbromarone, rasburicase, or febuxostat in a gout population with mild or moderate renal insufficiency. High risk of bias (5/8 trials) and heterogeneity precluded formal metaanalysis. The trials showed the following hierarchy in efficacy (lowering the SUA below 6.0 mg/dl): febuxostat 80 mg (44%-71%) > febuxostat 40 mg (43%-52%) > allopurinol 100 mg or 200 mg (0-46%) after 6 months of therapy; rasburicase (46%) > allopurinol 300 mg (16%) after 7 days of therapy; benzbromarone 100-200 mg (93%) > allopurinol 100-200 mg (63%) after 9-24 months of therapy. The combination of allopurinol and benzbromarone seemed to be effective, with a significant reduction in the SUA from 7.8 to 5.7 mg/dl (p < 0.05) after 1 month. One study showed that 89% achieved the target SUA using higher doses of allopurinol than usually recommended for patients with renal impairment without an apparent increase in adverse events. In addition, allopurinol and benzbromarone significantly improved renal function. CONCLUSION: In gout patients with renal insufficiency febuxostat, rasburicase, benzbromarone, and allopurinol + benzbromarone seemed to be effective and safe; allopurinol may be cautiously titrated until the target uric acid level has been reached, and may improve renal function.

24 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.

25 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.

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