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Gout: HELP
Articles from Stoke on Trent
Based on 30 articles published since 2008
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These are the 30 published articles about Gout that originated from Stoke on Trent during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial The role of diet in serum urate concentration. 2018

Watson, Lorraine / Roddy, Edward. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK l.watson@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK. ·BMJ · Pubmed #30305276.

ABSTRACT: -- No abstract --

2 Review Gout - a guide for the general and acute physicians. 2017

Abhishek, Abhishek / Roddy, Edward / Doherty, Michael. ·University of Nottingham, Nottingham, UK Abhishek.abhishek@nottingham.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK. · University of Nottingham, Nottingham, UK. ·Clin Med (Lond) · Pubmed #28148582.

ABSTRACT: Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients. Gout can be diagnosed on clinical grounds in those with typical podagra. However, in those with involvement of other joints, joint aspiration is recommended to demonstrate monosodium urate crystals and exclude other causes of acute arthritis, such as septic arthritis. However, a clinical diagnosis of gout can be made if joint aspiration is not feasible. This review summarises the current understanding of the pathophysiology, clinical presentation, investigations and treatment of gout.

3 Review Gout and risk of chronic kidney disease and nephrolithiasis: meta-analysis of observational studies. 2015

Roughley, Matthew J / Belcher, John / Mallen, Christian D / Roddy, Edward. ·School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK. mattjroughley@gmail.com. · School of Computing and Mathematics, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.belcher@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK. c.d.mallen@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK. e.roddy@keele.ac.uk. ·Arthritis Res Ther · Pubmed #25889144.

ABSTRACT: INTRODUCTION: To determine the prevalence of chronic kidney disease and nephrolithiasis in people with gout, and the association between gout and prevalent or incident chronic kidney disease and nephrolithiasis. METHODS: Systematic review and meta-analysis of epidemiological studies. Data sources; MEDLINE, EMBASE and CINAHL databases, hand-searched reference lists, citation history and contact with authors. ELIGIBILITY CRITERIA: cohort, case-control or cross-sectional studies which examined the occurrence of chronic kidney disease or nephrolithiasis amongst adults with gout (with or without a non-gout comparator group) in primary care or general population samples. Prevalence and risk estimate meta-analyses were performed using a random-effects model. RESULTS: Seventeen studies were included in the meta-analysis (chronic kidney disease n = 7, nephrolithiasis n = 8, both n = 2). Pooled prevalence estimates of chronic kidney disease stage ≥3 and self-reported lifetime nephrolithiasis in people with gout were 24% (95% confidence interval 19% to 28%) and 14% (95% CI 12% to 17%) respectively. Gout was associated with both chronic kidney disease (pooled adjusted odds ratio 2.41, 95% confidence interval 1.86 to 3.11) and self-reported lifetime nephrolithiasis (1.77, 1.43 to 2.19). CONCLUSIONS: Chronic kidney disease and nephrolithiasis are commonly found amongst patients with gout. Gout is independently associated with both chronic kidney disease and nephrolithiasis. Patients with gout should be actively screened for chronic kidney disease and its consequences.

4 Review Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. 2015

Clarson, L E / Chandratre, P / Hider, S L / Belcher, J / Heneghan, C / Roddy, E / Mallen, C D. ·Keele University, Keele, UK l.clarson@keele.ac.uk. · Keele University, Keele, UK. · Oxford University, Oxford, UK. ·Eur J Prev Cardiol · Pubmed #24281251.

ABSTRACT: BACKGROUND: Hyperuricaemia, the biochemical precursor to gout, has been shown to be an independent risk factor for mortality from cardiovascular disease (CVD), although studies examining the clinical phenomenon of gout and risk of CVD mortality report conflicting results. This study aimed to produce a pooled estimate of risk of mortality from cardiovascular disease in patients with gout. DESIGN: Systematic review and meta-analysis. METHODS: Electronic bibliographic databases were searched from inception to November 2012, with results reviewed by two independent reviewers. Studies were included if they reported data on CVD mortality in adults with gout who were free of CVD at time of entry into the study. Pooled hazard ratios (HRs) for this association were calculated both unadjusted and adjusted for traditional vascular risk factors. RESULTS: Six papers, including 223,448 patients, were eligible for inclusion (all (CVD) mortality n = 4, coronary heart disease (CHD) mortality n = 3, and myocardial infarction mortality n = 3). Gout was associated with an excess risk of CVD mortality (unadjusted HR 1.51 (95% confidence interval, CI, 1.17-1.84)) and CHD mortality (unadjusted HR 1.59, 95% CI 1.25-1.94)). After adjusting for traditional vascular risk factors, the pooled HR for both CVD mortality (HR 1.29, 95% CI 1.14-1.44) and CHD mortality (HR 1.42, 95% CI 1.22-1.63) remained statistically significant, but none of the studies reported a significant association with myocardial infarction. CONCLUSIONS: Gout increases the risk of mortality from CVD and CHD, but not myocardial infarction, independently of vascular risk factors.

5 Review Epidemiology of gout. 2014

Roddy, Edward / Choi, Hyon K. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. Electronic address: e.roddy@keele.ac.uk. · Section of Rheumatology and Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118, USA. ·Rheum Dis Clin North Am · Pubmed #24703341.

ABSTRACT: Gout is the most prevalent inflammatory arthritis in men. The findings of several epidemiologic studies from a diverse range of countries suggest that the prevalence of gout has risen over the past few decades. Although incidence data are scarce, data from the United States suggests that the incidence of gout is also rising. Evidence from prospective epidemiologic studies has confirmed dietary factors (animal purines, alcohol, and fructose), obesity, the metabolic syndrome, hypertension, diuretic use, and chronic kidney disease as clinically relevant risk factors for hyperuricemia and gout. Low-fat dairy products, coffee, and vitamin C seem to have a protective effect.

6 Review Health-related quality of life in gout: a systematic review. 2013

Chandratre, Priyanka / Roddy, Edward / Clarson, Lorna / Richardson, Jane / Hider, Samantha L / Mallen, Christian D. ·Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK. e.roddy@keele.ac.uk. ·Rheumatology (Oxford) · Pubmed #23934311.

ABSTRACT: OBJECTIVES: To identify the instruments that have been used to measure health-related quality of life (HRQOL) in gout and assess their clinimetric properties, determine the distribution of HRQOL in gout and identify factors associated with poor HRQOL. METHODS: Medline, CINAHL, EMBASE and PsycINFO were searched from inception to October 2012. Search terms pertained to gout, health or functional status, clinimetric properties and HRQOL. Study data extraction and quality assessment were performed by two independent reviewers. RESULTS: From 474 identified studies, 22 met the inclusion criteria. Health Assessment Questionnaire Disability Index (HAQ-DI) and Short Form 36 (SF-36) were most frequently used and highest rated due to robust construct and concurrent validity, despite high floor and ceiling effects. The Gout Impact Scale had good content validity. Gout had a greater impact on physical HRQOL compared to other domains. Both gout-specific features (attack frequency and intensity, intercritical pain and number of joints involved) and comorbid disease were associated with poor HRQOL. Evidence for objective features such as tophi and serum uric acid was less robust. Limitations of existing studies include cross-sectional design, recruitment from specialist clinic settings and frequent use of generic instruments. CONCLUSION: Most studies have used the generic HAQ-DI and SF-36. Gout-specific characteristics and comorbidities contribute to poor HRQOL. There is a need for a cohort study in primary care (where most patients with gout are treated) to determine which factors predict changes in HRQOL over time. This will enable those at risk of deterioration to be identified and better targeted for treatment.

7 Review Treatment of hyperuricaemia and gout. 2013

Roddy, Edward / Doherty, Michael. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK. e.roddy@keele.ac.uk ·Clin Med (Lond) · Pubmed #23908515.

ABSTRACT: -- No abstract --

8 Review Epidemiology of gout. 2010

Roddy, Edward / Doherty, Michael. ·Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. e.roddy@cphc.keele.ac.uk ·Arthritis Res Ther · Pubmed #21205285.

ABSTRACT: Gout is the most prevalent form of inflammatory arthropathy. Several studies suggest that its prevalence and incidence have risen in recent decades. Numerous risk factors for the development of gout have been established, including hyperuricaemia, genetic factors, dietary factors, alcohol consumption, metabolic syndrome, hypertension, obesity, diuretic use and chronic renal disease. Osteoarthritis predisposes to local crystal deposition. Gout appears to be an independent risk factor for all-cause mortality and cardiovascular mortality and morbidity, additional to the risk conferred by its association with traditional cardiovascular risk factors.

9 Article Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the Clinical Assessment Study of the Foot. 2019

Petty, Helen R / Rathod-Mistry, Trishna / Menz, Hylton B / Roddy, Edward. ·1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG UK. · 0000 0004 0415 6205 · grid.9757.c · 2School of Allied Health, La Trobe University, Bundoora, Victoria 3086 Australia. · 0000 0001 2342 0938 · grid.1018.8 · 3Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Haywood Hospital, Burslem, Staffordshire UK. · 0000 0004 0417 8199 · grid.413807.9 ·J Foot Ankle Res · Pubmed #30700995.

ABSTRACT: Background: Gout frequently affects the foot yet relatively little is known about the effects of gout on foot structure, pain and functional ability. This study aimed to describe the impact of gout in a UK primary care population. Methods: A cross-sectional study was nested within an observational cohort study of adults aged ≥50 years with foot pain. Participants with gout were identified through their primary care medical records and each matched on age (±2 years) and gender to four participants without gout. Differences in person-level variables (SF-12 Physical Component Score, Manchester Foot Pain and Disability Index and Short Physical Performance Battery) between gout and non-gout participants were determined using regression models. Differences in foot-level variables (pain regions, skin lesions, deformities, foot posture, and non-weightbearing range of motion) were determined using multi-level regression models. All models were adjusted for body mass index. Means and probabilities with 95% confidence intervals were calculated. Results: Twenty-six participants with gout were compared to 102 participants without gout (77% male; mean age 66 years, standard deviation 11). Subtalar joint inversion and eversion and 1st metatarsophalangeal joint (MTPJ) dorsiflexion range of motion were significantly lower in the gout participants compared to the non-gout participants. Gout participants were more likely to have mallet toes and less likely to have claw toes compared to non-gout participants. There were no statistically significant differences in person-level variables, foot posture, ankle dorsiflexion range of motion, hallux valgus, pain regions, or skin lesions. Conclusions: Non-weightbearing range of motion at the subtalar joint and 1st MTPJ was reduced in people with gout. Patients with gout who present with chronic foot problems should therefore undergo appropriate clinical assessment of foot structure.

10 Article Obesity, hypertension and diuretic use as risk factors for incident gout: a systematic review and meta-analysis of cohort studies. 2018

Evans, Peter L / Prior, James A / Belcher, John / Mallen, Christian D / Hay, Charles A / Roddy, Edward. ·Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. · Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@keele.ac.uk. ·Arthritis Res Ther · Pubmed #29976236.

ABSTRACT: BACKGROUND: Gout treatment remains suboptimal. Identifying populations at risk of developing gout may provide opportunities for prevention. Our aim was to assess the risk of incident gout associated with obesity, hypertension and diuretic use. METHODS: We conducted a systematic review and meta-analysis of prospective and retrospective cohort studies in adults (age ≥ 18 years) from primary care or the general population, exposed to obesity, hypertension or diuretic use and with incident gout as their outcome. RESULTS: A total of 9923 articles were identified: 14 met the inclusion criteria, 11 of which contained data suitable for pooling in the meta-analysis. Four articles were identified for obesity, 10 for hypertension and six for diuretic use, with four, nine and three articles included respectively for each meta-analysis. Gout was 2.24 times more likely to occur in individuals with body mass index ≥ 30 kg/m CONCLUSIONS: Obesity, hypertension and diuretic use are risk factors for incident gout, each more than doubling the risk compared to those without these risk factors. Patients with these risk factors should be recognised by clinicians as being at greater risk of developing gout and provided with appropriate management and treatment options.

11 Article Health-related quality of life in gout in primary care: Baseline findings from a cohort study. 2018

Chandratre, Priyanka / Mallen, Christian / Richardson, Jane / Muller, Sara / Hider, Samantha / Rome, Keith / Blagojevic-Bucknall, Milisa / Roddy, Edward. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. · Auckland University of Technology, Auckland, New Zealand. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. Electronic address: e.roddy@keele.ac.uk. ·Semin Arthritis Rheum · Pubmed #29398125.

ABSTRACT: OBJECTIVES: To examine gout-related, comorbid, and sociodemographic characteristics associated with generic and disease-specific health-related quality of life (HRQOL) in gout. METHODS: Adults with gout from 20 general practices were mailed a questionnaire containing the Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form-36 Physical Function subscale (PF-10), Gout Impact Scale (GIS), and questions about gout-specific, comorbid and sociodemographic characteristics. Variables associated with HRQOL were examined using multivariable linear regression models. RESULTS: A total of 1184 completed questionnaires were received (response 65.9%). Worse generic and gout-specific HRQOL was associated with frequent gout attacks (≥5 attacks PF-10 β = -4.90, HAQ-DI β = 0.14, GIS subscales β = 8.94, 33.26), current attack (HAQ-DI β = 0.15, GIS β = -1.94, 18.89), oligo/polyarticular attacks (HAQ-DI β = 0.11, GIS β = 0.78, 7.86), body pain (PF-10 β = -10.68, HAQ-DI β = 0.29, GIS β = 2.61, 11.89), anxiety (PF-10 β = -1.81, HAQ-DI β = 0.06, GIS β = 0.38, 1.70), depression (PF-10 β = -1.98, HAQ-DI β = 0.06, GIS 0.42, 1.47) and alcohol non-consumption (PF-10 β = -16.10, HAQ-DI β = 0.45). Gout-specific HRQOL was better in Caucasians than non-Caucasians (GIS β = -13.05, -13.48). Poorer generic HRQOL was associated with diabetes mellitus (PF-10 β = -4.33, HAQ-DI β = 0.14), stroke (PF-10 β = -12.21, HAQ-DI β = 0.37), renal failure (PF-10 β = -9.43, HAQ-DI β = 0.21), myocardial infarction (HAQ-DI β = 0.17), female gender (PF-10 β = -17.26, HAQ-DI β = 0.43), deprivation (PF-10 β = -7.80, HAQ-DI β = 0.19), and body mass index ≥35kg/m CONCLUSIONS: HRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy. Both gout-specific and generic questionnaires identify the impact of disease-specific features on HRQOL but studies focusing on comorbidity should include generic instruments.

12 Article Factors Influencing Allopurinol Initiation in Primary Care. 2017

Clarson, Lorna E / Hider, Samantha L / Belcher, John / Roddy, Edward / Mallen, Christian D. ·Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom l.clarson@keele.ac.uk. · Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom. · Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent, Partnership NHS Trust, Haywood Hospital, Burslem, Staffordshire, United Kingdom. ·Ann Fam Med · Pubmed #29133496.

ABSTRACT: Despite guidance on appropriate initiation, urate-lowering therapy is prescribed for only a minority of patients with gout. Electronic health records for 8,142 patients with gout were used to investigate the effect of age, sex, comorbidities, number of consultations, and meeting internationally agreed eligibility criteria on time to allopurinol initiation. Time to first prescription was modeled using multilevel Cox proportional hazards regression. Allopurinol initiation was positively associated with meeting eligibility criteria at diagnosis of gout, but negatively associated with becoming eligible after diagnosis. Managing gout as a chronic disease, with regular reviews to discuss allopurinol treatment, may reduce barriers to treatment.

13 Article Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study. 2017

Balasubramaniam, Gowrie / Parker, Trisha / Turner, David / Parker, Mike / Scales, Jonathan / Harnett, Patrick / Harrison, Michael / Ahmed, Khalid / Bhagat, Sweta / Marianayagam, Thiraupathy / Pitzalis, Costantino / Mallen, Christian / Roddy, Edward / Almond, Mike / Dasgupta, Bhaskar. ·Department of Renal Medicine, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Southend, Essex, UK. · Clinical Trials Unit, Anglia Ruskin University, Bishops Hall Lane, Chelmsford, UK. · Norwich Medical School, University of East Anglia, Norwich, UK. · School of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester, UK. · The Princess Alexandria Hospital NHS Trust, Harlow, Essex, UK. · West Suffolk Hospital NHS Foundation Trust, Bury Saint Edmunds, Suffolk. · Lister Hospital, East and North Herfordshire NHS Trust, Corey Mills Lane, Stevenage, Hertfordshire, UK. · Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London, London, UK. · Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK. ·BMJ Open · Pubmed #28877949.

ABSTRACT: INTRODUCTION: Acute gout occurs in people with chronic kidney disease, who are commonly older people with comorbidities such as hypertension, heart disease and diabetes. Potentially harmful treatments are administered to these vulnerable patients due to a lack of clear evidence. Newly available treatment that targets a key inflammatory pathway in acute gout attacks provides an opportunity to undertake the first-ever trial specifically looking treating people with kidney disease. This paper describes the protocol for a feasibility randomised controlled trial (RCT) comparing anakinra, a novel interleukin-1 antagonist versus steroids in people with chronic kidney disease (ASGARD). METHODS AND ANALYSIS: ASGARD is a two-parallel group double-blind, double-dummy multicentre RCT comparing anakinra 100 mg, an interleukin-1 antagonist, subcutaneous for 5 days against intramuscular methylprednisolone 120 mg. The primary objective is to assess the feasibility of the trial design and procedures for a definitive RCT. The specific aims are: (1) test recruitment and retention rates and willingness to be randomised; (2) test eligibility criteria; (3) collect and analyse outcome data to inform sample and power calculations for a trial of efficacy; (4) collect economic data to inform a future economic evaluation estimating costs of treatment and (5) assess capacity of the project to scale up to a national multicentre trial. We will also gather qualitative insights from participants. It aims to recruit 32 patients with a 1:1 randomisation. Information from this feasibility study will help design a definitive trial and provide general information in designing acute gout studies. ETHICS AND DISSEMINATION: The London-Central Ethics Committee approved the protocol. The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: EudraCT No. 2015-001787-19, NCT/Clinicalstrials.gov No. NCT02578394, pre-results, WHO Universal Trials Reference No. U1111-1175-1977. NIHR Grant PB-PG-0614-34090.

14 Article Gout and subsequent erectile dysfunction: a population-based cohort study from England. 2017

Abdul Sultan, Alyshah / Mallen, Christian / Hayward, Richard / Muller, Sara / Whittle, Rebecca / Hotston, Matthew / Roddy, Edward. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. a.abdul.sultan@keele.ac.uk. · Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. · Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LQ, UK. ·Arthritis Res Ther · Pubmed #28587655.

ABSTRACT: BACKGROUND: An association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England. METHODS: We utilised the UK-based Clinical Practice Research Datalink to identify 9653 men with incident gout age- and practice-matched to 38,218 controls. Absolute and relative rates of incident ED were calculated using Cox regression models. Absolute rates within specific time periods before and after gout diagnosis were compared to control using a Poisson regression model. RESULTS: Overall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184-202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24-1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27-2.08). Similar findings were also observed for severe ED warranting pharmacological intervention. CONCLUSIONS: We have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

15 Article Improving management of gout in primary care: a new UK management guideline. 2017

Mallen, Christian D / Davenport, Graham / Hui, Michelle / Nuki, George / Roddy, Edward. ·Institute for Primary Care and Health Sciences, Keele University, Keele. · Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby. · University of Edinburgh, Edinburgh. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, and Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent. ·Br J Gen Pract · Pubmed #28546417.

ABSTRACT: -- No abstract --

16 Article Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. 2016

Walsh, Ciaran P / Prior, James A / Chandratre, Priyanka / Belcher, John / Mallen, Christian D / Roddy, Edward. ·Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. · Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@keele.ac.uk. ·BMC Musculoskelet Disord · Pubmed #27639692.

ABSTRACT: BACKGROUND: Patients' perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use. METHODS: A health questionnaire was sent to 1805 people with gout aged ≥18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics. RESULTS: One thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively). CONCLUSIONS: Patients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of ULT.

17 Article A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout. 2016

Richardson, Jane C / Liddle, Jennifer / Mallen, Christian D / Roddy, Edward / Hider, Samantha / Prinjha, Suman / Ziebland, Sue. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK. j.c.richardson@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. ·BMC Musculoskelet Disord · Pubmed #27267878.

ABSTRACT: BACKGROUND: Although international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout. METHODS: A qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used. RESULTS: Participants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring. CONCLUSION: Patients' understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients' perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through "a joint effort over a period of time".

18 Article The association between gout and radiographic hand, knee and foot osteoarthritis: a cross-sectional study. 2016

Bevis, Megan / Marshall, Michelle / Rathod, Trishna / Roddy, Edward. ·Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. meganbevis@hotmail.com. · Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. ·BMC Musculoskelet Disord · Pubmed #27085669.

ABSTRACT: BACKGROUND: Gout is the most common type of inflammatory arthritis and is largely managed in primary care. It classically affects the first metatarsophalangeal joint and distal peripheral joints, whereas the axial joints are typically spared. The reason for this particular distribution is not well understood, however, it has been suggested that osteoarthritis (OA) may be the key factor. One hypothesis is that there is an association between the disease states of gout and OA as the conditions share common risk factors. The objective of this study was to determine whether there is an association between gout and radiographic osteoarthritis (OA). METHODS: A cross-sectional study was nested within three observational cohorts of people aged ≥ 50 years with hand, knee and foot pain. Participants with gout were identified through primary care medical records and each matched by age and gender to four individuals without gout. The presence and severity of radiographic OA were scored using validated atlases. Conditional logistic regression models were used to examine associations between gout and the presence, frequency and severity of radiographic OA at the hand, knee and foot and adjusted for BMI, diuretic use and site of joint pain. RESULTS: Fifty-three people with gout were compared to 211 matched subjects without gout. No statistically significant associations were observed between gout and radiographic hand, knee or foot OA. However, individuals with gout had increased odds of having nodal hand OA (aOR 1.46; 95% CI 0.61, 3.50), ≥8 hand joints with moderate to severe OA (aOR 3.57; 95%CI 0.62, 20.45), foot OA (aOR 2.16; 95% CI 0.66, 7.06), ≥3 foot joints affected (aOR 4.00; 95% CI 0.99, 16.10) and ≥1 foot joints with severe OA (aOR 1.46; 95% CI 0.54, 3.94) but decreased odds of tibiofemoral (aOR 0.44; 95% CI 0.15, 1.29) or patellofemoral (aOR 0.70; 95% CI 0.22, 2.22) OA in either knee. CONCLUSION: There was no association between gout and radiographic OA, however, people with gout appeared to be more likely to have small joint OA and less likely to have large joint OA.

19 Article Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study. 2016

Prior, James Andrew / Mallen, Christian D / Chandratre, Priyanka / Muller, Sara / Richardson, Jane / Roddy, Edward. ·Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom. Electronic address: j.a.prior@keele.ac.uk. · Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom. ·Joint Bone Spine · Pubmed #27068619.

ABSTRACT: OBJECTIVES: To determine the prevalence of anxiety and depression in gout, examine associations between gout characteristics and these comorbidities and determine the role of allopurinol in any such relationships. METHOD: As part of a prospective cohort study, a baseline questionnaire was sent to 1805 participants with gout aged≥18 years from UK primary care. Participants had a gout diagnosis or prescriptions for allopurinol or colchicine in their medical records 2 years prior to baseline. Prevalence of anxiety was defined using the Generalised Anxiety Disorder questionnaire and depression using the Patient Health Questionnaire. Logistic regression was used to examine any association between gout characteristics (12-month attack frequency, oligo/polyarticular gout and gout duration) and the presence of anxiety or depression. Crude and adjusted associations were reported as odds ratios (OR) and 95% confidence intervals (CI). Adjusted gout characteristics were stratified by allopurinol use. RESULTS: One thousand one hundred and eighty-four participants responded to baseline (65.6%). Prevalence of anxiety and depression were 10.0% and 12.6% respectively. There was no association between gout characteristics and anxiety. However, there was an association between attack frequency and depression amongst those gout patients using allopurinol (2.87 [1.2 to 6.6]) and also between oligo/polyarticular gout and depression (2.01 [1.2 to 3.3]), irrespective of allopurinol use (2.09 [1.1 to 4.0]) or not (2.64 [1.0 to 6.8]). CONCLUSION: Patients experiencing frequent gout attacks or attacks in multiple joints are likely to experience depressive symptoms, even when using allopurinol. Depression may influence medication adherence and participation in routine reviews, hence impacting adversely on gout management outcomes.

20 Article "You want to get on with the rest of your life": a qualitative study of health-related quality of life in gout. 2016

Chandratre, Priyanka / Mallen, Christian D / Roddy, Edward / Liddle, Jennifer / Richardson, Jane. ·Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. · Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.c.richardson@keele.ac.uk. ·Clin Rheumatol · Pubmed #26245722.

ABSTRACT: The objective of the study is to examine the impact of gout and its treatments on health-related quality of life (HRQOL) using focus group interviews. From the baseline phase of a cohort study of HRQOL in gout, 17 participants (15 males, mean age 71 years) with varying attack frequency and treatment with and without allopurinol participated in one of four focus group interviews. All interviews were audio-recorded and transcribed verbatim. Data was analysed thematically. Physical and psychosocial HRQOL in gout was affected by characteristics of acute gout (particularly the unpredictable nature of attacks, location of joint involved in an attack, pain and modifications in lifestyle), lack of understanding of gout by others (association with unhealthy lifestyle, symptoms ridiculed as non-severe and non-serious) as well as participants (not considered a disease) and the lack of information provided by physicians (about causes and pharmacological as well as non-pharmacological treatments of gout). Participants emphasised the impact of acute attacks of gout and prioritised dietary modifications and treatment of acute attacks over long-term urate-lowering therapy. Characteristics of acute gout, lack of understanding and information about gout and its treatments perpetuate poor HRQOL. HRQOL (maintenance of usual diet and reduced frequency of attacks) was associated with urate-lowering treatment. Better patient, public and practitioner education about gout being a chronic condition associated with co-morbidities and poor HRQOL may improve understanding and long-term treatment of gout.

21 Article "Why me? I don't fit the mould … I am a freak of nature": a qualitative study of women's experience of gout. 2015

Richardson, Jane C / Liddle, Jennifer / Mallen, Christian D / Roddy, Edward / Prinjha, Suman / Ziebland, Sue / Hider, Samantha. ·Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.c.richardson@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.liddle@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. c.d.mallen@keele.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. e.roddy@keele.ac.uk. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. suman.prinjha@phc.ox.ac.uk. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. sue.ziebland@phc.ox.ac.uk. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. s.hider@keele.ac.uk. ·BMC Womens Health · Pubmed #26710971.

ABSTRACT: BACKGROUND: Gout is more common in men, and is often perceived by both patients and health practitioners to be a disorder of men, but its prevalence in women is increasing. Little is known about women's experience of gout and the impact it has on their lives. It is important for practitioners to be aware of these areas, given the increasing numbers of women with gout they are likely to see in the future. This study aimed to explore women's experiences of gout. METHODS: A qualitative research design was used. Semi-structured interviews were conducted with 43 people, of whom 14 were women. Interviews were video and/or tape recorded and transcribed verbatim. Data from the interviews was first grouped into broad categories, followed by a more detailed thematic analysis and interpretation. RESULTS: Participants' ages ranged from 32 to 82. Nine participants were retired and five were in fulltime work. Four themes emerged: (1) experience of onset, help seeking and diagnosis (2) understanding and finding information about gout, (3) impact on identity, and (4) impact on roles and relationships. CONCLUSIONS: The diagnostic process for women with gout can be uncertain due to lack of awareness of gout in women (by health care professionals and women themselves). Women do not have a good understanding of the condition and find it difficult to find information that feels relevant to them. Gout has a major impact on women's identity and on their roles and relationships. These findings are of importance to health care professionals dealing with women with potential gout and those with an existing diagnosis.

22 Article Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK clinical practice research datalink. 2015

Clarson, Lorna E / Hider, Samantha L / Belcher, John / Heneghan, Carl / Roddy, Edward / Mallen, Christian D. ·Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK. · Department of Primary Care Health Sciences, Oxford University, Oxford, UK. ·Ann Rheum Dis · Pubmed #25165032.

ABSTRACT: OBJECTIVES: To determine whether gout increases risk of incident coronary heart disease (CHD), cerebrovascular (CVD) and peripheral vascular disease (PVD) in a large cohort of primary care patients with gout, since there have been no such large studies in primary care. METHODS: A retrospective cohort study was performed using data from the Clinical Practice Research Datalink (CPRD). Risk of incident CHD, CVD and PVD was compared in 8386 patients with an incident diagnosis of gout, and 39 766 age, sex and registered general practice-matched controls, all aged over 50 years and with no prior vascular history, in the 10 years following incidence of gout, or matched index date (baseline). Multivariable Cox Regression was used to estimate HRs and covariates included sex and baseline measures of age, Body Mass Index, smoking, alcohol consumption, Charlson comorbidity index, history of hypertension, hyperlipidaemia, chronic kidney disease, statin use and aspirin use. RESULTS: Multivariable analysis showed men were at increased risk of any vascular event (HRs (95% CIs)) HR 1.06 (1.01 to 1.12), any CHD HR 1.08 (1.01 to 1.15) and PVD HR 1.18 (1.01 to 1.38), while women were at increased risk of any vascular event, HR 1.25 (1.15 to 1.35), any CHD HR 1.25 (1.12 to 1.39), and PVD 1.89 (1.50 to 2.38)) but not any CVD. CONCLUSIONS: In this cohort of over 50s with gout, female patients with gout were at greatest risk of incident vascular events, even after adjustment for vascular risk factors, despite a higher prevalence of both gout and vascular disease in men. Further research is required to establish the reason for this sex difference.

23 Article Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. 2014

Kuo, Chang-Fu / Grainge, Matthew J / Mallen, Christian / Zhang, Weiya / Doherty, Michael. ·Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England. · Arthritis Research UK Primary Care Centre, Keele University, Keele, England. · Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, England. ·JAMA · Pubmed #25536262.

ABSTRACT: -- No abstract --

24 Article Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. 2013

Cottrell, Elizabeth / Crabtree, Valerie / Edwards, John J / Roddy, Edward. ·Research Institute for Primary Care & Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire. e.cottrell@keele.ac.uk. ·BMC Fam Pract · Pubmed #24225170.

ABSTRACT: BACKGROUND: Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate. METHODS: Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. RESULTS: Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. CONCLUSIONS: The primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence.

25 Article The association of gout with socioeconomic status in primary care: a cross-sectional observational study. 2013

Hayward, Richard A / Rathod, Trishna / Roddy, Edward / Muller, Sara / Hider, Samantha L / Mallen, Christian D. ·Arthritis Research UK Primary Care Centre, Keele ST5 5BG, UK. r.hayward@keele.ac.uk. ·Rheumatology (Oxford) · Pubmed #23901133.

ABSTRACT: OBJECTIVE: Little is known about the association between gout and socioeconomic status (SES). Inequalities in rheumatology provision associated with SES may need to be addressed by health care planners. The aim of this study is to investigate the association of gout and SES in the community at both the individual and area levels. METHODS: Questionnaires were sent to all patients older than age 50 years who were registered with eight general practices in North Staffordshire. Data on individual SES were collected by questionnaire while area SES was measured using the Index of Multiple Deprivation derived from respondents' postcodes. Responders reported their occupation, education and the adequacy of their income; their medical records were searched for consultations for gout. RESULTS: Of the 348 consultations for gout in this period, at the individual level there was a significant association between gout and income. An association of gout with education was seen only in the unadjusted analyses. No association was found between gout and area level deprivation. CONCLUSION: Gout is associated with some aspects of individual level but not area level deprivation. More extensive musculoskeletal services may need to be provided in low income areas, although further research is needed.

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