Diagnosis Of Gout Research Articles

Development of knowledge base structure for gout diagnosis

Gout belongs to the group of microcrystalline arthritides and is a systemic tophus manifested by inflammation of various tissues caused by deposition of monosodium urate crystals. Verification of gout diagnosis in Russia takes on average four to eight years from the beginning of the disease. This period is sufficient for the development of various complications (for example, gouty nephropathy) and disability of patient, and, therefore, it is necessary to revise the existing strategy for the diagnosis of this disease. One of the options for improving the provision of medical care can be attributed to the creation of a clinical decision support system (CDSS), which is based on the knowledge of experts, formalized as a knowledge base (KB).Aim. To develop a KB structure for CDSS for gout diagnosis.Material and Methods. Clinical information for gout diagnosis, presented as a nomenclature of medical concepts and logical schemes, which were collected on the basis of federal clinical recommendations, various literature sources and expert knowledge were used as materials. The ontological method was used as a method of knowledge structuring. Combined semantic network and frames were used as the methods of representation.Results. While developing KB structure, a combination of two methods of knowledge representation including semantic network and frames was used. An ontological approach was used in terms of knowledge structuring. The structure was built on the clinical knowledge collected in cooperation with experts in gout diagnosis. Compared with similar developments of diagnosing diseases based on knowledge engineering methods, the main feature of developed KB structure was the use of a separate type “Syndrome” concept as an aggregator accepted in medicine, significantly reducing the volume of KB for diseases.Conclusion. The KB structure was developed comprising the use of seven types of concepts and 11 types of relationships. The structure involved the use of ontological approach and combination of two models of knowledge representation, namely: a semantic network and a frame model.

Research progress on microRNA in gout.

Gout is a common form of arthritis caused by the deposition of sodium urate crystals in the joints and tissues around them. MicroRNAs (miRNAs) are noncoding RNAs that have been shown to be involved in regulating the pathogenesis of gout through multiple cellular signaling pathways, which may be potential targets for the treatment of gout. In this review, we systematically discuss the regulatory roles of related miRNAs in gout, which will provide help for the treatment of gout and miRNAs is expected to become a potential biomarker for gout diagnosis.

Association between gout and the development of Parkinson’s disease: a systematic review and meta-analysis

BackgroundAs a natural antioxidant, uric acid plays a protective role against neurodegenerative disorders, including Parkinson’s disease (PD). Therefore, the risk of PD has been found to be lower in people with hyperuricemia. In this article, we conducted a systematic review and meta-analysis to investigate whether gout affects the future risk of developing PD.MethodsWe searched PubMed, Scopus, the Web of Science, and Google Scholar to find relevant studies, up to March 16, 2022. Studies investigating the risk of PD, following a gout diagnosis, were included if they were cross-sectional, case–control or cohort studies. The Newcastle Ottawa Scale (NOS) checklist was used to assess the quality of all included studies. The meta-analysis was performed using STATA 17.0.ResultsTen studies were included, which were comprised of three case-controls, six cohort studies and one nested case–control study. We found no significant association between gout and the risk of PD among both sexes (RR = 0.94, 95% CI: 0.86–1.04), although the association was significant for females (RR = 1.09; 95% CI: 1.02–1.17). Subgroup analysis also showed no significant findings by age group, whether they were receiving treatment for gout, study design, quality assessment score, and method of gout ascertainment. In contrast, the studies that defined PD according to the use of drugs showed significant results (RR = 0.82; 95% CI: 0.76–0.89). There was a significant publication bias on the association between gout and PD.ConclusionsThe presence of gout had no significant effect on the risk of subsequently developing PD. Further analyses are recommended to investigate the effects of demographic and behavioral risk factors.

The impact of short-chain fatty acid-producing bacteria of the gut microbiota in hyperuricemia and gout diagnosis.

Persistent hyperuricemia is a key factor in gout; however, only 13.5% of hyperuricemic individuals manifest the disease. The gut microbiota could be one of the many factors underlying this phenomenon. We aimed to assess the difference in taxonomic and predicted functional profiles of the gut microbiota between asymptomatic hyperuricemia (AH) individuals and gout patients. The V3-V4 region of the 16S rRNA gene of the gut microbiota of AH individuals, gout patients, and controls was sequenced. Bioinformatic analyses were carried out with QIIME2 and phyloseq to determine the difference in the relative abundance of bacterial genera among the study groups. Tax4fun2 was used to predict the functional profile of the gut microbiota. AH individuals presented a higher abundance of butyrate- and propionate-producing bacteria than gout patients; however, the latter had more bacteria capable of producing acetate. The abundance of Prevotella genus bacteria was not significantly different between the patients but was higher than that in controls. This result was corroborated by the functional profile, in which AH individuals had less pyruvate oxidase abundance than gout patients and less abundance of an enzyme that regulates glutamate synthetase activation than controls. We observed a distinctive taxonomic profile in AH individuals characterized by a higher abundance of short-chain fatty acid-producing bacteria in comparison to those observed in gout patients. Furthermore, we provide scientific evidence that indicates that the gut microbiota of AH individuals could provide anti-inflammatory mediators, which prevent the appearance of gout flares. Key Points • AH and gout patients both have a higher abundance of Prevotella genus bacteria than controls. • AH individuals' gut microbiota had more butyrate- and propionate-producing bacteria than gout patients. • The gut microbiome of AH individuals provides anti-inflammatory mediators that could prevent gout flares.

Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes patients: a propensity score-matched study

Abstract Background The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of new gout diagnosis have not been explored. This study aims to compare the effects of SGLT2I against DPP4I on gout risks in a Chinese population. Methods This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus treated with SGLT2I or DPP4I between January 1st, 2015 and December 31st, 2020 in Hong Kong. The study outcomes are new-onset gout and all-cause mortality. Propensity score matching (1:1 ratio) between SGLT2I and DPP4I was performed. Univariable and multivariable Cox regression analysis models were conducted. Competing risks models and multiple approaches based on the propensity score were applied. Patients This study included 60996 patients (median age: 62.3 years old, 54.96% males; SGLTI group: n=21690; DPP4I group: n=39306). Results In the matched cohort, 1096 developed gout (IR: 2.52%) and 2195 died (IR: 5.05%). Univariable Cox regression showed that SGLT2I use was associated with lower risks of new diagnosis of gout (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.30–0.39; P-value<0.0001) and all-cause mortality (HR: 0.35; 95% CI: 0.32–0.39; P-value<0.0001) compared to DPP4I. The associated remained for both new diagnosis of gout (HR: 0.46; 95% CI: 0.37–0.57; P-value<0.0001) and all-cause mortality (HR: 0.38; 95% CI: 0.33–0.44; P-value<0.0001) after adjusting for significant demographics, past comorbidities, and non-SGLT2I/DPP4I medications. The risks of gout were lowered in each types of SGLT2I. The results were consistent on competing risk and other propensity score approaches analyses. Conclusions SGLT2I use was associated with lower risks of new gout diagnosis compared to DPP4I use. Funding Acknowledgement Type of funding sources: None.

Onset of depression and anxiety among patients with gout after diagnosis: a population-based incident cohort study

BackgroundGout may be associated with an increased incidence of mental health disorders, however, published findings have been limited and inconsistent. Therefore, our objective was to conduct a population-based cohort study to evaluate the incidence of depression and anxiety after gout diagnosis.MethodsWe used linked population-based administrative health data in British Columbia, Canada that includes information on demographics, outpatient visits, and inpatient visits from the period of January 1, 1990 to March 31, 2018. We assessed depression and anxiety using validated International Classification of Diseases, 9th and 10th Revision coding algorithms. We applied multivariable Cox proportional hazard models to evaluate incident depression and anxiety among patients with gout in comparison to non-gout controls, adjusting for age, sex, neighbourhood income quintile, residence, comorbidities, and health care utilization.ResultsWe included 157,426 incident cases of gout (60.2% male; mean age 57.1 years) and 157,426 non-gout controls (60.2% male; mean age 56.9 years). The incidence rate of depression among individuals with gout and non-gout controls was 12.9 (95% confidence interval [CI] 12.7–13.2) and 11.1 (95% CI 10.9–11.4) per 1000 person-years, respectively. The incidence rate of anxiety for those with gout was 5.4 (95% CI 5.3–5.5) per 1000 person-years and for non-gout controls was 4.6 (95% CI 4.4–4.7) per 1000 person-years. Individuals with gout had an increased onset of depression (adjusted hazard ratio [aHR], 1.08; 95% CI 1.05–1.11) and anxiety (aHR, 1.10; 95% CI 1.05–1.14) compared to non-gout controls.ConclusionOur population-based study shows an increased incidence of depression and anxiety following gout diagnosis in comparison to non-gout controls. Findings suggest the importance of considering psychiatric impacts in addition to the physical impacts of gout.

Raman hyperspectral imaging detects novel and combinations of crystals in synovial fluids of patients with a swollen joint

AbstractThe identification of synovial crystals is important for diagnosing rheumatic diseases. Currently, rheumatologists worldwide use compensated polarized light microscopy (CPLM) for crystal identification, but this technique is flawed. Raman spectroscopy might offer an objective, accurate alternative. We have tested Raman hyperspectral imaging on synovial fluid samples of 28 patients with swollen joints, measuring 5–10 crystals in each of these. Reference spectra for identification were measured using patient material, synthetic compounds, and oxalate kidney stones. Additionally, RRUFF and PANGAEA Raman databases were used to identify spectra. We identified the classical pathological crystals monosodium urate for gout and calcium pyrophosphate for calcium pyrophosphate deposition disease (CPPD). Hydroxyapatite, lipid spherules, and calcium oxalate monohydrate have also been observed and had been previously identified in synovial fluids. Other crystals, which were not previously observed in synovial fluid using CPLM, have been identified as well: calcite, aragonite, anatase, rutile, thenardite, dolomite, and a carotenoid. In addition, we found combinations of crystals in 13 out of 28 patients. We propose that the observed large variation of detectable crystals from a small population of patients and a small number of crystals per patient has significant ramifications for the use of compensated polarized light microscopy for the diagnosis of gout and CPPD. Further studies are required to learn the clinical significance of these crystals in human arthritis.

Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes.

The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) vs dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of new-onset gout remains unknown. This study aims to compare the effects of SGLT2I against DPP4I on gout risks. This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus treated with SGLT2I or DPP4I between 1 January 2015 and 31 December 2020 in Hong Kong. The study outcomes are new-onset gout and all-cause mortality. Propensity score matching (1:1 ratio) between SGLT2I and DPP4I was performed. Univariable and multivariable Cox regression models were conducted. Competing risks models and multiple approaches based on the propensity score were applied. This study included 43 201 patients [median age: 63.23 years old (Interquartile range, IQR): 55.21-71.95, 53.74% males; SGLT2I group: n = 16 144; DPP4I group: n = 27 057] with a median follow-up of 5.59 years (IQR: 5.27-5.81 years) since initial drug exposure. The incidence rate of developing gout [Incidence rate (IR): 2.5; 95% CI: 2.2, 2.9] among SGLT2I users was significantly lower than DPP4I users (IR: 5.2; 95% CI: 4.8, 5.8). SGLT2I was associated with 51% lower risks of gout (HR: 0.49; 95% CI: 0.42, 0.58; P-value < 0.0001) and 51% lower risks of all-cause mortality (HR: 0.49; 95% CI: 0.42, 0.58; P-value < 0.0001) after adjusting for significant demographics, past comorbidities, medications and laboratory results. The results remained consistent on competing risk and other propensity score approaches. SGLT2I use was associated with lower risks of new gout diagnosis compared with DPP4I use.

The Clinical Utility of Dual-Energy Computed Tomography in the Diagnosis of Gout-A Cross-Sectional Study.

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806–0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878–0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924–0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p < 0.001), and decreased glomerular filtration rate (GFR) (p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout.

Effects of vitamin C supplementation on gout risk: results from the Physicians’ Health Study II trial

Short-term randomized trials suggest that a 500mg/d vitamin C supplement reduces serum urate, whereas observational studies show vitamin E is inversely associated with gout risk. We evaluated the effect of supplemental vitamin C (prespecified primary exposure) and vitamin E (prespecified secondary exposure) on new diagnoses of gout. We performed a post hoc analysis of data from the Physicians' Health Study II, a randomized, double-blind, placebo-controlled factorial trial of randomized vitamin C (500mg/d) and vitamin E (400 IU every other day). The primary outcome was new gout diagnoses, self-reported at baseline and throughout the follow-up period of ≤10 y. Of 14,641 randomly assigned male physicians in our analysis, the mean age was 64 ± 9 y; 1% were Black, and 6.5% had gout prior to randomization. The incidence rate of new gout diagnoses during follow-up was 8.0 per 1000 person-years among those assigned vitamin C compared with 9.1 per 1000 person-years among those assigned placebo. The vitamin C assignment reduced new gout diagnoses by 12% (HR: 0.88; 95% CI: 0.77, 0.99; P=0.04). These effects were greatest among those with a BMI <25kg/m 2 (P-interaction=0.01). Vitamin E was not associated with new gout diagnoses (HR: 1.05; 95% CI: 0.92, 1.19; P=0.48). Vitamin C modestly reduced the risk of new gout diagnoses in middle-aged male physicians. Additional research is needed to determine the effects of higher doses of vitamin C supplementation on serum urate and gout flares in adults with established gout.The Physicians' Health Study II is registered at clinicaltrials.gov (identifier: NCT00270647).

ROLE OF DUAL ENERGY COMPUTED TOMOGRAPHY IMAGING IN GOUT

Context: Gout is a crystal induced inammatory arthritis triggered by crystallization of uric acid in joints. The detection of urate crystals is done using polarization light microscopy after synovial uid aspiration which is approach is invasive. Dual energy CT (DECT) is a new imaging modality that is able to identify tophi based on their chemical composition. To evaluate the rol Aims: e of Dual Energy Computed Tomography imaging in gout. A cross sectional observational study, comprising of 30 clinically suspected pati Settings And Design: ents of gout underwent DECT of all peripheral joints (including hand, wrist, elbow, ankle, foot and knee). This Methods And Material: study was conducted on 128 slice SIEMENS Somatom Denition Flash CT scan. A dual energy gout colour coded protocol assessed the chemical composition of the material and an automated volume assessment software, measured the monosodium urate crystal deposition volume. Analysis was Statistical Analysis Used: done using SPSS version 21.0. In lower limb the MTP joint (73.33%) was commonest foll Results: owed by ankle (33%) and knee (26%) with mean crystal volume of 3.51 cm3. In upper limb, MCP and PIP joints (20%) of hand are most commonly affected with mean volume of 0.24cm3. High serum uric acid (&gt;6.4mg/dl) levels showed a positive correlation with MSU crystal deposition in all peripheral joints on DECT. Conclusions: DECT is useful for the diagnosis of gout in symptomatic patients. It can detect MSU crystals volume and urate burden non-invasively.

Surgical Treatment of Patients with Tophus Gout

Introduction. Modern diagnostics, comprehensive orthopedic treatment, prevention of complications and adequate rehabilitation of patients with chronic gout can reduce the frequency and severity of exacerbations, prevent the development of secondary osteoarthrosis, maintain ability to work, improve social adaptation of patients and reduce their disability.&#x0D; Objective: to improve treatment results of patients with chronic tofus gout by developing indications for surgical treatment and improving existing methods of modern orthopedic treatment.&#x0D; Materials and Methods. The materials of the study were based on treatment results of 58 patients with a diagnosis of chronic tofus gout, who were observed and treated in clinics of SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” during 2012-2021. The age of patients ranged from 30 to 80 years (mean age 58.4±5.3 years). All patients were divided into two groups – main and control. The main group included patients (27 patients) who, in addition to conservative methods, underwent surgical treatment. The control group included 31 patients with chronic tofus gout who did not undergo surgery. For the development of indications and visualization of the pathological process severity, all patients underwent sonographic examination; removed tissues after surgery underwent morphological examination.&#x0D; Results. The results of pathomorphological studies allowed us systematically evaluate the dynamics of morphological changes in joint tissues in tofus gout, to clarify the features of the inflammatory process and the formation of tofus, and to determine the effects of tofus impact on the structural and functional state of tissues in affected joint.&#x0D; Conclusions. Surgical treatment in combination with conservative allows reducing the activity of the disease compared to the control group, to achieve a faster decrease in uric acid serum levels, reduce the number and duration of exacerbations regardless of the duration of the disease, reduce pain, improve quality of life, and reduce or avoid disability in patients.

The paradoxical relation between serum uric acid and outcomes of hip fracture in older patients after surgery: A 1-year follow-up study

BackgroundThe relation between serum uric acid and bone metabolism has been reported in many studies, but few studies have focused on serum uric acid and fracture rehabilitation. We aimed to explore the potential relationships between serum uric acid and outcomes of hip fractures. MethodsA total of 742 patients with hip fractures who underwent surgeries between December 2017 and February 2021 and met the inclusion criteria were included. The data of male and female patients were analyzed separately. Cox models with different adjusted forms were performed to explore the potential risk factors, and restricted cubic splines were used to determine the nonlinear relationships between serum uric acid and outcomes and optimal cutoff points of serum uric acid. Then, the outcomes were analyzed in the groups divided by cutoff points mentioned above, as well as groups divided by the diagnosis of hyperuricemia or gout. ResultsCox analysis showed that hyperuricemia or gout was associated with increased death risk, and a typical J-shaped curve was observed in the restricted cubic spline. For male patients, a serum uric acid of high level may relate to a high risk of 6-month (P = .008) and 1-year (P = .016) mortality, and a serum uric acid of low level may predict a poor 6-month free walking ability. For female patients, both a serum uric acid of high level and low level were associated with poor 1-year survival (all P < .05), and a serum uric acid of high level may relate to poor 6-month (P = .001) and 1-year (P = .001) free walking ability. ConclusionPatients with hyperuricemia or gout or patients with high and low levels of serum uric acid may face poor outcomes of hip fractures.

In patients with acute mono/oligoarthritis, a targeted ultrasound scanning protocol shows great accuracy for the diagnosis of gout and CPPD.

To determine an US scanning protocol with the best accuracy for the diagnosis of gout and CPPD in patients with acute mono/oligo-arthritis of unknown origin. Patients with acute mono/oligo-arthritis in whom a joint aspiration at the most clinically involved joint (target joint) was requested were consecutively enrolled. US was performed in each patient before the arthrocentesis. The accuracy of different US findings and scanning protocols for the diagnosis of gout and CPPD was calculated. A total of 161 subjects were included (32 gout patients, 30 CPPD patients and 99 disease-controls). US findings had a high specificity for gout (0.92-0.96) and CPPD (0.90-0.97), while the sensitivity ranged from 0.73 to 0.85 in gout (double contour sign and tophi, respectively) and from 0.60 to 0.90 in CPPD (hyaline and fibrocartilage deposits, respectively). The US assessment of two joints bilaterally (gout: knees, MTP1 joints; CPPD: knees, wrists) plus the target joint had an excellent diagnostic sensitivity (gout: 0.91, CPPD: 0.93) and specificity (gout: 0.91, CPPD: 0.89). This targeted US scanning protocol yielded to higher diagnostic accuracy compared with the US evaluation of the target joint [gout area under the curve (AUC) 0.91 vs 0.84, P = 0.03; CPPD AUC 0.93 vs 0.84, P = 0.04] unless the target joint was the knee or the MTP1 joint in gout and the knee or the wrist in CPPD. A targeted US scanning protocol of two joints bilaterally plus the target joint showed an excellent accuracy (>90%) for the diagnosis of crystal arthritis in patients with acute mono/oligoarthritis.

Febuxostat as an effective drug of choice for urate-lowering therapy for gout (case report)

The prognosis for gout is largely determined by its timely diagnosis and the choice of drugs for effective urate-lowering therapy which considers the peculiarity of a particular patient’s disease course: the signs of complications, comorbid pathology, and drug tolerability. The report presents a clinical case of gout, which a 30-year-old man with acute arthritis of the right big toe experienced for the first time. The diagnosis of gout was verified by a rheumatologist only 6 years after the first attack. In addition to gout, the patient was also diagnosed with urolithiasis, obesity, hypertension, prediabetes and dyslipoproteinemia. Initially, allopurinol was prescribed, which at a dose of 300 mg/day ensured the achievement of the target level of uric acid. However, the patient stopped taking the drug and eased the frequent gouty attacks by taking nonsteroidal anti-inflammatory drugs. He turned to the rheumatologist again 2 years later. The level of uric acid in the blood was 744 umol/l, the glomerular filtration rate (GFR) was 55 ml/min. The resumption of allopurinol intake was accompanied by the development of dermatitis. Therefore, instead of allopurinol, febuxostat was prescribed, which at a dose of 120 mg/day ensured the achievement of a normal level of uric acid. At this dose, the patient has been taking the drug for the last 2.5 years. The drug tolerability is good. An improvement in kidney function (GFR – 89 ml/min) and normalization of carbohydrate metabolism were recorded associated with medication intake. Thus, febuxostat for gout is an effective drug for urate-lowering therapy. prescription is especially recommended in case of intolerance to allopurinol and kidney damage.

Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout

Gout is associated with cardiovascular diseases. The temporal association between gout flares and cardiovascular events has not been investigated. To investigate whether there is a transient increase in risk of cardiovascular events after a recent gout flare. A retrospective observational study was conducted using electronic health records from the Clinical Practice Research Datalink in England between January 1, 1997, and December 31, 2020. A multivariable nested case-control study was performed among 62 574 patients with gout, and a self-controlled case series, adjusted for season and age, was performed among 1421 patients with gout flare and cardiovascular event. Gout flares were ascertained using hospitalization, primary care outpatient, and prescription records. The primary outcome was a cardiovascular event, defined as an acute myocardial infarction or stroke. Association with recent prior gout flares was measured using adjusted odds ratios (ORs) with 95% CIs in a nested case-control study and adjusted incidence rate ratios (IRRs) with 95% CIs in a self-controlled case series. Among patients with a new diagnosis of gout (mean age, 76.5 years; 69.3% men, 30.7% women), 10 475 patients with subsequent cardiovascular events were matched with 52 099 patients without cardiovascular events. Patients with cardiovascular events, compared with those who did not have cardiovascular events, had significantly higher odds of gout flare within the prior 0 to 60 days (204/10 475 [2.0%] vs 743/52 099 [1.4%]; adjusted OR, 1.93 [95% CI, 1.57-2.38]) and within the prior 61 to 120 days (170/10 475 [1.6%] vs 628/52 099 [1.2%]; adjusted OR, 1.57 [95% CI, 1.26-1.96]). There was no significant difference in the odds of gout flare within the prior 121 to 180 days (148/10 475 [1.4%] vs 662/52 099 [1.3%]; adjusted OR, 1.06 [95% CI, 0.84-1.34]). In the self-controlled case series (N = 1421), cardiovascular event rates per 1000 person-days were 2.49 (95% CI, 2.16-2.82) within days 0 to 60; 2.16 (95% CI, 1.85-2.47) within days 61 to 120; and 1.70 (95% CI, 1.42-1.98) within days 121 to 180 after a gout flare, compared with cardiovascular event rates of 1.32 (95% CI, 1.23-1.41) per 1000 person-days within the 150 days before or the 181 to 540 days after the gout flare. Compared with 150 days before or the 181 to 540 days after a gout flare, incidence rate differences for cardiovascular events were 1.17 (95% CI, 0.83-1.52) per 1000 person-days, and adjusted IRRs were 1.89 (95% CI, 1.54-2.30) within days 0 to 60; 0.84 (95% CI, 0.52-1.17) per 1000 person-days and 1.64 (95% CI, 1.45-1.86) within days 61 to 120; and 0.38 (95% CI, 0.09-0.67) per 1000 person-days and 1.29 (95% CI, 1.02-1.64) within days 121 to 180 after a gout flare. Among individuals with gout, those who experienced a cardiovascular event, compared with those who did not experience such an event, had significantly higher odds of a recent gout flare in the preceding days. These findings suggest gout flares are associated with a transient increase in cardiovascular events following the flare.

Hypomethylation of the opioid receptor delta 1 gene combined with high opioid receptor delta 1 protein levels indicates increased risk of gout.

BackgroundThe purpose of this study was to identify biomarkers for the diagnosis of gout in Chinese Han males using methylation microarray profiling.MethodsWe screened for differentially methylated genes (DMGs) in gout using a methylation microarray and analyzed the functions of the DMGs using gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. We verified gene methylation levels by pyrosequencing and protein levels by enzyme‐linked immunosorbent assays (ELISAs). Statistical analyses were performed using SPSS. Two‐sided p values <0.05 were deemed to be statistically significant for all analyses.ResultsWe identified 20,426 significant differential methylation sites (5719 high‐methylation sites and 14,707 low‐methylation sites). Bioinformatics analysis showed that the DMGs were mainly involved in 43 biological functions, 13 cellular components, 18 molecular functions, and 35 KEGG pathways. We selected opioid receptor delta 1 (OPRD1) for verification of methylation levels between 50 gout patients and 50 controls. The methylation levels of OPRD1 (Chr1:29,139,121) were significantly lower in the gout group (p < 0.05), while OPRD1 protein levels were significantly higher in the gout group (p < 0.05). In addition, the AUC of the combination of OPRD1 (Chr1:29,139,121) methylation and OPRD1 protein levels was 0.796 (0.710, 0.883) with a high sensitivity of 82% and a specificity of 68% (p < 0.001).ConclusionsThe combination of OPRD1 (Chr1:29,139,121) hypomethylation and high levels of OPRD1 protein is a potential biomarker for gout diagnosis.

Gout Screening Identifies a Large Cardiovascular Population at Increased Risk of Mortality.

Gout is prevalent in people with cardiovascular disease, although up to a third of the cases remain unregistered. We aimed to assess whether active gout screening in inpatients with cardiovascular events helps identify patients at higher risk of mortality after discharge. This study included patients admitted for cardiovascular events. Gout was established by records review and clinical interview. After discharge, electronic medical records were reviewed for mortality and cause of death. The association between gout and subsequent mortality was tested using Cox regression models. Of 266 recruited patients, 17 were lost to follow-up, leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5%) were classified as having gout; 13 of these (36.1%) were identified through the interview. Mean follow-up was 19.9 (SD, 8.6) months. Gout significantly increased the risk of all-cause mortality in the overall sample (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.13-3.58) and in the subgroup with a prior diagnosis of gout (HR, 2.89; 95% CI, 1.54-5.41). The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI, 1.01-3.41). Patients with gout carried an increased risk of both cardiovascular and noncardiovascular deaths; age and chronic kidney disease were mortality predictors within the gout population. Gout was an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed the detection of a larger population at high risk of mortality and could help tailor patient management to minimize the cardiovascular impact.

An unusual clinical presentation of granulomatous tophaceous gout in the wrist

The possibility of infection with mycobacterium tuberculosis (TB), and other infectious agents is the first option when granulomatous inflammation wasobserved in the histological examination of a tissue specimen. However, gout with manifestations of granulomatous synovitis may mimic TB tenosynovitis. An 80-year-old male with a history of hypertension, and gout presented with the swelling of the right wrist, and deformity as a result of trauma. The results of cytology for malignancy, TB polymerase chain reaction (PCR), and TB culture were negative. Histopathological examination with an electron microscope confirmed the diagnosis of tophaceous gout along with granulomatous synovitis. The current case emphasizes the significance of a correct gouty process diagnosis in patients who exhibit granulomatous tophaceous tuberculous tenosynovitis or rheumatoid arthritis. We suggested that gout should be considered in differential diagnosis of granulomatous synovitis, especially in cases with negative mycobacterium TB-PCR.

Tophaceous Gout on Ear Imitating Squamous Cell Carcinoma

We report a case of tophaceous gout occurring in a Hispanic 69-year-old immunocompetent man. The patient presented with a 0.8 cm pink, purple, and brown dome-shaped papule on the right superior helix of the ear. The lesion was tender to palpitation. A deep shave biopsy was performed and the histological findings demonstrated pseudoepitheliomatous hyperplasia overlying large dermal deposits of pink, hyalinized feathery material surrounded by mild granulomatous inflammation. This finding supported the diagnosis of tophaceous gout rather than the clinical findings imitating squamous cell carcinoma. Concurrently, the patient received an intralesional Kenalog (ILK) injection to suppress any existing or ensuing inflammation. Treatment of the residual lesion was achieved via curettage and electrodesiccation.