Gout Control Research Articles

#2387 Case study of a patient with gouty nephropathy treated with immunosorbent therapy

Abstract Background and Aims Gouty nephropathy is a kidney disease caused by chronic hyperuricemia, in which uric acid crystals are deposited in the kidneys leading to tubular and glomerular damage, which in turn affects kidney function. Patient female, 68 years old, 7 years ago, no obvious cause of the first toe joint of the right foot, the right ankle joint redness, swelling and pain, the local skin temperature increases, serious limitation of activities, had checked the high uric acid (specific unknown), diagnosed as “gout”, simple treatment after the symptoms are relieved, but did not have systematic treatment, and gradually appeared in the left foot, the first toe joint, the left ankle joint, double knee joint redness, swelling and pain, oral pain medication treatment, pain disappears after still no systematic treatment. After that, redness, swelling and pain appeared gradually in the first toe joint of the left foot, left ankle joint and both knee joints, and the pain disappeared without systematic treatment after taking pain-relieving medicines. He was admitted to our hospital as an outpatient with the diagnosis of “gout”. Method Immunosorbent therapy was given once/day on days 1-3, along with Jinshuibao and urotoxin clearing granules. Immunosorbent therapy was given again three times on the 8th-10th day of admission. Results Before admission, uric acid: 899.3 µmol/L; creatinine: 586.1 µmol/L, both seriously out of the normal range. 3 days later, uric acid: 770.4 µmol/L, creatinine: 468.7 µmol/L. At the time of discharge, serum uric acid: 298.5 µmol/L and creatinine: 182.6 µmol/L were detected and restored to the normal range. Conclusion The case demonstrated the presence of gout with arthritic symptoms, vascular damage, anemia, and hepatic and renal impairment. The patient's gout progressively worsened due to prolonged absence of systemic treatment. After admission, the levels of uric acid and creatinine were effectively controlled and restored by immunosorbent therapy. This indicates that immunosorbent therapy plays a positive role in removing uric acid from the body and improving renal function. Meanwhile, the management and control of gout was further strengthened by combining the comprehensive treatment with Jinshuibao and uremic acid granules.

The experiences and perspectives of people with gout on urate self-monitoring.

Gout management remains suboptimal despite safe and effective urate-lowering therapy. Self-monitoring of urate may improve gout management, however, the acceptability of urate self-monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self-monitoring in people with gout. Semistructured interviews were conducted with people taking urate-lowering therapy (N = 30) in a 12-month trial of urate self-monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self-management. Deidentified transcripts were analysed thematically. Participants valued the ability to self-monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self-monitoring at home was easy, convenientand informed gout self-management behaviours such as dietary modifications, hydration, exerciseand medication routines. Many participants self-monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases. Urate self-monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self-monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines. One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.

Correlation analysis of serum TLR4 protein levels and TLR4 gene polymorphisms in gouty arthritis patients.

The Toll-like receptor (TLR) 4-mediated nuclear factor kappa B (NF-κB) signaling pathway regulates the production of inflammatory factors and plays a key role in the pathogenesis of gouty arthritis. The aim of the present study was to investigate the link among TLR4 gene polymorphisms at various loci, protein expression, and gouty arthritis susceptibility. Between 2016 and 2021, a case-control study was used to collect a total of 1207 study subjects, including 317 male patients with gouty arthritis (gout group) and 890 healthy males (control group). The association between gout susceptibility and different genetic models was analyzed by typing three loci of the TLR4 gene (rs2149356, rs2737191, and rs10759932) using a multiplex point mutation rapid assay, and the association between protein expression and gout was confirmed by measuring TLR4 protein concentrations using enzyme-linked immunosorbent assays (ELISAs). In a codominant models AA and AG, the rs2737191 polymorphism in the gout group increased the risk of gout compared to the AA genotype (OR = 2.249, 95%CI 1.010~5.008), and the risk of gout was higher for those carrying the G allele compared to the A allele (OR = 2.227, 95%CI 1.006~4.932). TLR4 protein expression was different between the two groups with different locus genotypes. The differences in TLR4 protein expression between the gout group and control group were statistically significant between the following genotypes: the GG and GT genotypes of the rs2149356 polymorphism; the AA and AG genotypes of the rs2737191 polymorphism; and the TT and TC genotypes of the rs10759932 polymorphism(P<0.05). The TLR4 protein level in the gout group (19.19±3.09 ng/ml) was significantly higher than that in the control group (15.85±4.75 ng/ml). The AG genotype of the TLR4 gene rs2737191 polymorphism may be correlated with the development of gouty arthritis. The level of TLR4 protein expression is significantly higher in patients with gouty arthritis than in controls, and there is a correlation between high TLR4 protein expression and the development of gouty arthritis.

Treatment and diagnostics of gout: Unsolved problems in clinical practice

The possibilities for diagnosing and treating gout have expanded significantly. However, this did not lead to solving the problem of timely diagnosis of gout, nor to improving control over it, nor to reducing mortality in patients with gout. In the article possible reasons of absence of the progress in gout control connected with the lack of usage of contemporary capabilities in diagnosis and mistakes in usage of drugs therapy is discussed. These should include the lack of conversance of medical stuff about sonography high informativity for gout diagnosis, low availability of polarizing microscopy and dual energy computer tomography; causeless ignore of prescribing prophylactic symptomatic therapy, usage of inadequate doses of drugs. Another reason may be the absence of unified concept regarding specific indications of prescribing urate-lowering drugs and choice of specific medicine.

Prevention and control of gout through health screening at Posbindu, Gilis Village, Tangen District

Petunjuk pelaksanaan pos pembinaan terpadu (posbindu) merupakan wadah untuk melakukan kegiatan monitoring dan deteksi dini resiko berbagai penyakit. Kesehatan bagi manusia sangat penting untuk menunjang dalam melaksanakan bebagai aktifitas sehari – hari, oleh karena itu pemeriksaan melalui screening merupakan cara untuk mencegah dan mengendalikan timbulnya bebagai penyakit. Pola makan, berat badan yang berlebih, Riwayat keluarga, usia dan jenis kelamin merupakan faktor – faktor resiko mengalami asam urat. Dalam pengabdian kepada Masyarakat ini dihadiri oleh 34 anggota diposbindu Desa Gilis, Kecamatan Tangen. Berdasarkan dari hasil screening di dapatkan tekanan darah dalam batas normal sebanyak 32,36% dan kadar goutuntuk laki – laki sebanyak 61,76% dan kadar goutperempuan sebanyak 55,88% dan keduanya dalam batas normal. Berdasarkan hasil tersebut dapat disimpulkan bahwa masarakat diabwah naungan Posbindu Desa Gilis Kecamatan Tangen sudah menerapkan hidup sehat baik pola makan maupun aktifitas yang berkaitan dengan Kesehatan.

Epidemiology and risk factors associated with gout control among adult Asians: a real-world retrospective cohort study.

Gout is associated with significant morbidity and mortality, yet suboptimal gout control remains a problem globally. Identifying the risk factors associated with poor gout control among patients in primary care allows targeted interventions to improve their clinical management. This study aimed to determine the prevalence of poor gout control and its associated demographic and clinical factors among urbanized community-dwelling Asian patients. This retrospective study was based on data extracted from the electronic medical records of 8 public primary care clinics in Singapore. Patients with a diagnostic code of gout who had 2 or more visits between 1st January 2018 and 31st December 2019 were included in the analysis. Data extracted included: demographics, anthropological measurements, comorbidities, serum uric acid levels and medication prescription. A patient is defined to have poor gout control if they suffer two or more acute gout attacks within a year. Chi-Squared test was used for categorical parameters. For continuous variables, univariate logistic regression analysis was first performed. Significant factors (p ≤ 0.1) were then included in the logistics regression model to account for confounders. A total of 7,970 patients and 24,624 visits were included in the analysis. The prevalence of poorly controlled gout was 28.2% (n = 2,244/7,970); only 46.3% of them (n = 1,039/2,244) were prescribed allopurinol and 13.4% (n = 301/2,244) were taking doses ≥300 mg. Using logistic regression, factors associated with poor gout control were: male gender [adjusted OR (AOR) =1.66, p < 0.001], Malay ethnicity (AOR = 1.27, p = 0.007), congestive heart failure (AOR = 1.64, p = 0.037). Patients prescribed allopurinol (AOR = 1.52, p < 0.001), NSAIDs (AOR = 2.76, p < 0.001) and corticosteroids (AOR = 2.83, p < 0.001) were more likely to have poorly-controlled gout. Nearly 30% of patients had poor gout. Interventions should focus on male and Malay patients and those with congestive cardiac failure.

Tailored hydrogel composite membrane for the regulated crystallization of monosodium urate monohydrate within coffee’s metabolites system

Herein, a facile bionic research platform with fabricated hydrogel composite membrane (HCM) is constructed to uncover the effects of the main components of coffee’s metabolites on MSUM crystallization. Tailored and biosafety polyethylene glycol diacrylate/N-isopropyl acrylamide (PEGDA/NIPAM) HCM allows the proper mass transfer of coffee’s metabolites and can well simulate the process of coffee’s metabolites acting in the joint system. With the validations of this platform, it is shown that chlorogenic acid (CGA) can hinder the MSUM crystals formation from 45 h (control group) to 122 h (2 mM CGA), which is the most likely reason that reduces the risk of gout after long-term coffee consumption. Molecular dynamics simulation further indicates that the high interaction energy (Eint) between CGA and MSUM crystal surface and the high electronegativity of CGA both contribute to the restraint of MSUM crystal formation. In conclusion, the fabricated HCM, as the core functional materials of the research platform, presents the understanding of the interaction between coffee consumption and gout control.

Predictors of Patient and Physician Assessments of Gout Control.

To understand the clinical variables that contribute to the patient and physician assessments of gout control and which variables predict discordant assessments. Patients (n=223) with gout taking allopurinol ≥300 mg daily attended a standardized gout assessment visit. Participants and physicians completed questionnaires rating their assessment of current gout control using a numerical rating scale (0=not at all controlled, 10=fully controlled). Discordance between patients' and physicians' scores was defined as an absolute difference of >2 units. The mean ± SD patient gout control score was 8.09 ± 2.24, and the physician gout control score was 7.38 ± 2.63 (P < 0.001 for comparison). Absence of gout flares in the last 12 months and in the last 3 months and serum urate at the treatment target (<6 mg/dl) were associated with higher patient and physician gout control scores. Absence of tophus also predicted higher physician, but not patient, gout control scores. Discordant scores for gout control were present in 50 participants (22.3%), mostly due to lower assessment of disease control by physicians. Gout flare in the preceding 3 months (odds ratio [OR] 5.9, P < 0.001) and tophus (OR 3.1, P=0.007) predicted discordant disease-control assessments in which physicians scored lower gout control than patients. For both patients and physicians, absence of gout flares and serum urate levels at the treatment target predict assessment of gout control. However, discordance between patients and physicians in their assessment of disease control is not uncommon, with recent gout flares and tophus predicting lower scores by physicians than patients.

Key Genes Associated with Pyroptosis in Gout and Construction of a miRNA-mRNA Regulatory Network.

This study aimed to analyze key hub genes related to pyroptosis in gout and construct a miRNA-mRNA regulatory network using bioinformatic tools to elucidate the pathogenesis of gout and offer novel ideas to develop targeted therapeutic strategies for gout. Methods: The GSE160170 dataset was downloaded from the GEO database. The expression data extracted from the dataset were used to screen for differentially expressed genes (DEGs), which intersected with pyroptosis-related genes. These DEGs were analyzed via Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, and a protein–protein interaction (PPI) network was constructed to identify pyroptosis-related hub DEGs. The relationship between upstream miRNAs and the hub genes was analyzed, miRNA-mRNA networks belonging to gout disease were constructed and samples from patients with gout were used for experimental verification. The CTDbase tool was used to analyze the identified hub genes and construct a molecular docking model. Results: A total of 943 DEGs (380 upregulated and 563 downregulated) were identified by analyzing the data of patients with early-stage gout and healthy control individuals in the GSE160170 dataset. DEGs and pyroptosis-related genes were intersected to obtain 17 pyroptosis-related DEGs associated with gout; of which, 12 were upregulated, and five were downregulated. The results of GO and KEGG analyses revealed that the DEGs were enriched in inflammatory and immune signaling pathways. Additionally, the DEGs were found to regulate inflammatory responses and were associated with apoptosis. TNF, IL-1β, NLRP3, CXCL8, PTGS2, NFE2L2, CASP8, and CD274 were identified as key hub genes in the PPI network, and a miRNA-mRNA network was constructed, which had 16 edges. Experimental validation revealed that PTGS2 and NFE2L2 were significantly upregulated, and CASP8 and CD274 were significantly downregulated in gout. In addition, miR-128-3p, miR-16-5p, miR-155-5p, and miR-20a-5p (associated with the miRNA-mRNA regulatory network) were significantly downregulated in gout. Five potential therapeutic drugs with stable PTGS2 binding were selected to develop a molecular docking model. Conclusion: A miRNA-mRNA potential regulatory network was constructed based on pyroptosis-related DEGs associated with gout. miR-16-5p, miR-128-3p, miR-20a-5p, and miR-155-5p can potentially influence pyroptosis and the occurrence and development of gout by affecting the expression of the PTGS2, CASP8, NFE2L2, and CD274 genes. Screening of celecoxib and resveratrol and other targeted drugs with stable binding. The findings of this study offer valuable insights into the regulatory mechanisms of gout and may help to identify Biomarkers and develop targeted therapeutic strategies for gout.

Restrained MSUM crystallization via hydrogel composited membrane based platform for gout prevention and control

Gout is the most common of inflammatory arthropathy caused by the crystallization and accumulation of monosodium urate monohydrate (MSUM) in joints. Herein, fabricated hydrogel composited membrane (HCM) is developed to simulate the mass transfer in joints. A facile and versatile HCM based dynamic platform is established to investigate the “triggers” mechanism of gout under alcohol and its metabolites (acetaldehyde (AH) and acetic acid (HAc) intake condition. The distinct role of EtOH on enhanced gout onset was demonstrated, which attributes to the low interaction energy (Eint) between EtOH and the main crystal surface. While, HAc and carboxyl groups exhibit potentially restrain the MSUM crystallization. This conclusion is furtherly confirmed by the different restraint performance of two kinds of fabricated HCM. PEGDA/AA (polyethylene glycol diacrylate/acrylic acid) with abundant carboxyl groups can delay the appearance time of MSUM crystals from 20 h to 82 h and reduce the crystal yield to 7.5% of the one via PEGDA/NIPAM (N-isopropylacrylamide). The excellent electronegativity of PEGDA/AA renders the adsorption of sodium ion on the HCM interface, which furtherly increases the nucleation energy barrier of MSUM crystal. The functional HCM based platform can guide the relevant biomedical research and rational drug design for gout prevention.

Computer-assisted in vitro reconstitution of purine degradation pathway to lower the purine content in food.

With the increasing prevalence of gout and its etiological hyperuricemia, dietary control of gout based on low-purine food according to patients' eating habits is becoming a better choice compared to the existing drug treatment such as allopurinol with notorious side effects. Reconstructing the purine metabolic pathway in vitro to degrade purine substances in food into natural functional allantoin appears to be an innovative method for preparing nutritious and healthy food of low purine content. The present study reports a computer-assisted in vitro reconstruction of four purinolytic enzymes metabolizing adenosine into allantoin to reduce purine content in food for personalized dietary control of hyperuricemia and gout. Under the optimum reaction conditions of 40 °C and pH7, 0.1U of enzymes and 0.5 mmol L-1 adenosine determined by an orthogonal test design, 16 different enzyme complexes were experimentally tested. The tested enzyme composition and allantoin production values were used as input and output to build a three-layer back propagation artificial neural network (BP-ANN) model, which was further optimized by a genetic algorithm (GA). The optimum enzyme complex predicted by the GA-BP-ANN model produced 248.08±7.832 μmol L-1 allantoin, which was 19.9% higher than equimolar mixture of enzymes, and also more efficiently lowered purine contents in beer, as well as beef and yeast extracts. This is the first in vitro reconstitution of complete purine metabolic pathway by combining ANN and GA technologies, with successful application with respect to lowering the purine content in food, indicating a promising application of computer-assisted in vitro reconstitution of purinolytic pathway in low-purine food to prevent hyperuricemia and gout. © 2022 Society of Chemical Industry.

Trends in risk factor control in patients with gout: data from the National Health and Nutrition Examination Survey, 2007-2018.

To explore trends in risk factor control (hypertension, diabetes mellitus, hyperlipidaemia) in patients with gout and medication use among those whose risk factor control targets were not achieved. We used the data from National Health and Nutrition Examination Survey (NHANES) between 2007-2008 and 2017-2018 for analyses. The study samples were weighted so that they could be representative of the non-institutionalized US population. We conducted a cross-sectional analysis to assess trends in risk factor control and medication use, and employed logistic regression analyses to explore patient characteristics associated with risk factor control. The prevalence of participants in whom blood pressure control target was achieved decreased from 64.6% in 2007-2008 to 55.3% in 2017-2018 (P-value for trend = 0.03). The percentage of participants whose glycaemic, lipid or all three risk factor control targets were achieved remained stable temporally (P > 0.05). Some patient characteristics were significantly related to risk factor control, including age 45-64, age ≥65, Asian Americans, non-Hispanic Blacks, higher family income, and being overweight and obese. A trend towards increased use of glucose-lowering medication was found (from 71.0% in 2007-2008 to 94.7% in 2017-2018, P < 0.01), while the prevalence of taking blood pressure-lowering and lipid-lowering medications remained stable (P > 0.05). Based on NHANES data, a significant trend towards decreased blood pressure control was observed in patients with gout, while glycaemic and lipid control levelled off. These findings emphasize that more endeavours are needed to improve management of cardiovascular risk factors in patients with gout.

Specular Microscopic Corneal Endothelial Cell Changes following Uneventful Phacoemulsification in Patients with Gout.

Purpose To assess the effects of phacoemulsification on the corneal endothelium in patients with gout and age-related cataracts. Methods Eighty-eight patients who underwent uneventful phacoemulsification for age-related cataracts were included in this retrospective comparative study. The patients were divided into two groups: group A included 31 patients with gout and tight control of uric acid levels and group B included 57 patients without gout or any other systemic disease. All patients completed follow-up assessments over 6 months, and the two groups were compared in terms of changes to their specular microscopic values. Results Both groups showed marked improvement in uncorrected and best-corrected visual acuity at the end of the follow-up period. Corneal endothelial cell loss was more severe in group A than in group B, with a mean difference of 221.35 ± 43.87 in group A and 169.88 ± 52.67 in group B at the sixth month (p < 0.001). The difference between the two groups in terms of other specular microscopic values did not reach statistical significance. Conclusion Patients with gout are more prone to corneal endothelial cell damage after phacoemulsification than those without gout. To confirm these results, future studies with a prospective design and longer durations of follow-up are needed.

Characterization of Plasma Extrachromosomal Circular DNA in Gouty Arthritis.

Objective: Extrachromosomal circular DNA elements (eccDNAs) are known for their broad existence in cells and plasma, which may potentially play important roles in many biological processes. Our aim was to identify potentially functional or marked eccDNAs in gout patients. Methods: The Circle-Seq approach was applied for eccDNA detection from plasma in acute gout patients and healthy controls. Further analysis was performed on the distribution of genomic elements and eccDNA gene annotations in two groups. Results: We detected 57,216 and 109,683 eccDNAs from the acute gout and healthy control plasma, respectively. EccDNAs were mapped to the reference genome to identify diverse classes of genomic elements and there was no significant difference of eccDNAs on genomic element annotation between gout and control group. A total of 256 eccDNA-associated genes were detected as gout unique eccDNA genes, including COL1A1 and EPB42, which potentially contribute to hyperuricemia and gout, and a couple of genes involved in inflammation or immune response. Enrichment analysis showed that these eccDNA genes were highly correlated with defense response, stress response, and immune and inflammatory responses, including T cell receptor signaling pathway, Fc epsilon RI signaling pathway, and JAK-STAT signaling pathway. Conclusion: Our discovery reveals the novel potential biological roles of plasma eccDNAs in gouty arthritis.

Assessment of Antigout, Antioxidant and Production Performance Augmenting Activity of Piper betle L. in Gout Induced Broiler Chicken

Background: The gout is commonly reported in birds and causes severe economic losses to the farmers. Hence to prevent the gout occurrence P.betle L. herb was selected and its antigout potential was studied in comparison with Allopurinol.Methods: The biological experiment was conducted with 120 broiler chicks and was divided into 5 treatment groups of 8 birds each with triplicate study for six weeks. The groups were control (T1), gout control (T2), Allopurinol (T3), P.betle L. - 10 g/kg (T4) and P.betle L. - 12.5 g/kg of feed (T5). The gout was induced using toxic dose of sodium bicarbonate in water (20 g/litre). The clinical signs and production performance were recorded and gross and histopathology studies were conducted. Serum biochemical parameters viz., uric acid and creatinine were periodically estimated (day 10, 15, 18 and 42 of trial) and anti-oxidant and xanthine oxidase enzyme activity were measured.Result: The production performances and the antioxidant activity were improved in P.betle L. groups and even better than Allopurinol. Also progressive reduction of uric acid and equivalent suppression of xanthine oxidase activity as that of Allopurinol were observed. Hence P.betle L. herb can be used effectively in the prevention of gout in birds.

Study on the association of &lt;i&gt;SLC2A9&lt;/i&gt; rs16890979 with gout in 410 Vietnamese individuals

Gout is a common form of inflammatory arthritis caused by crystallization of acid uric in the joints. The development of gout is not only triggered by environmental factors but also by genetic variation of individuals. In this study, the association between the variation SLC2A9 rs16890979 and gout was investigated. Total DNA was extracted from 410 blood samples of 163 gout patients and 247 age-matched healthy controls. Genotypes of SLC2A9 rs16890979 were obtained using PCR-RFLP. Chi-Square test was used to test whether allele distribution of rs16890979 followed Hardy-Weinberg Equilibrium (HWE). Associations of the clinical characteristics between gout patient and control groups were assessed using Mann-Whitney U. Chi-Square test or Fisher’s exact test was used to check four models (additive, recessive, dominant, co-dominant) for association of rs16890979 with gout. The obtained results showed that the allele distribution of SLC2A9 rs16890979 was in accordance with HWE (p &gt; 0.05). Clinical characteristics such as triglyceride and creatinine were significantly different between gout patient and control groups. However, there was no association of rs16890979 with the risk of gout in Vietnamese population. Further study with a larger sample size should be implemented to confirm our results regarding the association of SLC2A9 rs16890979 with gout in the Vietnamese population. This study would help enrich the knowledge about the effects of hereditary factors on gout disease in the Vietnamese population.

Trends in the manifestations of 9754 gout patients in a Chinese clinical center: A 10-year observational study.

The prevalence of gout is increasing but studies of its clinical features in large samples are lacking. This study aimed to clarify changes in the clinical manifestations of gout in China over the last decade and investigate the clinical features and risk factors of early-onset gout. Clinical manifestations were compared between 9754 gout patients who first presented at our clinic with gout in 2008-2012 (earlier group) or 2013-2018 (later group). Gout onset≤30 years old was defined as early-onset and>30 years as late-onset. Clinical features and risk factors were compared between the groups. The gout-onset age was 4.14 years younger and the percentage of early-onset gout (3827 patients) was higher in the later 2013-2018 group (5979 patients). The disease duration was significantly shorter (5.72±0.09 vs. 6.01±0.11 years P < 0,05) and the ratio of patients with tophi was correspondingly lower in the later group (22.0% vs. 20.0%, P < 0,05). More patients were obese (32.6% vs. 37.7%, P<0.001) and serum urate levels (465.0±1.9μmol/L vs. 485.5±1.5μmol/L) were significantly higher in the later group. As the age of gout-onset became younger, we did the multivariate logistic regression and identified a positive family history, male sex, obesity, elevated serum urate, and sugar-sweetened soft drinks as independent predictors of early-onset gout. The manifestations of gout in China have changed over the last decade, associated with a trend towards younger onset.

Achievement of the target serum urate level among patients with gout treated with allopurinol or febuxostat in an arthritis clinic in the Philippines

Objective Gout is an important cause of disability among Filipinos, despite measures for effective management. This study aims to determine attainment of target serum uric acid level (SUA ≤ 6 mg/dl) among patients with gout given urate-lowering therapy (ULT) over 6–12 months. Methods This is a single-center, prospective cohort study conducted in one adult Arthritis Clinic at the University of the Philippines-Philippine General Hospital which included 138 patients with gout (1977 ACR criteria), SUA ≥ 6 mg/dl prior to ULT, initiated on ULT (allopurinol or febuxostat), with six months minimum follow-up and with SUA determination post-treatment. Results 37.7% (52/138) and 36.2% (50/138), achieved target SUA at 6 and 12 months. The factors associated with achieving target SUA in 6 months are BMI > 25 kg/m2 [OR 6.98, 95% confidence interval (CI) 1.44–33.88, p value = .016], allopurinol dose ≥ 300 mg (OR 15.76, 95% CI 2.24–111.06, p value = .006), and baseline SUA (OR 0.52, 95% CI 0.33–0.82, p value = .005). The factors associated with achieving target SUA in 12 months are employment (OR 5.51, 95% CI 1.00–30.33, p value = .050), baseline SUA (OR 0.45, 95% CI 0.28–0.74, p value = .002), and age at onset of gout (OR 1.08, 95% CI 1.01–1.15, p value = .026). Conclusion Target SUA level was not achieved at 6 and 12 months of ULT in most of this cohort. This mirrors the deficient control of gout and should urge health professionals to fully study and address the problem.

Incidence and progression of foot osteoarthritis: the Johnston county osteoarthritis project

Purpose: To describe the incidence and progression of foot osteoarthritis (OA) in a large population-based cohort. Methods: Data were obtained from the Johnston County Osteoarthritis Project (JoCoOA), a prospective population-based cohort of African American and Caucasian residents of Johnston County, North Carolina. Participants completed foot radiographs at baseline (2013-2015) and follow-up (2016-2018). Five specific joints were examined: the first metatarsophalangeal (1st MTP), first cuneometatarsal (1st CMT), second cuneometatarsal (2nd CMT), naviculocuneiform (NC), and talonavicular (TN). Using the La Trobe Foot Atlas, which examines osteophytes (OP, score 0-3) and joint space narrowing (JSN, score 0-3) in the five specified joints, incident foot radiographic OA (rOA) was defined as baseline score <2 OP and JSN in all 5 joints with ≥2 OP or JSN at follow-up in any of the 5 joints. Progression was defined as worsening score of OP or JSN in a joint with baseline foot rOA. At baseline and follow-up, participants were asked to rate their pain, aching, or stiffness [PAS] in each foot as 0-10 (none to extreme) on most days of any month in the past 12 months. PAS worsening was defined as an increase in the PAS from baseline to follow-up. The Foot and Ankle Outcome Score (FAOS), a 42-item questionnaire assessing patient relevant outcomes in five subscales (pain, other symptoms, activities of daily living [ADL], sport and recreation function [Sports & Rec], foot and ankle-related quality of life [QOL]) was also obtained. Joint-based logistic regression models with generalized estimating equations were used to examine associations of foot rOA incidence and progression and covariates of interest (refer to Table 1 for full list). Two-way interactions between risk factors and foot rOA status at baseline were assessed at a 0.10 alpha level and adjusted odds ratios and 95% confidence intervals (aOR [95% CI]) were shown by baseline status if significant; otherwise overall associations were shown. Results: A total of 541 participants were included with radiographs of 1082 feet. Table 1 shows baseline characteristics: 71% were women, with mean age of 69 years; 35% were African American and 53% were obese. The most commonly affected joint at baseline was the first MTP (42%) followed by the TN (31%). Table 1 shows the incidence and progression of foot rOA. Among 928 feet without baseline rOA, 4% developed incident foot rOA and roughly 2% of those had PAS of the same foot at follow-up. Among 154 feet with baseline foot rOA, 55% had radiographic progression and 16% of those had PAS of the same foot at follow-up. Female sex and higher BMI were associated with incident foot rOA, while self-reported history of gout was associated with increased odds of both incidence and progression of foot rOA (Table 2). A history of foot injury was associated with significantly increased odds of foot OA with PAS present, but not for rOA alone. Although work disability was not associated with increased odds of foot rOA incidence or progression, it was associated with PAS and FAOS worsening particularly for pain, ADL, and Sports & Rec subscales (Table 3). BMI was associated with increased odds for worsening of all FAOS subscales. Age was not associated with worsening of FAOS symptoms or QOL. Gout was associated with increased odds of worsening for FAOS ADL and Sports & Rec subscales. Conclusions: Progression of foot rOA is relatively common although it is not necessarily related to worsening symptoms. Older age was not found to be associated with incidence or progression of foot rOA suggesting that other factors may be more important such as sex, BMI and history of gout. Given increased risk of foot rOA with higher BMI, BMI may be a modifiable risk factor for the development of foot rOA, similar to other weight-bearing joints such as the hip and knee. Strategies for prevention of foot injuries may be particularly important for foot rOA with symptoms. Further studies should determine if interventions, such as weight loss or intensive gout control, could lead to better symptom control in foot OA and should examine the association of foot OA with OA at other joints.

Understanding the patient voice in gout: a quantitative study conducted in Europe.

BackgroundAlthough commonly diagnosed, gout often remains a poorly managed disease. This is partially due to a lack of awareness of the long-term effect of gout among patients and healthcare professionals.AimTo understand unmet needs for patients and provide insight into achieving better treatment.Design & settingA quantitative online questionnaire collected from 1100 people with gout from 14 countries within Europe.MethodPatients were recruited to complete an online survey via healthcare professional (HCP) referral, patient associations, or market research panels. Patients were included if they had been diagnosed with gout by a physician. Prior to commencement, patients were made aware that this study was sponsored by Grünenthal. The responses collected were collated and analyses were performed.ResultsPatients had an average of 2.9 gout flares within a 12-month period. Although 79% of patients were satisfied with treatment, inadequate gout control was also reported by 71% of patients. Furthermore, 84% experienced moderate-to-severe pain with their most recent flare. Of those who acknowledged treatment dissatisfaction, only 24% discussed other options with their GP. Most patients reported irregular follow-up and serum uric acid (sUA) monitoring. In addition, loss of belief that more can be done was a key barrier for patients.ConclusionPatients reported severe pain and social burden, coupled with low treatment expectation and lack of awareness of target sUA. Education around knowing and reaching sUA target is needed so that patients can receive and GPs can deliver higher quality management.