Gout In Taiwan Research Articles

Effect of febuxostat on adverse events and mortality in gout in Taiwan: An interrupted time series analysis

To evaluate the influence of febuxostat on adverse events and mortality in gout. We retrospectively enrolled patients with newly diagnosed gout and prescribed urate-lowering therapy between 2006 and 2017 from the Taiwan National Health Insurance Database. These patients were divided into 2 groups: with and without comorbidities (n= 294 847 and 194 539). An interrupted time series analysis with adjustments for demographics, comorbidities, and comedication by propensity score-based stabilized weights was used to compare the trend of adverse events and mortality before vs after febuxostat was introduced in 2012. The proportion of febuxostat use gradually increased from 0% in 2012 to 30% in those with comorbidities and 10% in those without comorbidities in 2017. Allopurinol use decreased from 30% in 2012 to 10% in 2017. The slope of the 1-year incidence rate of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) (per 10 000 patients) significantly reduced after 2012 in those with and without comorbidities (-0.375 per quarter, P= .015 and -.253 per quarter, P= .049). The slope of the 3-year incidence rate of acute myocardial infarction (AMI) (per 1000 patients), percutaneous coronary intervention (PCI) (per 1000 patients), and all-cause mortality (per 100 patients) significantly increased after 2012 in those with comorbidities (+0.207 per quarter, P= .013; +.389 per quarter, P= .002; +.103 per quarter, P= .001). Febuxostat may reduce SJS and TEN in all gout patients but increase AMI, PCI, and all-cause mortality in gout patients with comorbidities.

Association of Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and Incidence of Gout in Taiwan

The use of sodium-glucose transport protein 2 (SGLT2) inhibitors is currently a standard intervention in patients with type 2 diabetes (T2DM) and exerts favorable pleiotropic effects to consistently lower blood urate levels. However, to date, no association between SGLT2 inhibitor use and the incidence of gout have been established. To investigate whether prescribed SGLT2 inhibitors are associated with lower gout incidence in patients with T2DM. In a cohort study, all patients with incident T2DM in Taiwan National Health Institution databases between May 1, 2016, and December 31, 2018, were retrospectively analyzed. As a comparator, patients using dipeptidyl peptidase 4 (DPP4) inhibitors were included. A total of 47 905 individuals receiving an SGLT2 inhibitor and 183 303 receiving a DPP4 inhibitor were evaluated, along with 47 405 pairs of patients using an SGLT2 inhibitor or DPP4 inhibitor in 1:1 propensity score-matched analyses. Data analysis was conducted from April 1 to June 30, 2021. A gout diagnosis was based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Multiple Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs. In total, 231 208 patients with T2DM were included in the population; 113 812 individuals (49.22%) were women, and the mean (SD) age was 61.53 (12.86) years. The overall gout incidence was 20.26 per 1000 patient-years for SGLT2 inhibitor users and 24.30 per 1000 patient-years for DPP4 inhibitor users. When potential risk factors were adjusted in the propensity score-matched population, use of SGLT2 inhibitors was associated with a lower risk of gout (HR, 0.89; 95% CI, 0.82-0.96) compared with DPP4 inhibitors, particularly for patients receiving dapagliflozin (HR, 0.86; 95% CI, 0.78-0.95). A sensitivity analysis, performed when a gout diagnosis was ascertained using the ICD-9-CM or ICD-10-CM code with gout-related medication, also showed a significantly lower risk for gout incidence of 15% with SGLT2 inhibitors (HR, 0.85; 95% CI, 0.74-0.97). Subgroup analysis indicated that SGLT2 inhibitor benefits in patients with T2DM to achieve a lower gout risk were not different across subgroups. The findings of this study suggest that patients with T2DM who are receiving SGLT2 inhibitors may have a lower risk for gout compared with those receiving DPP4 inhibitors.

Effects of Urate-Lowering Therapy on Risk of Hyperlipidemia in Gout by a Population-Based Cohort Study and on In Vitro Hepatic Lipogenesis-Related Gene Expression.

Patients with gout are at a higher risk of cardiovascular disease, which is associated with hyperlipidemia. Management of gout in Taiwan is poor, and the association between urate-lowering therapy (ULT) among gout patients and hyperlipidemia is unclear. We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database (LHID) of Taiwan on new-onset gout patients and a comparison cohort without gout. A Cox proportional hazards model was used to analyze differences in the risk of hyperlipidemia between patients with and without gout after considering related comorbidities. We also examined the ULT medications on the hepatic expression of lipogenesis-related genes. After adjusting for potential confounders, the case group (44,413 patients) was found to have a higher risk of hyperlipidemia than the control cohort (177,652 patients) [adjusted hazards ratio (aHR) = 2.55]. Gout patients without antigout treatment had significantly higher risk of hyperlipidemia than the control cohort (aHR = 3.10). Among gout patients receiving ULT, except those receiving probenecid (aHR = 0.80), all had significantly lower risk of hyperlipidemia than gout patients without ULT (all aHR < 0.90). Using real-time polymerase chain reaction, we found that most of the antigout drugs decreased the expression of hepatic genes related to lipogenesis in differentiated HepaRG cells. These data indicate that these antigout drugs reduce hyperlipidemia in gout patients, partly via the reduction in expression of lipogenesis-related genes, leading to improved blood lipid profiles. We provide evidence of the strong association between gout and hyperlipidemia and highlight the need for appropriate treatment guidelines.

Association of gout and colorectal cancer in Taiwan: a nationwide population-based cohort study

ObjectivesThis study aimed to determine colorectal cancer (CRC) risks among patients with gout through a follow-up study on a nationwide population-based cohort that included patients with gout and the general...

PMS7 - Evaluation of Health Care Costs and Utilization Patterns for Patients with Gout in Taiwan

As recommended in a recent review, there is a critical need for economic studies of gout that use large patient datasets, particularly in non-US countries. In addition, despite the higher incidence rate of gout in Taiwan compared to other countries, little is known about gout’s economic impact in Taiwan. Therefore, this study aims to examine the healthcare costs and utilization patterns for patients with gout in Taiwan from the perspective of the national health insurance. The National Health Insurance Research Database (NHIRD) was used to identify gout patients, and gout-free controls were matched with cases at a 1:3 ratio by age, gender, residential areas, and Charlson Comorbidity Index scores. Gout cases were defined as having (1) two primary or secondary diagnoses of gout on separate medical claims in 2011 or (2) one diagnosis of gout plus at least one gout-related pharmacy claim in 2011. Medical utilization and costs within the 365 days following the index date were assessed for both cases and controls. All costs were in new Taiwan dollars (NTDs). A total of 21,376 gout patients met the inclusion criteria and were matched with 64,128 controls. Compared to controls, gout patients had more outpatient visits (mean: 31.8 vs. 22.8), more inpatient visits (mean: 1.8 vs. 1.7), and more emergency department (ED) visits (mean: 1.9 vs. 1.7). The mean (median) all-cause outpatient, inpatient, and ED costs of the cases were $34,815 ($20,162), $101,526 ($40,839), and $5,640 ($2,634), respectively. The mean (median) all-cause outpatient, inpatient, and ED costs of the controls were $30,068 ($12,802), $92,489 ($38,103), and $5,626 ($2,708), respectively. Patients with gout had higher all-cause healthcare utilization and costs compared with matched gout-free patients. These results could be useful both in future economic evaluations and as a starting point for efficiently and appropriately allocating healthcare resources.

Type 2 diabetes increases the risk for gout in Taiwan

Type 2 diabetes increases the risk for gout in Taiwan

Acanthopanax trifoliatus inhibits lipopolysaccharide-induced inflammatory response in vitro and in vivo

Acanthopanax trifoliatus is a well-known herb that is used for the treatment of bruising, neuralgia, impotence, and gout in Taiwan. This herb exhibits multifunctional activities, including anticancer, anti-inflammation, and antioxidant effects. This paper investigated the in vitro and in vivo anti-inflammatory effect of A. trifoliatus. High-performance liquid chromatography analysis established the fingerprint chromatogram of the ethyl acetate fraction of A. trifoliatus (EAAT). The anti-inflammatory effect of EAAT was detected using lipopolysaccharide (LPS) stimulation of the mouse macrophage cell line RAW264.7 in vitro and LPS-induced lung injury in vivo. The effects of EAAT on LPS-induced production of inflammatory mediators in RAW264.7 murine macrophages and the mouse model were measured using enzyme-linked immunosorbent assay and Western blot. EAAT attenuated the production of LPS-induced nitric oxide (NO), tumor necrosis factor-alpha, interleukin-1β (IL-1β), and IL-6 in vitro and in vivo. Pretreatment with EAAT markedly reduced LPS-induced histological alterations in lung tissues. Furthermore, EAAT significantly reduced the number of total cells and protein concentration levels in the bronchoalveolar lavage fluid. Western blotting test results revealed that EAAT blocked protein expression of inducible NO synthase, cyclooxygenase-2, phosphorylation of Nuclear factor-kappa-B Inhibitor alpha (IκB-α) protein, and mitogen-activated protein kinases in LPS-stimulated RAW264.7 cells as well as LPS-induced lung injury. This study suggests that A. trifoliatus may be a potential therapeutic candidate for the treatment of inflammatory diseases.

Epidemiology and management of gout in Taiwan: a nationwide population study.

IntroductionGout is the most common inflammatory arthritis worldwide and is the only type of chronic arthritis that potentially can be ‘cured’. However, data on gout incidence, prevalence and management, assessed at multiple time points in the same population, are sparse, particularly in Asian populations. The aim of this study was to describe trends in the epidemiology of gout in the general population of Taiwan.MethodsThe National Health Insurance Research Database was used to identify patients with gout and to estimate the prevalence and incidence of gout for each calendar year from 2005 to 2010. The pattern of gout management was also examined.ResultsOf 23,371,362 beneficiaries in 2010, there were 1,458,569 prevalent and 56,595 incident cases of gout, giving a prevalence of 6.24% (95% confidence interval (CI), 6.23% to 6.25%) and an incidence of 2.74 (95% CI, 2.72 to 2.76) per 1,000 person-years. The annual percentage change (APC) of the standardised prevalence was −0.7% (95% CI, −1.7% to 0.3%; P = 0.14), suggesting that the prevalence of gout was essentially the same throughout the study period. However, The APC of incidence was −13.4 (95% CI, −16.1 to −10.6) between 2005 and 2007 and −2.1 (95% CI, −10.4 to 7.1) between 2007 and 2010. Regions with the highest prevalence and incidence were eastern coastal counties and offshore islets, where indigenous people are clustered. Among prevalent gout cases in 2010, only 22.93% (95% CI, 22.87% to 23.00%) were prescribed urate-lowering treatment (ULT), which remained unchanged between 2005 and 2010 at an APC of 0.0 (95% CI, −3.8 to 4.0). Uricosuric agents were more commonly prescribed than xanthine oxidase inhibitors in Taiwan.ConclusionsIn Taiwan, 1 in 16 people have gout. Whereas the incidence has decreased recently, the prevalence remains unchanged. Management of gout in Taiwan is poor, with only one in five affected people being treated with ULT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0522-8) contains supplementary material, which is available to authorized users.

The methanol extract of Euonymus laxiflorus, Rubia lanceolata and Gardenia jasminoides inhibits xanthine oxidase and reduce serum uric acid level in rats

Chinese herbal medicinal plants, Euonymus laxiflorus (EL), Rubia lanceolata (RL) and Gardenia jasminoides (GJ), have been used wildly to treat arthritis and gout in Taiwan for decades. To understand the beneficial effects of these three plants, their xanthine oxidase (XO) inhibitory activity in vitro and hypouricaemic activity in vivo were investigated. Our results suggested that methanol extracts were better than water extracts for inhibition of XO activity and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, except the water extract of GJ, which exhibited the strongest radical scavenging effect. In animal study, the serum urate level was significantly decreased after oral administration of higher dose (0.39g/kg) methanol extract of the mixture of three plants (ERG). In addition, methanol extract of ERG reduced the pain reaction time in the second phase of formalin induced pain. The results provide useful information on the pharmacological activities of these plants for the potential in treating hyperuricemia.

AB1062 Gout: Clinical pattern at first evaluation, changes in the last 15 years

BackgroundYounger age at onset and higher frequency of severe gout has been reported in some countries (1-3), when compared to previous reports. It seems that these patterns could be changing...

Update in Treatment Guidelines of Gout in Taiwan

Update in Treatment Guidelines of Gout in Taiwan

The Updated Strategies in the Management of Hyperuricemia and Gout in Taiwan

There is a significant advancement in the treatment of hyperuricemia and gouty in the current Taiwan, but gout was only a rare disease before the World War II. The first case was diagnosed in 1915, and the second was a tophaceous gout described by a Japanese Dr Tsuda in 1920. However, the case number increased dramatically after the War II, and it was majorly due to changing life style. A large-scaled community-based cohort study in a remote Kinmen island found the transformation with younger onset, increased female patients, and more with metabolic syndrome but less severe tophaceous gout. The most recent studies disclosed that the prevalence of hyperuricemia is around 20%, and gout 1-2%. The prevalence rate is much higher among aborigines, which genetically belong to Malayo-Polynesian, around 50% for hyperuricemia and 10% for gout. The studies found Atayal familial gout locus linked to ADMCKD on 1q21 region, HGPRT (Tsou) gene, and reduced fractional UA clearance, which connect to gout and hyperuricemia in aborigines. A prospective cohort study from the nationwide MJ Health Screening Centers reported hyperuricemia was an independent risk factor of mortality from all causes, total cardiovascular disease and ischemic stroke. Another study from databank of CGMH found that hyperuricemia is strongly associated with chronic kidney disease (CKD). Furthermore, from our national Longitudinal Health Insurance Database (LHID), gout linked to cancer risk and increased mortality from cardiovascular, endocrine and renal causes.

台湾における若年性痛風の臨床検討

The increasing proportion of patients showing a family history and renal insufficiency in gout suggests that genes for gout may be closely linked with familial juvenile hyperuricemic nephropathy (FJHN), especially for those with precocious onset of gouty attack. This study investigated the clinical features of juvenile gout as well as its possible association with FJHN. A total of 543 cases of juvenile gout with onset of gouty attack earlier than 20 years of age listed in the Hoping Gout Database were enrolled, and 5,269 gouty cases with the onset age between 40 to 50 years were selected as control group. The body weight, height and body mass index in juvenile gout were significantly higher than those in the control group (P<0.0001). The number of joints involved and the percentages of hypertension, diabetes, hyperlipidemia and nephrolithiasis in juvenile gout were significantly lower than those in the control group (P<0.0001). There was no significant difference in the percentage of female gout and tophaceous gout between the two groups. Serum orate level,24-hour urinary uric acid excretion and creatinine clearance in juvenile gout were significantly higher than those in the control group (P<0.0001). The percentage of renal insufficiency in juvenile gout was only 9.8% and was significantly lower than that in the control group (P<0.0001). The percentage of familial aggregation in juvenile gout was about 1.9-fold higher than that in control group (44.3% vs.23.8%, P<0.0001). Among patients with a family history juvenile gout shows a significantly higher proportion of heritage from the father (P<0.0001) and a significant lower proportion of heritage from the sibs and mother than the control group (P<0.0001 for both). In conclusion, juvenile gout is associated with both excessive weight and hereditary background, while the FJHN gene may not be the main gene responsible for juvenile gout in Taiwan.

A case-control study of the association of diet and obesity with gout in Taiwan

Gout has been a significant metabolic disorder for Chinese men in Taiwan; however, there is insufficient information on diet and lifestyle risk factors in this population. The purpose of this case-control study was to explore potential dietary and lifestyle risk factors associated with gout in Chinese men. Between 1998 and 1999, we recruited and conducted face-to-face interviews with patients from outpatient clinics in Taipei who had incident gout (n = 92) and with their healthy coworkers (controls; n = 92). Systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, waist-to-height ratio, and body mass index were significantly higher in cases than in controls. Family histories of gout and diabetes mellitus were strong risk factors for gout. Frequencies of vegetable and fruit consumption were significantly lower in cases than in controls. Logistic regression analyses showed that high alcohol intake and low intakes of fiber, folate, and vitamin C increased the risk of gout, but no association was found with purine intake. After covariates were controlled for, the adjusted odds ratios for the middle and highest tertiles of waist-to-height ratio (0.50-0.54 and >/==" BORDER="0"> 0.55, respectively) were 3.89 (95% CI: 1.32, 11.46) and 4.37 (1.18, 16.22), respectively, but no linear association was found for waist-to-hip ratio and waist circumference. Consumption of alcohol, but not of purine, may be a significant dietary risk factor for gout. Food sources rich in dietary fiber, folate, and vitamin C, such as fruit and vegetables, protect against gout. Waist-to-height ratio, which indicates central obesity, has a significant linear effect on gout occurrence, independent of body mass index.

Trends in the manifestations of gout in Taiwan.

To elucidate the recent changes in the clinical manifestations, risk factors and disorders associated with gout. All gouty cases in Ho-Ping Gout Database were divided into two groups according to the date of first visit to our clinic: 1983-1991 (earlier group) and 1992-1999 (later group). Study variables were compared between these two groups. In the later group, the age at onset of gout was lower by 2.7 yr (P < 0.0001) and the percentages of female gout and familial gout were higher (P = 0.0046 and P < 0.0001, respectively). Joint counts and the percentage of frequency of attacks > or =6 times/yr were lower in the later group (P < 0.0001), while the percentage of tophaceous gout was higher by 0.8% in the later group (P = 0.0004). The percentage of first attack at ankle was higher (P < 0.0001), while those at Achilles tendon, knee and upper extremity were lower in the later group (P < 0.0001). The percentages of diuretic use and alcohol consumption were lower in the later group (P < 0.0001). The percentages of obesity, hypertriglyceridaemia and nephrolithiasis were higher (P < 0.0001), while the percentages of hypertension and hypercholesterolaemia were lower in the later group (P < 0.0001 and P = 0.0003, respectively). The percentages of type 2 diabetes mellitus and renal insufficiency were not significantly different in multivariate analyses. The age of onset, clinical manifestations, risk factors and disorders associated with gout have recently changed in Taiwan.

台湾における女性痛風の病態と合併症についての検討

台湾における女性痛風の病態と合併症についての検討

Clinical aspects of gouty patients in Taiwan.

The mean age of the onset of gout in Taiwan is 49.6 years old. This is very similar to Japan. The female cases made up 5.78% of total cases. This is very similar to the world average of about 5%. As far as laboratory findings are concerned, uric acid had a significant correlation with BUN, creatinine, cholesterol and triglyceride. In our occupation study we found that gout occurs in almost every class of society and no particular group has any immunity.