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Sumpter NA, Takei R, Cadzow M, Topless RKG, Phipps-Green AJ, Murphy R, de Zoysa J, Watson H, Qasim M, Lupi AS, Abhishek A, Andrés M, Crișan TO, Doherty M, Jacobsson L, Janssen M, Jansen TL, Joosten LAB, Kapetanovic M, Lioté F, Matsuo H, McCarthy GM, Perez-Ruiz F, Riches P, Richette P, Roddy E, Stiburkova B, So A, Tausche AK, Torres RJ, Uhlig T, Major TJ, Stamp LK, Dalbeth N, Choi HK, Vazquez AI, Leask MP, Reynolds RJ, Merriman TR. Association of Gout Polygenic Risk Score With Age at Disease Onset and Tophaceous Disease in European and Polynesian Men With Gout. Arthritis Rheumatol 2022; 75:816-825. [PMID: 36281732 DOI: 10.1002/art.42393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether a gout polygenic risk score (PRS) is associated with age at gout onset and tophaceous disease in European, East Polynesian, and West Polynesian men and women with gout. METHODS A 19-variant gout PRS was produced in 7 European gout cohorts (N = 4,016), 2 East Polynesian gout cohorts (N = 682), and 1 West Polynesian gout cohort (N = 490). Sex-stratified regression models were used to estimate the relationship between the PRS and age at gout onset and tophaceous disease. RESULTS The PRS was associated with earlier age at gout onset in men (β = -3.61 in years per unit PRS [95% confidence interval (95% CI) -4.32, -2.90] in European men; β = -6.35 [95% CI -8.91, -3.80] in East Polynesian men; β = -3.51 [95% CI -5.46, -1.57] in West Polynesian men) but not in women (β = 0.07 [95% CI -2.32, 2.45] in European women; β = 0.20 [95% CI -7.21, 7.62] in East Polynesian women; β -3.33 [95% CI -9.28, 2.62] in West Polynesian women). The PRS showed a positive association with tophaceous disease in men (odds ratio [OR] for the association 1.15 [95% CI 1.00, 1.31] in European men; OR 2.60 [95% CI 1.66, 4.06] in East Polynesian men; OR 1.53 [95% CI 1.07, 2.19] in West Polynesian men) but not in women (OR for the association 0.68 [95% CI 0.42, 1.10] in European women; OR 1.45 [95% CI 0.39, 5.36] in East Polynesian women). The PRS association with age at gout onset was robust to the removal of ABCG2 variants from the PRS in European and East Polynesian men (β = -2.42 [95% CI -3.37, -1.46] and β = -6.80 [95% CI -10.06, -3.55], respectively) but not in West Polynesian men (β = -1.79 [95% CI -4.74, 1.16]). CONCLUSION Genetic risk variants for gout also harbor risk for earlier age at gout onset and tophaceous disease in European and Polynesian men. Our findings suggest that earlier gout onset involves the accumulation of gout risk alleles in men but perhaps not in women, and that this genetic risk is shared across multiple ancestral groups.
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Affiliation(s)
- Nicholas A Sumpter
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, and Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Riku Takei
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Ruth K G Topless
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Janak de Zoysa
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Huti Watson
- Ngāti Porou Hauora Trust, Te Puia Springs, New Zealand
| | | | - Alexa S Lupi
- Department of Epidemiology and Biostatistics, Michigan State University, and The Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, Michigan
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK, and GlobalGoutGenetics Consortium
| | - Mariano Andrés
- GlobalGoutGenetics Consortium, and Department of Rheumatology, Alicante General University Hospital-ISABIAL, Miguel Hernandez University, Alicante, Spain
| | - Tania O Crișan
- GlobalGoutGenetics Consortium, and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK, and GlobalGoutGenetics Consortium
| | - Lennart Jacobsson
- GlobalGoutGenetics Consortium, and Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Matthijs Janssen
- GlobalGoutGenetics Consortium, and Complex Gout Expert Centre, Department of Rheumatology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Tim L Jansen
- GlobalGoutGenetics Consortium, and Complex Gout Expert Centre, Department of Rheumatology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Leo A B Joosten
- GlobalGoutGenetics Consortium, and Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, and Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Meliha Kapetanovic
- GlobalGoutGenetics Consortium, and Lund University and Skåne University Hospital, Lund, Sweden
| | - Frédéric Lioté
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hirotaka Matsuo
- GlobalGoutGenetics Consortium, and Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Geraldine M McCarthy
- GlobalGoutGenetics Consortium, and Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | - Fernando Perez-Ruiz
- GlobalGoutGenetics Consortium, and Rheumatology Division, Osakidetza, OSI EE-Cruces, Cruces University Hospital, Barakaldo, Biocruces-Bizkaia Health Research Institute, Barakaldo, and the Medicine Department of the Medicine School of the University of the Basque Country, Leioa, Spain
| | - Philip Riches
- GlobalGoutGenetics Consortium, and IGC, University of Edinburgh, Scotland
| | - Pascal Richette
- GlobalGoutGenetics Consortium, and Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Cité, Paris, France
| | - Edward Roddy
- GlobalGoutGenetics Consortium, and School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Blanka Stiburkova
- GlobalGoutGenetics Consortium, and Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic, and Institute of Rheumatology, Prague, Czech Republic
| | - Alexander So
- GlobalGoutGenetics Consortium, and Service of Rheumatology, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Anne-Kathrin Tausche
- GlobalGoutGenetics Consortium, and Division of Rheumatology, University Clinic Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Rosa J Torres
- GlobalGoutGenetics Consortium, and Department of Biochemistry, La Paz University Hospital Health Research Institute (FIBHULP), IdiPaz, and Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Till Uhlig
- GlobalGoutGenetics Consortium, and Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tanya J Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Lisa K Stamp
- GlobalGoutGenetics Consortium, and Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand, and GlobalGoutGenetics Consortium
| | - Hyon K Choi
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston
| | - Ana I Vazquez
- Department of Epidemiology and Biostatistics, Michigan State University, and The Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, Michigan
| | - Megan P Leask
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Richard J Reynolds
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Tony R Merriman
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Department of Biochemistry, University of Otago, Dunedin, New Zealand, and GlobalGoutGenetics Consortium
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Affiliation(s)
- Anne-Kathrin Tausche
- Medizinische Klinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland.
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Abstract
Gout is the most common inflammatory arthritis in men with a rising incidence worldwide. It is a metabolic disease caused by hyperuricemia. Common causes of hyperuricemia, in addition to hereditary reduced renal excretion of urate, include purine over-nutrition, aging, comorbidities and associated medications, some of which increase serum urate levels. The first gout flare represents the signal for deposited urate crystals. If hyperuricemia remains untreated, crystal deposition proceeds and can cause recurrent gout flares, joint destruction and tophi. There is evidence that silent inflammation is ongoing even during asymptomatic stages. Gout patients often exhibit other metabolic, renal and cardiovascular co-morbidities and have higher (cardiovascular) mortality. Therefore, guidelines call for consequent urate lowering strategies to bring serum urate levels to a target at least below 360 µmol/l. The following article summarizes the recent state of knowledge regarding the diagnosis and therapy of gout.
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Affiliation(s)
- Anne-Kathrin Tausche
- Medizinische Klinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland.
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Drosos GC, Vedder D, Houben E, Boekel L, Atzeni F, Badreh S, Boumpas DT, Brodin N, Bruce IN, González-Gay MÁ, Jacobsen S, Kerekes G, Marchiori F, Mukhtyar C, Ramos-Casals M, Sattar N, Schreiber K, Sciascia S, Svenungsson E, Szekanecz Z, Tausche AK, Tyndall A, van Halm V, Voskuyl A, Macfarlane GJ, Ward MM, Nurmohamed MT, Tektonidou MG. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis 2022; 81:768-779. [PMID: 35110331 DOI: 10.1136/annrheumdis-2021-221733] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). METHODS Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. RESULTS Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering. CONCLUSION These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.
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Affiliation(s)
- George C Drosos
- First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daisy Vedder
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Eline Houben
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Laura Boekel
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Sara Badreh
- EULAR Patient Research Partner, Brussels, Belgium
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece.,Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital Corp, Stockholm, Sweden
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Miguel Ángel González-Gay
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla and University of Cantabria, Santander, Spain
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - György Kerekes
- Intensive Care Unit, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Chetan Mukhtyar
- Rheumatology Department, Norfolk and Norwich University Hospital, Colney Lane, UK
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Karen Schreiber
- EMEUNET member, Danish Hospital for Rheumatic Diseases, Sonderburg, Denmark
| | - Savino Sciascia
- EMEUNET member, CMID-Nephrology, San Giovanni Bosco Hospital, University of Torino, Torino, Italy
| | - Elisabet Svenungsson
- Department of Medicine, Rheumatology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Alan Tyndall
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - Vokko van Halm
- Department of Cardiology, Amsterdam University Medical Center, location VU University medical center, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael T Nurmohamed
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Amsterdam University Medical Center, location VU University Medical Centre, Amsterdam, The Netherlands
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece .,Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Gout is the most common inflammatory arthritis in men with a rising incidence worldwide. It is a metabolic disease caused by hyperuricemia. Common causes of hyperuricemia, in addition to hereditary reduced renal excretion of urate, include purine over-nutrition, aging, comorbidities and associated medications, some of which increase serum urate levels. The first gout flare represents the signal for deposited urate crystals. If hyperuricemia remains untreated, crystal deposition proceeds and can cause recurrent gout flares, joint destruction and tophi. There is evidence that silent inflammation is ongoing even during asymptomatic stages. Gout patients often exhibit other metabolic, renal and cardiovascular co-morbidities and have higher (cardiovascular) mortality. Therefore, guidelines call for consequent urate lowering strategies to bring serum urate levels to a target at least below 360 µmol/l. The following article summarizes the recent state of knowledge regarding the diagnosis and therapy of gout.
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Affiliation(s)
- A K Tausche
- Medizinische Klinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland.
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Abstract
Sehr geehrte Damen und Herren, liebe Kolleginnen und Kollegen in der Rheumatologie,im vorliegenden Schwerpunktheft soll es im Wesentlichen um ganz verschiedene Aspekte der Kristallarthritis Gicht gehen.
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Tausche AK. Laudatio Prof. Dr. med. habil. Hans-Egbert Schröder zum 80. Geburtstag. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1337-5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Wir möchten in diesem Format einen großen ostdeutschen Rheumatologen, unseren ehemaligen Chef, Emeritus Herrn Prof. Dr. med. habil. Hans-Egbert Schröder anlässlich seines 80. Geburtstages würdigen.
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Desideri G, Rajzer M, Gerritsen M, Nurmohamed MT, Giannattasio C, Tausche AK, Borghi C. Effects of intensive urate lowering therapy with febuxostat in comparison with allopurinol on pulse wave velocity in patients with gout and increased cardiovascular risk: the FORWARD study. Eur Heart J Cardiovasc Pharmacother 2021; 8:236-242. [PMID: 33410912 DOI: 10.1093/ehjcvp/pvaa144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 01/06/2023]
Abstract
AIMS Hyperuricaemia and gout are strongly related with traditional cardiovascular risk factors and vascular damage. This study aimed to assess whether febuxostat and allopurinol could differently influence carotid-femoral pulse wave velocity (cfPWV) in patients with gout and elevated serum uric acid (SUA) levels. METHODS AND RESULTS A multi-centre, multinational, phase IV, randomized, parallel-group, active-controlled, open label trial with blind end-points evaluation. One hundred and ninetyseven adults with gout and SUA levels ≥8 mg/dL were randomised to febuxostat or allopurinol in a 1:1 ratio for 36 weeks. The primary outcome was the comparison of the effects of febuxostat and allopurinol on changes in cfPWV. The mean cfPWV values at randomisation and week 36 were respectively 8.69 m/s and 9.00 m/s for subjects randomised to febuxostat and 9.02 m/s and 9.05 m/s for subjects randomised to allopurinol. No statistically significant changes in cfPWV by treatment assignment were observed at any time point for any of the assessed parameters. More subjects who received febuxostat had serum urate concentrations ≤6 mg/dL following treatment (78.3% vs 61.1% at week 36, p = 0.0137). Treatment-emergent adverse events were reported by 51 (52.0%) patients randomised to febuxostat and 63 (62.5%) patients randomised to allopurinol. The majority of events were mild in both treatment groups and included gout flares and arthralgia. CONCLUSIONS In patients with gout and elevated SUA levels the arterial stiffness remained stable both with febuxostat and allopurinol. Febuxostat was more effective and faster than allopurinol in achieving the SUA target. Both treatments were safe and well tolerated.
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Affiliation(s)
- Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of l'Aquila, L'Aquila, Italy
| | - Marek Rajzer
- I-st Department of Cardiology Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Cracow, Poland
| | | | - Michael T Nurmohamed
- Amsterdam Rheumatology & immunology Center
- Reade Dept of Rheumatology, Amsterdam, The Netherlands
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano Bicocca University and Cardio Center de Gasperis ASST Niguarda, Milano, Italy
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Ospedale Malpighi, University of Bologna, Bologna, Italy
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Hansildaar R, Vedder D, Baniaamam M, Tausche AK, Gerritsen M, Nurmohamed MT. Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout. Lancet Rheumatol 2021; 3:e58-e70. [PMID: 32904897 PMCID: PMC7462628 DOI: 10.1016/s2665-9913(20)30221-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The increased risk of cardiovascular morbidity and mortality in rheumatoid arthritis and gout has been increasingly acknowledged in past decades, with accumulating evidence that gout, just as with rheumatoid arthritis, is an independent cardiovascular risk factor. Although both diseases have a completely different pathogenesis, the underlying pathophysiological mechanisms in systemic inflammation overlap to some extent. Following the recognition that systemic inflammation has an important causative role in cardiovascular disease, anti-inflammatory therapy in both conditions and urate-lowering therapies in gout are expected to lower the cardiovascular burden of patients. Unfortunately, much of the existing data showing that urate-lowering therapy has consistent beneficial effects on cardiovascular outcomes in patients with gout are of low quality and contradictory. We will discuss the latest evidence in this respect. Cardiovascular disease risk management for patients with rheumatoid arthritis and gout is essential. Clinical guidelines and implementation of cardiovascular risk management in daily clinical practice, as well as unmet needs and areas for further investigation, will be discussed.
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Affiliation(s)
- Romy Hansildaar
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Daisy Vedder
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Milad Baniaamam
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Martijn Gerritsen
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
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Abstract
Zusammenfassung
Hintergrund Von Gicht sind überwiegend Männer betroffen (m:w; 9:1). Zur Diagnosestellung werden daher in der Regel die klinischen Merkmale einer akuten Monarthritis der unteren Extremität beim Mann herangezogen. Im Moment ist die Datenlage zur Gicht bei Frauen begrenzt. Bei ihnen wird die Gicht oft nicht in die Differenzialdiagnosen einer Arthritis einbezogen. Wir untersuchten daher die Epidemiologie und klinische Präsentation der Gicht bei Frauen und verglichen sie mit denen der Gicht bei Männern. In der Folge wurden die Daten auf Merkmale analysiert, welche bei Frauen die Gicht von Arthritiden anderer Genese unterscheiden und damit Fehldiagnosen vermeiden helfen können.
Methoden Retrospektiv wurden alle Patienten eingeschlossen, die zwischen 2012 und 2018 mit einer primären Entlassungsdiagnose einer Gicht (ICD-10 M10.XX) am Universitätsklinikum Dresden behandelt wurden. Es wurden klinische, laborchemische sowie radiologische Befunde erfasst und deskriptiv sowie multivariat mittels SPSS und R analysiert. In einem zweiten Schritt wurden die Daten von Frauen mit Gichtarthritis mit denen ohne Gicht (Monarthritis anderer Genese) verglichen und mittels univariater sowie multivariater Regressionsanalyse auf Signifikanz geprüft.
Resultate Insgesamt wurden 238 Gicht-Patienten (71 Frauen, 167 Männer) eingeschlossen. Frauen dieser Kohorte waren bei Diagnosestellung im Mittel 20 Jahre älter als Männer und hatten dann insgesamt häufiger mehrere Komorbiditäten: 92% aller Gichtpatientinnen litten an einer Hypertonie (Männer 74%), 84% hatten eine eGFR<60 ml/min (Männer 52%) und 40% hatten kardiovaskuläre Vorereignisse (Männer 14%). 90% nahmen regelmäßig Diuretika ein (Männer 47%). Fast die Hälfte der Frauen hatte bereits eine manifeste Polyarthrose (47 vs. 30% der Männer). Klinisch trat bei Frauen seltener die klassische MTP I-Arthritis (69 vs. 84%) auf. Der Vergleich von Frauen mit durch mikroskopischen Kristallnachweis gesicherter Gicht und Frauen mit Kristall-negativer Monarthritis zeigte signifikante Unterschiede: Frauen mit Gicht waren älter und wiesen signifikant häufiger eine Hypertonie oder kardiovaskuläre Erkrankung, einen Diabetes mellitus Typ 2, einen adipösen Habitus auf oder nahmen Diuretika ein. Bestanden zudem eine eingeschränkte Nierenfunktion sowie eine Hyperurikämie, lag mit hoher Sicherheit eine Gicht vor.
Schlussfolgerungen Die Gicht muss bei einer akuten Monarthritis auch bei Frauen in die Differenzialdiagnose einbezogen werden. Das gilt besonders ab dem Rentenalter und wenn Hypertonie, kardiovaskuläre Erkrankungen, Diabetes mellitus Typ 2 oder Adipositas vorliegen und Diuretika Teil der Dauermedikation sind. Die Einschränkung der Nierenfunktion und eine Serumharnsäure von>390 µmol/l (>6,5 mg/dL) machen eine Gicht sehr wahrscheinlich.
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Affiliation(s)
- Anna Giordano
- Medizinische Klinik III, Abteilung Rheumatologie, Universitätsklinikum „Carl Gustav Carus“ der TU Dresden, Dresden, Deutschland
| | - Martin Aringer
- Medizinische Klinik III, Abteilung Rheumatologie, Universitätsklinikum „Carl Gustav Carus“ der TU Dresden, Dresden, Deutschland
| | - Anne-Kathrin Tausche
- Medizinische Klinik III, Abteilung Rheumatologie, Universitätsklinikum „Carl Gustav Carus“ der TU Dresden, Dresden, Deutschland
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Tausche AK. Aktuelle Erkenntnisse zur Gicht – eine Nachlese vom eEULAR 2020. AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1301-1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Gicht ist die häufigste entzündliche Arthritis beim Mann. Zumeist stellen sich die Patienten mit einem ersten akuten Gichtanfall beim Hausarzt vor. In Kenntnis der existierenden Leitlinien sollte neben der antientzündlichen Therapie des Gichtanfalles zeitnah mit einer harnsäuresenkenden Therapie begonnen werden, wenn sich die für die Gicht ursächliche Hyperurikämie nicht durch diätetische Bemühungen in den Zielwert senken lässt. Leider ist die Versorgungsrealität von Gichtpatienten oft nicht optimal und komplizierte Verläufe werden beim Rheumatologen vorstellig. Die Rheumatologen mit ihren Fachgesellschaften waren es auch, die sich initial der Erstellung von Leitlinien zur Diagnostik und Therapie der metabolisch verursachten Gelenkerkrankung angenommen haben; darüber hinaus tragen Rheumatologen seit vielen Jahren zum Wissensgewinn auf dem Gebiet der Gicht durch Grundlagenforschung sowie klinische Forschung bei. So wurde auch dieses Jahr, welches durch die Covid-19-Situation ein ganz besonderes Jahr ist, eine Vielzahl neuer Erkenntnisse zur Gicht auf dem EULAR erstmalig in virtueller Form präsentiert.
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Affiliation(s)
- Anne-Kathrin Tausche
- Medizinische Klinik III, Abteilung Rheumatologie, Universitätsklinikum „Carl Gustav Carus“ der TU Dresden, Dresden, Deutschland
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12
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Wrigley R, Phipps-Green AJ, Topless RK, Major TJ, Cadzow M, Riches P, Tausche AK, Janssen M, Joosten LAB, Jansen TL, So A, Harré Hindmarsh J, Stamp LK, Dalbeth N, Merriman TR. Pleiotropic effect of the ABCG2 gene in gout: involvement in serum urate levels and progression from hyperuricemia to gout. Arthritis Res Ther 2020; 22:45. [PMID: 32164793 PMCID: PMC7069001 DOI: 10.1186/s13075-020-2136-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background The ABCG2 Q141K (rs2231142) and rs10011796 variants associate with hyperuricaemia (HU). The effect size of ABCG2 rs2231142 on urate is ~ 60% that of SLC2A9, yet the effect size on gout is greater. We tested the hypothesis that ABCG2 plays a role in the progression from HU to gout by testing for association of ABCG2 rs2231142 and rs10011796 with gout using HU controls. Methods We analysed 1699 European gout cases and 14,350 normouricemic (NU) and HU controls, and 912 New Zealand (NZ) Polynesian (divided into Eastern and Western Polynesian) gout cases and 696 controls. Association testing was performed using logistic and linear regression with multivariate adjusting for confounding variables. Results In Europeans and Polynesians, the ABCG2 141K (T) allele was associated with gout using HU controls (OR = 1.85, P = 3.8E− 21 and ORmeta = 1.85, P = 1.3E− 03, respectively). There was evidence for an effect of 141K in determining HU in European (OR = 1.56, P = 1.7E− 18) but not in Polynesian (ORmeta = 1.49, P = 0.057). For SLC2A9 rs11942223, the T allele associated with gout in the presence of HU in European (OR = 1.37, P = 4.7E− 06), however significantly weaker than ABCG2 rs2231142 141K (PHet = 0.0023). In Western Polynesian and European, there was epistatic interaction between ABCG2 rs2231142 and rs10011796. Combining the presence of the 141K allele with the rs10011796 CC-genotype increased gout risk, in the presence of HU, 21.5-fold in Western Polynesian (P = 0.009) and 2.6-fold in European (P = 9.9E− 06). The 141K allele of ABCG2 associated with increased gout flare frequency in Polynesian (Pmeta = 2.5E− 03). Conclusion These data are consistent with a role for ABCG2 141K in gout in the presence of established HU.
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Affiliation(s)
- Rebekah Wrigley
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand
| | | | - Ruth K Topless
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand
| | - Tanya J Major
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand
| | - Philip Riches
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic "Carl-Gustav-Carus", Dresden, Germany
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Institute of Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tim L Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Alexander So
- Laboratory of Rheumatology, University of Lausanne, CHUV, Nestlé 05-5029, 1011, Lausanne, Switzerland
| | | | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand.
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13
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Klück V, van Deuren RC, Cavalli G, Shaukat A, Arts P, Cleophas MC, Crișan TO, Tausche AK, Riches P, Dalbeth N, Stamp LK, Hindmarsh JH, Jansen TLTA, Janssen M, Steehouwer M, Lelieveld S, van de Vorst M, Gilissen C, Dagna L, Van de Veerdonk FL, Eisenmesser EZ, Kim S, Merriman TR, Hoischen A, Netea MG, Dinarello CA, Joosten LA. Rare genetic variants in interleukin-37 link this anti-inflammatory cytokine to the pathogenesis and treatment of gout. Ann Rheum Dis 2020; 79:536-544. [PMID: 32114511 DOI: 10.1136/annrheumdis-2019-216233] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Gout is characterised by severe interleukin (IL)-1-mediated joint inflammation induced by monosodium urate crystals. Since IL-37 is a pivotal anti-inflammatory cytokine suppressing the activity of IL-1, we conducted genetic and functional studies aimed at elucidating the role of IL-37 in the pathogenesis and treatment of gout. METHODS Variant identification was performed by DNA sequencing of all coding bases of IL37 using molecular inversion probe-based resequencing (discovery cohort: gout n=675, controls n=520) and TaqMan genotyping (validation cohort: gout n=2202, controls n=2295). Predictive modelling of the effects of rare variants on protein structure was followed by in vitro experiments evaluating the impact on protein function. Treatment with recombinant IL-37 was evaluated in vitro and in vivo in a mouse model of gout. RESULTS We identified four rare variants in IL37 in six of the discovery gout patients; p.(A144P), p.(G174Dfs*16), p.(C181*) and p.(N182S), whereas none emerged in healthy controls (Fisher's exact p-value=0.043). All variants clustered in the functional domain of IL-37 in exon 5 (p-value=5.71×10-5). Predictive modelling and functional studies confirmed loss of anti-inflammatory functions and we substantiated the therapeutic potential of recombinant IL-37 in the treatment of gouty inflammation. Furthermore, the carrier status of p.(N182S)(rs752113534) was associated with increased risk (OR=1.81, p-value=0.031) of developing gout in hyperuricaemic individuals of Polynesian ancestry. CONCLUSION Here, we provide genetic as well as mechanistic evidence for the role of IL-37 in the pathogenesis of gout, and highlight the therapeutic potential of recombinant IL-37 for the treatment of gouty arthritis.
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Affiliation(s)
- Viola Klück
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosanne C van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giulio Cavalli
- Internal Medicine and Clinical Immunology, Vita-Salute San Raffaele University, Milan, Italy.,Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Amara Shaukat
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Peer Arts
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology and the University of South Australia, Adelaide, South Australia, Australia
| | - Maartje C Cleophas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tania O Crișan
- Department of Medical Genetics, Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Anne-Kathrin Tausche
- Department of Internal Medicine, Section of Rheumatology, University Clinic Carl Gustav Carus, Dresden, Saxonia, Germany
| | - Philip Riches
- Rheumatology and Bone Disease, University of Edinburgh, Edinburgh, UK
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, Otago University, Christchurch, Canterbury, New Zealand
| | - Jennie Harré Hindmarsh
- Te Rangawairua o Paratene Ngata Research Centre, Ngāti Porou Hauora Charitable Trust, Te Puia Springs, Tairāwhiti, New Zealand
| | - Tim L Th A Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Marloes Steehouwer
- Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Lelieveld
- Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje van de Vorst
- Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christian Gilissen
- Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Dagna
- Internal Medicine and Clinical Immunology, Vita-Salute San Raffaele University, Milan, Italy
| | - Frank L Van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elan Z Eisenmesser
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Denver, Colorado, USA
| | - SooHyun Kim
- Laboratory of Cytokine Immunology, Konkuk University, Seoul, Korea (the Republic of)
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Alexander Hoischen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Genomics and Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Charles A Dinarello
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Leo Ab Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands .,Department of Medical Genetics, Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania
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14
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Bursill D, Taylor WJ, Terkeltaub R, Kuwabara M, Merriman TR, Grainger R, Pineda C, Louthrenoo W, Edwards NL, Andrés M, Vargas-Santos AB, Roddy E, Pascart T, Lin CT, Perez-Ruiz F, Tedeschi SK, Kim SC, Harrold LR, McCarthy G, Kumar N, Chapman PT, Tausche AK, Vazquez-Mellado J, Gutierrez M, da Rocha Castelar-Pinheiro G, Richette P, Pascual E, Fisher MC, Burgos-Vargas R, Robinson PC, Singh JA, Jansen TL, Saag KG, Slot O, Uhlig T, Solomon DH, Keenan RT, Scire CA, Biernat-Kaluza E, Dehlin M, Nuki G, Schlesinger N, Janssen M, Stamp LK, Sivera F, Reginato AM, Jacobsson L, Lioté F, Ea HK, Rosenthal A, Bardin T, Choi HK, Hershfield MS, Czegley C, Choi SJ, Dalbeth N. Gout, Hyperuricemia, and Crystal-Associated Disease Network Consensus Statement Regarding Labels and Definitions for Disease Elements in Gout. Arthritis Care Res (Hoboken) 2019; 71:427-434. [PMID: 29799677 DOI: 10.1002/acr.23607] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/22/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The language currently used to describe gout lacks standardization. The aim of this project was to develop a consensus statement on the labels and definitions used to describe the basic disease elements of gout. METHODS Experts in gout (n = 130) were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach consensus on the labeling and definitions for the basic disease elements of gout. Disease elements and labels in current use were derived from a content analysis of the contemporary medical literature, and the results of this analysis were used for item selection in the Delphi exercise and face-to-face consensus meeting. RESULTS There were 51 respondents to the Delphi exercise and 30 attendees at the face-to-face meeting. Consensus agreement (≥80%) was achieved for the labels of 8 disease elements through the Delphi exercise; the remaining 3 labels reached consensus agreement through the face-to-face consensus meeting. The agreed labels were monosodium urate crystals, urate, hyperuric(a)emia, tophus, subcutaneous tophus, gout flare, intercritical gout, chronic gouty arthritis, imaging evidence of monosodium urate crystal deposition, gouty bone erosion, and podagra. Participants at the face-to-face meeting achieved consensus agreement for the definitions of all 11 elements and a recommendation that the label "chronic gout" should not be used. CONCLUSION Consensus agreement was achieved for the labels and definitions of 11 elements representing the fundamental components of gout etiology, pathophysiology, and clinical presentation. The Gout, Hyperuricemia, and Crystal-Associated Disease Network recommends the use of these labels when describing the basic disease elements of gout.
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Affiliation(s)
- David Bursill
- University of Auckland, Auckland, New Zealand, and Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - William J Taylor
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Veterans Affairs Medical Center and University of California, San Diego
| | - Masanari Kuwabara
- Toranomon Hospital, Tokyo, Japan, and University of Colorado Denver, Aurora
| | | | - Rebecca Grainger
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Carlos Pineda
- Instituto Nacional Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | - Mariano Andrés
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | | | | | - Tristan Pascart
- Lille Catholic University and Saint-Philibert Hospital, Lomme, France
| | | | - Fernando Perez-Ruiz
- University of the Basque Country, Biscay, and Cruces University Hospital and Biocruces Health Research Institute, Baracaldo, Spain
| | - Sara K Tedeschi
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Seoyoung C Kim
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslie R Harrold
- Corrona, LLC, Waltham, and University of Massachusetts Medical School, Worcester
| | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | | | - Anne-Kathrin Tausche
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | | | | | - Pascal Richette
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Eliseo Pascual
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | - Mark C Fisher
- Harvard Medical School and Massachusetts General Hospital Boston
| | - Ruben Burgos-Vargas
- Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Philip C Robinson
- University of Queensland School of Medicine and Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jasvinder A Singh
- Veterans Affairs Medical Center, Birmingham, and University of Alabama at Birmingham
| | | | | | - Ole Slot
- Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Daniel H Solomon
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Carlo Alberto Scire
- University of Ferrara, Ferrara, and Italian Society for Rheumatology, Milan, Italy
| | | | - Mats Dehlin
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | - Anthony M Reginato
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | | | - Frédéric Lioté
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hang-Korng Ea
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Ann Rosenthal
- Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee
| | - Thomas Bardin
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hyon K Choi
- Harvard Medical School and Massachusetts General Hospital Boston
| | | | - Christine Czegley
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sung Jae Choi
- University of California, San Diego, and Korea University Ansan Hospital, Ansan, South Korea
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15
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Bursill D, Taylor WJ, Terkeltaub R, Abhishek A, So AK, Vargas-Santos AB, Gaffo AL, Rosenthal A, Tausche AK, Reginato A, Manger B, Sciré C, Pineda C, van Durme C, Lin CT, Yin C, Albert DA, Biernat-Kaluza E, Roddy E, Pascual E, Becce F, Perez-Ruiz F, Sivera F, Lioté F, Schett G, Nuki G, Filippou G, McCarthy G, da Rocha Castelar Pinheiro G, Ea HK, Tupinambá HDA, Yamanaka H, Choi HK, Mackay J, ODell JR, Vázquez Mellado J, Singh JA, Fitzgerald JD, Jacobsson LTH, Joosten L, Harrold LR, Stamp L, Andrés M, Gutierrez M, Kuwabara M, Dehlin M, Janssen M, Doherty M, Hershfield MS, Pillinger M, Edwards NL, Schlesinger N, Kumar N, Slot O, Ottaviani S, Richette P, MacMullan PA, Chapman PT, Lipsky PE, Robinson P, Khanna PP, Gancheva RN, Grainger R, Johnson RJ, Te Kampe R, Keenan RT, Tedeschi SK, Kim S, Choi SJ, Fields TR, Bardin T, Uhlig T, Jansen T, Merriman T, Pascart T, Neogi T, Klück V, Louthrenoo W, Dalbeth N. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis 2019; 78:1592-1600. [PMID: 31501138 DOI: 10.1136/annrheumdis-2019-215933] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.
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Affiliation(s)
- David Bursill
- Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Alexander K So
- Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland
| | - Ana Beatriz Vargas-Santos
- Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angelo Lino Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ann Rosenthal
- Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany
| | - Anthony Reginato
- Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Bernhard Manger
- Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carlo Sciré
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlos Pineda
- Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Caroline van Durme
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Congcong Yin
- Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Daniel Arthur Albert
- Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | - Edyta Biernat-Kaluza
- Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland
| | - Fernando Perez-Ruiz
- Rheumatology Division, Cruces University Hospital, Baracaldo, Spain.,Department of Medicine, University of the Basque Country, Biscay, Spain.,Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Frédéric Lioté
- Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France.,Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Georg Schett
- Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - George Nuki
- Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Hang-Korng Ea
- Department of Rheumatology, Hôpital Lariboisière, Paris, France
| | | | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hyon K Choi
- Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Mackay
- President and CEO, Aristea Therapeutics, San Diego, California, USA
| | - James R ODell
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Janitzia Vázquez Mellado
- Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jasvinder A Singh
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D Fitzgerald
- Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Leo Joosten
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA
| | - Lisa Stamp
- Department of Medicine, Otago University, Christchurch, New Zealand
| | - Mariano Andrés
- Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México
| | - Masanari Kuwabara
- Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.,Department of Cardiology, Toranomon Hospital, Minato-ku, Japan
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael S Hershfield
- Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Pillinger
- Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA
| | | | - Naomi Schlesinger
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nitin Kumar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA
| | - Ole Slot
- Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Sebastien Ottaviani
- Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Paul A MacMullan
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Peter T Chapman
- Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand
| | - Peter E Lipsky
- CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA
| | - Philip Robinson
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Puja P Khanna
- Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rada N Gancheva
- Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA
| | - Ritch Te Kampe
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea
| | - Theodore R Fields
- Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tim Jansen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Tony Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Klück
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Tausche AK, Reuss-Borst M. [Crystal arthropathies]. Dtsch Med Wochenschr 2019; 144:1055-1060. [PMID: 31350748 DOI: 10.1055/a-0857-0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Crystals are one of the commonest reasons for acute joint inflammation. The most relevant types of crystals are those of monosodium urate (MSU) and calcium pyrophosphates (CPP). To get proven diagnosis of a crystal arthropathy the microscopic identification of those crystals in synovial fluid is still recommended by the actual guidelines. Whenever arthrocentesis is not feasible, ultrasound or dual-energy-computed tomography might help to visualize specific changes induced especially by MSU crystals. Both types of crystals act as danger signals inducing flares of immediate inflammatory response via activation of the innate immune system. Therefore crystal arthropathies could be seen as an auto-inflammatory condition. As neutrophils, monocytes and macrophages are the key cells and Interleukin 1β is one of the dominant cytokines the way of blocking inflammation by colchicine and override IL-1β are specific options in treating inflammation due to the crystals. For gout, causal treatment with urate lowering therapy can result in clearance of urate crystals. Unfortunately, to date there is no causal therapy for CPPD available. The present article summarises the recent knowledge highlighting the news regarding the crystal arthropathies gout and CPPD.
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Affiliation(s)
- Anne-Kathrin Tausche
- Medizinische Klinik III, Rheumatologie, Universitätsklinikum "Carl Gustav Carus" an der TU Dresden
| | - Monika Reuss-Borst
- Schwerpunktpraxis am Reha- und Präventionszentrum Bad Bocklet/Bad Kissingen
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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Perez-Ruiz F, Jansen TL, Tausche AK, Richette P, Lioté F, So AK, Stack A. Reassessing the Safety Profile of Lesinurad in Combination with Xanthine Oxidase Inhibitor Therapy. Rheumatol Ther 2019; 6:101-108. [PMID: 30767124 PMCID: PMC6393267 DOI: 10.1007/s40744-019-0143-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The rate of adverse renal events has been shown to be higher in patients treated with lesinurad plus a xanthine-oxidase inhibitor (XOI) than in patients treated only with a XOI. We reassessed the risks for various adverse renal events from a different perspective and devised a hypothesis to explain the results. METHODS We used data from phase 3 trials that were publicly available from the full prescribing information document and estimated the relative risk and the number needed to treat for increased serum creatinine (sCri), renal failure, and renal lithiasis. We examined these risks for each treatment group and the risks stratified by estimated glomerular filtration rate (eGFR). RESULTS Overall, the relative risk for sCri was > 1.0 with the 400 mg/day dose of lesinurad and higher with the 200 mg/day dose, but it was < 1.0 for both lithiasis and renal failure with the 200 mg/day dose. The relative risk was only statistically significant for sCri with the highest dose of lesinurad. When results stratified by eGFR were considered, the rates of adverse events increased with declining renal function, but the relative risks decreased in parallel, as the rate of adverse events increased much more in the placebo arm than in the active arm (200 mg/day dose). Indeed, the relative risk was only significant for the highest dose of lesinurad in patients with normal eGFR. CONCLUSION The rate of sCri events was higher in patients treated with both lesinurad and a XOI rather than a XOI alone. This rate was found to increase with decreasing eGFR, but as it does in for both active and placebo arms the relative risk is not different from that observed in the placebo arms in the labeled 200 mg/day dose. This may be explained by pathophysiological changes that develop in chronic kidney disease.
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Affiliation(s)
- Fernando Perez-Ruiz
- Rheumatology Division, Cruces University Hospital, Biocruces Bizkaia Health Research Institute and Medicine Department, Medicine and Nursery School, University of the Basque Country, Bilbao, Vizcaya, Spain.
| | - Tim L Jansen
- Department of Rheumatology, VieCuri MC, Teglseweg 210, 9012 BL, Venlo, The Netherlands
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic "Carl Gustav Carus" at the Technical University, Dressden, Germany
| | - Pascal Richette
- Rheumatology Department and Inserm URM 1132, Centre Viggo Petersen, Hôpital Lariboisière (AP-HP) and Université Paris Diderot, USPC, Paris, France
| | - Frédéric Lioté
- Rheumatology Department and Inserm URM 1132, Centre Viggo Petersen, Hôpital Lariboisière (AP-HP) and Université Paris Diderot, USPC, Paris, France
| | | | - Austin Stack
- Nephrology Division, University Hospital Limerick, Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
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Abstract
The metabolic diseases gout and calciumpyrophosphate deposition (CPPD) (formerly: chondrocalcinosis/pseudogout) are crystal arthropathies which are caused by crystals in synovial fluid and in the case of gout also in periarticular structures. Today, in particular gout is considered as an auto-inflammatory process since phagocytosis of monosodium urate crystals by monocytes/macrophages results in the activation of the innate immune system by activation of the NRLP3-Inflammasome and consecutive secretion of the key cytokine interleukin-1ß and other pro-inflammatory cytokines. The prevalence of both crystal arthropathies rises with increasing age of patients. Most often they present clinically as an acute monarthritis of different locations. Beside typical clinical presentation, performance of ultrasonography, conventional X-Ray of joints and under special circumstances dual-energy-computer tomography could be also helpful diagnostic tools. There are EULAR guidelines describing the diagnostic algorithm for making right diagnosis. The arthrocentesis with microscopic detection of crystals is established diagnostic gold standard. Whereas crystals of monosodium urate could be very clearly be seen as relatively large intra- and extracellular needles with a strong birefringence in polarized light microscopy the detection of CPPD-crystals is more difficult. Those crystals are much smaller, showing weaker birefringence and are sometimes only seen with ordinary light microscopy. As both crystal diseases are mediated by IL-1 driven processes, the therapeutic intervention first target the acute inflammation consisting in colchicine, NSAIDs and glucocorticoids. Secondarily, in gout there are well established causal therapies to lower effectively serum urate levels below the target of 6 mg/dL (360 µmol/l). Unfortunately, those causal therapeutic options are still lacking in CPPD.
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Reuss-Borst M, Tausche AK. Stoffwechselkrankheit Gicht. AKTUEL RHEUMATOL 2018. [DOI: 10.1055/s-0043-121141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie Gicht ist die häufigste entzündliche Gelenkerkrankung. Ihr liegt mit der Hyperurikämie als Ursache eine metabolische Störung zugrunde. Abgelagerte Harnsäurekristalle führen zu den typischen anfallsartigen Gelenkentzündungen. In den letzten Jahrzehnten ist die Gichtinzidenz zusammen mit anderen metabolischen Erkrankungen zunehmend. Der Rheumatologe ist besonders gefragt, wenn sich die Gicht klinisch nicht typisch manifestiert (oligo- und polyartikulär), also andere Differenzialdiagnosen infrage kommen, wenn bereits Komplikationen aufgetreten sind (fortgeschrittene Arthropathie, tophöse Gicht, zunehmende Nierenfunktionseinschränkung) oder wenn sich die Therapie aufgrund von Komorbiditäten schwierig gestaltet. Im Allgemeinen ist die Diagnostik der Gicht für den erfahrenen Rheumatologen keine Herausforderung, zumal er über Tools wie die Gelenksonografie und Gelenkpunktion mit mikroskopischer Beurteilung von Synovialflüssigkeit verfügt. Auch erscheint die Behandlung der Gicht als „treat-to-target“-Konzept in Analogie zu anderen entzündlich-rheumatischen Erkrankungen und aufgrund effektiver therapeutischer Optionen vergleichsweise übersichtlich. Immer wieder kommt jedoch die Frage nach eventuell modifizierbaren Faktoren bei der Entstehung der Hyperurikämie und Gicht auf. Die vorliegende Arbeit richtet den Fokus auf die Beeinflussung der zugrundeliegenden metabolischen Ursachen unter Berücksichtigung aktueller wissenschaftlicher Erkenntnisse. Ziel ist es, den Fokus von der rein symptomatischen Therapie der Entzündung im Gichtanfall hin auf die kausale Beeinflussung der metabolischen Harnsäure-Homöostase zu richten. Dazu gehört neben diätetischen Maßnahmen auch die Modifikation von Harnsäure-erhöhenden Faktoren wie Komedikationen.
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Tausche AK, Alten R, Dalbeth N, Kopicko J, Fung M, Adler S, Bhakta N, Storgard C, Baumgartner S, Saag K. Lesinurad monotherapy in gout patients intolerant to a xanthine oxidase inhibitor: a 6 month phase 3 clinical trial and extension study. Rheumatology (Oxford) 2017; 56:2170-2178. [PMID: 29029210 DOI: 10.1093/rheumatology/kex350] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the efficacy and safety of lesinurad, a selective uric acid reabsorption inhibitor, in a 6 month, phase 3 clinical trial and extension study. Methods Patients with gout who cannot take a xanthine oxidase inhibitor (XOI) and have serum uric acid (sUA) ⩾6.5 mg/dl were randomized to receive oral lesinurad (400 mg daily) or placebo. The primary endpoint was the proportion of patients with sUA <6.0 mg/dl at month 6. Safety assessments included treatment-emergent adverse events (TEAEs) and laboratory data. Patients who completed the study were eligible for an open-label, uncontrolled extension study of lesinurad 400 mg monotherapy. Results Patients (n = 214) were primarily white males (mean age 54.4 years; gout duration 11.2 years). Significantly more patients achieved the primary endpoint with lesinurad than placebo (29.9 vs 1.9%; P < 0.0001). Overall TEAE rates were higher with lesinurad (77.6 vs 65.4%); renal-related TEAEs (17.8%), renal-related serious TEAEs (4.7%) and serum creatinine elevations (1.5 times baseline, 24.3%) occurred only with lesinurad. A total of 143 patients (65 lesinurad, 78 placebo) enrolled in the extension study. Treatment with lesinurad 400 mg resulted in rapid and sustained sUA lowering that persisted for up to 18 months before the study was terminated prematurely. No new safety findings were observed in the extension. Conclusion In patients with gout and intolerance/contraindication to XOIs, lesinurad 400 mg monotherapy demonstrated superior sUA lowering compared with placebo, with sustained effects for up to 18 months. Due to a high incidence of serum creatinine elevations and renal-related adverse events, including serious adverse events with lesinurad 400 mg, lesinurad should not be used as monotherapy. Trial registration ClinicalTrials.gov (http://clinincaltrials.gov), NCT01508702.
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Affiliation(s)
| | - Rieke Alten
- Department of Internal Medicine II, University Medicine Berlin, Berlin, Germany
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jeff Kopicko
- Global Medicines Development, Cardiovascular and Metabolic Diseases Clinical Development Unit, AstraZeneca Pharmaceuticals, Gaithersburg, MD
| | - Maple Fung
- Global Medicines Development, Cardiovascular and Metabolic Diseases Clinical Development Unit, AstraZeneca Pharmaceuticals, Gaithersburg, MD
| | - Scott Adler
- Clinical Research and Development, Ardea Biosciences, Inc., San Diego, CA
| | - Nihar Bhakta
- Global Medicines Development, Cardiovascular and Metabolic Diseases Clinical Development Unit, AstraZeneca Pharmaceuticals, Gaithersburg, MD
| | - Chris Storgard
- Global Medicines Development, Cardiovascular and Metabolic Diseases Clinical Development Unit, AstraZeneca Pharmaceuticals, Gaithersburg, MD
| | - Scott Baumgartner
- Global Medicines Development, Cardiovascular and Metabolic Diseases Clinical Development Unit, AstraZeneca Pharmaceuticals, Gaithersburg, MD
| | - Kenneth Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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de Lautour H, Taylor WJ, Adebajo A, Alten R, Burgos-Vargas R, Chapman P, Cimmino MA, da Rocha Castelar Pinheiro G, Day R, Harrold LR, Helliwell P, Janssen M, Kerr G, Kavanaugh A, Khanna D, Khanna PP, Lin C, Louthrenoo W, McCarthy G, Vazquez-Mellado J, Mikuls TR, Neogi T, Ogdie A, Perez-Ruiz F, Schlesinger N, Ralph Schumacher H, Scirè CA, Singh JA, Sivera F, Slot O, Stamp LK, Tausche AK, Terkeltaub R, Uhlig T, van de Laar M, White D, Yamanaka H, Zeng X, Dalbeth N. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. Arthritis Care Res (Hoboken) 2017; 68:667-72. [PMID: 26414176 DOI: 10.1002/acr.22741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.
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Affiliation(s)
| | | | | | - Rieke Alten
- Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Ric Day
- University of New South Wales and St Vincent's Hospital, Sydney, Australia
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | | | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | | | | | - Puja P Khanna
- University of Michigan and Ann Arbor VA Medical Center, Ann Arbor
| | - Chingtsai Lin
- Taichung Veteran's General Hospital, Taichung, Taiwan
| | | | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | - Ted R Mikuls
- Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain
| | - Naomi Schlesinger
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Carlo A Scirè
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jasvinder A Singh
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham
| | | | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Douglas White
- Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Xuejun Zeng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
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23
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Ogdie A, Taylor WJ, Neogi T, Fransen J, Jansen TL, Schumacher HR, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Cagnotto G, Cavagna L, Lin C, Chou YY, Tausche AK, Lima Gomes Ochtrop M, Janssen M, Chen JH, Slot O, Lazovskis J, White D, Cimmino MA, Uhlig T, Dalbeth N. Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard. Arthritis Rheumatol 2017; 69:429-438. [PMID: 27748084 DOI: 10.1002/art.39959] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.
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Affiliation(s)
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Jaap Fransen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
| | - Geraldine McCarthy
- University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, BioCruces Health Research Institute, and Basque Country University, Barakaldo, Spain
| | | | - Hang-Korng Ea
- Université Paris Diderot, INSERM UMR 1132 and Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France
| | | | - Giovanni Cagnotto
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy, and Skane University Hospital Malmö/Lund, Lund, Sweden
| | - Lorenzo Cavagna
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | - Yin-Yi Chou
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | | | | | | | - Jiunn-Horng Chen
- China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | - Douglas White
- Waikato District Health Board and Waikato Clinical School, Hamilton, New Zealand
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Kiltz U, Alten R, Fleck M, Krüger K, Manger B, Müller-Ladner U, Nüsslein H, Reuss-Borst M, Schwarting A, Schulze-Koops H, Tausche AK, Braun J. [Evidence-based recommendations for diagnostics and treatment of gouty arthritis in the specialist sector : S2e guidelines of the German Society of Rheumatology in cooperation with the AWMF]. Z Rheumatol 2017; 76:118-124. [PMID: 28078432 DOI: 10.1007/s00393-016-0249-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Due to the increasing prevalence of gout, particularly in old age, the disease is becoming of increasing importance in Germany. Gout is one of the most common forms of recurrent inflammatory arthritis and is induced by the deposition of monosodium urate crystals in synovial fluid and other tissues. The principal goals of therapy in chronic gout are the symptomatic treatment of the acute joint inflammation and the causal treatment of the underlying metabolic cause, the hyperuricemia. Only a consistent and permanent reduction of the serum uric acid level ultimately results in an efficient avoidance of further gout attacks and therefore the prevention of structural damage. Due to an often inadequate treatment of gout, the target of healing the disease is often not achieved. A correct and timely diagnosis and adequate assessment of comorbidities associated with gout are, however, of substantial importance for patient and physician to achieve remission of the disease. In order to create a solid basis for a timely and effective treatment of affected patients, in 2016 the German Society of Rheumatology (DGRh) initiated the development of S2e guidelines on gouty arthritis for specialists. This article summarizes these S2e guidelines on the management of gouty arthritis in the specialist sector.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - R Alten
- Rheumatologie, Klinische Immunologie, Osteologie, Physikalische Therapie und Sportmedizin, Schlosspark-Klinik, Berlin, Deutschland
| | - M Fleck
- Klinik und Poliklinik für Innere Medizin I, Klinik für Rheumatologie/Klinische Immunologie, Asklepios-Klinikum, Uniklinikum Regensburg, Bad Abbach, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - B Manger
- Medizinische Klinik 3, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - H Nüsslein
- Rheumatologische Schwerpunktpraxis, Nürnberg, Deutschland
| | - M Reuss-Borst
- Facharzt-Praxis für Rheumatologie und Onkologie, Bad Bocklet, Deutschland
| | - A Schwarting
- Rheumatologisch-immunologische Ambulanz, Universitätsklinik Mainz, Mainz, Deutschland
| | | | - A K Tausche
- Medizinische Klinik III, Abteilung für Rheumatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
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Englbrecht M, Alten R, Aringer M, Baerwald CG, Burkhardt H, Eby N, Fliedner G, Gauger B, Henkemeier U, Hofmann MW, Kleinert S, Kneitz C, Krueger K, Pohl C, Roske AE, Schett G, Schmalzing M, Tausche AK, Peter Tony H, Wendler J. Validation of Standardized Questionnaires Evaluating Symptoms of Depression in Rheumatoid Arthritis Patients: Approaches to Screening for a Frequent Yet Underrated Challenge. Arthritis Care Res (Hoboken) 2016; 69:58-66. [DOI: 10.1002/acr.23002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/08/2016] [Accepted: 07/26/2016] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Martin Aringer
- University Clinical Center Carl Gustav Carus, Technical University of Dresden; Dresden Germany
| | | | - Harald Burkhardt
- Johann Wolfgang Goethe University Frankfurt am Main; Frankfurt Germany
| | - Nancy Eby
- AMS Advanced Medical Services GmbH; Mannheim Germany
| | | | | | - Ulf Henkemeier
- University Hospital Frankfurt am Main Goethe-University; Frankfurt Germany
| | | | | | - Christian Kneitz
- Klinikum Suedstadt Rostock, Klinik für Innere Medizin II; Rostock Germany
| | | | | | | | - Georg Schett
- University of Erlangen-Nuremberg; Erlangen Germany
| | | | - Anne-Kathrin Tausche
- University Clinical Center Carl Gustav Carus, Technical University of Dresden; Dresden Germany
| | | | - Joerg Wendler
- Rheumatologische Schwerpunktpraxis; Erlangen Germany
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Dalbeth N, Schumacher HR, Fransen J, Neogi T, Jansen TL, Brown M, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Scire CA, Cavagna L, Lin C, Chou YY, Tausche AK, da Rocha Castelar-Pinheiro G, Janssen M, Chen JH, Cimmino MA, Uhlig T, Taylor WJ. Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard. Arthritis Care Res (Hoboken) 2016; 68:1894-1898. [PMID: 27014846 DOI: 10.1002/acr.22896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/18/2016] [Accepted: 03/22/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. METHODS Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard. RESULTS For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%). CONCLUSION A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.
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Affiliation(s)
| | | | - Jaap Fransen
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
| | - Geraldine McCarthy
- Geraldine McCarthy, MD, FRCPI, University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain
| | | | - Hang-Korng Ea
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, INSERM, UMR 1132, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Hôpital Lariboisière, Paris, France
| | | | - Carlo A Scire
- Carlo A. Scire, MD, PhD, Italian Society for Rheumatology, Milan, Italy
| | - Lorenzo Cavagna
- University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yin-Yi Chou
- Taichung Veterans General Hospital, Taichung, Taiwan
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Langer M, Forkmann M, Richter U, Tausche AK, Sveric K, Christoph M, Ibrahim K, Günther M, Kolschmann S, Boscheri A, Barthel P, Strasser RH, Wunderlich C. Heart-type fatty acid-binding protein and myocardial creatine kinase enable rapid risk stratification in normotensive patients with pulmonary embolism. J Crit Care 2016; 35:174-9. [DOI: 10.1016/j.jcrc.2016.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 05/14/2016] [Indexed: 11/28/2022]
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Lioté F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016; 76:29-42. [DOI: 10.1136/annrheumdis-2016-209707] [Citation(s) in RCA: 817] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/14/2016] [Accepted: 06/29/2016] [Indexed: 12/22/2022]
Abstract
BackgroundNew drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.MethodsThe EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.ResultsThree overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.ConclusionsThese recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.
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29
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Rasheed H, Phipps-Green AJ, Topless R, Smith MD, Hill C, Lester S, Rischmueller M, Janssen M, Jansen TL, Joosten LA, Radstake TR, Riches PL, Tausche AK, Lioté F, So A, van Rij A, Jones GT, McCormick SP, Harrison AA, Stamp LK, Dalbeth N, Merriman TR. Replication of association of the apolipoprotein A1-C3-A4 gene cluster with the risk of gout. Rheumatology (Oxford) 2016; 55:1421-30. [PMID: 27094595 DOI: 10.1093/rheumatology/kew057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Gout is associated with dyslipidaemia. Association of the apolipoprotein A1-C3-A4 gene cluster with gout has previously been reported in a small study. To investigate a possible causal role for this locus in gout, we tested the association of genetic variants from APOA1 (rs670) and APOC3 (rs5128) with gout. METHODS We studied data for 2452 controls and 2690 clinically ascertained gout cases of European and New Zealand Polynesian (Māori and Pacific) ancestry. Data were also used from the publicly available Atherosclerosis Risk in Communities study (n = 5367) and the Framingham Heart Study (n = 2984). Multivariate adjusted logistic and linear regression was used to test the association of single-nucleotide polymorphisms with gout risk, serum urate, triglyceride and high-density lipoprotein cholesterol (HDL-C). RESULTS In Polynesians, the T-allele of rs670 (APOA1) increased (odds ratio, OR = 1.53, P = 4.9 × 10(-6)) and the G-allele of rs5128 (APOC3) decreased the risk of gout (OR = 0.86, P = 0.026). In Europeans, there was a strong trend to a risk effect of the T-allele for rs670 (OR = 1.11, P = 0.055), with a significant protective effect of the G-allele for rs5128 being observed after adjustment for triglycerides and HDL-C (OR = 0.81, P = 0.039). The effect at rs5128 was specific to males in both Europeans and Polynesians. Association in Polynesians was independent of any effect of rs670 and rs5128 on triglyceride and HDL-C levels. There was no evidence for association of either single-nucleotide polymorphism with serum urate levels (P ⩾ 0.10). CONCLUSION Our data, replicating a previous study, supports the hypothesis that the apolipoprotein A1-C3-A4 gene cluster plays a causal role in gout.
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Affiliation(s)
- Humaira Rasheed
- Department of Biochemistry, University of Otago, Dunedin, New Zealand Department of Chemistry, University of Engineering and Technology, Lahore, Pakistan
| | | | - Ruth Topless
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Malcolm D Smith
- Department of Medicine, Flinders Medical Centre and Repatriation General Hospital, Adelaide
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Susan Lester
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | | | | | - Leo A Joosten
- Department of Internal Medicine and Radboud Institute of Molecular Life Science, Radboud University Medical Center, Nijmegen
| | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philip L Riches
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl-Gustav-Carus, Dresden, Germany
| | - Frederic Lioté
- INSERM, UMR-S 1132, Hospital Lariboisière University Paris Diderot (UFR de Médecine), Sorbonne Paris Cité, Paris, F-75205, France
| | - Alexander So
- DAL, Service of Rheumatology, Laboratory of Rheumatology, University of Lausanne, CHUV, Nestlé 05-5029, Lausanne, Switzerland
| | | | | | - Sally P McCormick
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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30
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Albus E, Sinningen K, Winzer M, Thiele S, Baschant U, Hannemann A, Fantana J, Tausche AK, Wallaschofski H, Nauck M, Völzke H, Grossklaus S, Chavakis T, Udey MC, Hofbauer LC, Rauner M. Milk Fat Globule-Epidermal Growth Factor 8 (MFG-E8) Is a Novel Anti-inflammatory Factor in Rheumatoid Arthritis in Mice and Humans. J Bone Miner Res 2016; 31:596-605. [PMID: 26391522 PMCID: PMC6999704 DOI: 10.1002/jbmr.2721] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 12/31/2022]
Abstract
Milk fat globule-epidermal growth factor 8 (MFG-E8) is an anti-inflammatory glycoprotein that mediates the clearance of apoptotic cells and is implicated in the pathogenesis of autoimmune and inflammatory diseases. Because MFG-E8 also controls bone metabolism, we investigated its role in rheumatoid arthritis (RA), focusing on inflammation and joint destruction. The regulation of MFG-E8 by inflammation was assessed in vitro using osteoblasts, in arthritic mice and in patients with RA. K/BxN serum transfer arthritis (STA) was applied to MFG-E8 knock-out mice to assess its role in the pathogenesis of arthritis. Stimulation of osteoblasts with lipopolysaccharide (LPS) and tumor necrosis factor (TNF)-α downregulated the expression of MFG-E8 by 30% to 35%. MFG-E8-deficient osteoblasts responded to LPS with a stronger production of pro-inflammatory cytokines. In vivo, MFG-E8 mRNA levels were 52% lower in the paws of collagen-induced arthritic (CIA) mice and 24% to 42% lower in the serum of arthritic mice using two different arthritis models (CIA and STA). Similarly, patients with RA (n = 93) had lower serum concentrations of MFG-E8 (-17%) compared with healthy controls (n = 140). In a subgroup of patients who had a moderate to high disease activity (n = 21), serum concentrations of MFG-E8 rose after complete or partial remission had been achieved (+67%). Finally, MFG-E8-deficient mice subjected to STA exhibited a stronger disease burden, an increased number of neutrophils in the joints, and a more extensive local and systemic bone loss. This was accompanied by an increased activation of osteoclasts and a suppression of osteoblast function in MFG-E8-deficient mice. Thus, MFG-E8 is a protective factor in the pathogenesis of RA and subsequent bone loss. Whether MFG-E8 qualifies as a novel biomarker or therapeutic target for the treatment of RA is worth addressing in further studies.
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Affiliation(s)
- Elise Albus
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Kathrin Sinningen
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany.,Department of Obstetrics and Gynecology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maria Winzer
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sylvia Thiele
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Baschant
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Julia Fantana
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | | | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sylvia Grossklaus
- Department of Clinical Pathobiochemistry and Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Triantafyllos Chavakis
- Department of Clinical Pathobiochemistry and Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany.,DFG Research Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Mark C Udey
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lorenz C Hofbauer
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany.,DFG Research Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Martina Rauner
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
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31
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Rasheed H, McKinney C, Stamp LK, Dalbeth N, Topless RK, Day R, Kannangara D, Williams K, Smith M, Janssen M, Jansen TL, Joosten LA, Radstake TR, Riches PL, Tausche AK, Lioté F, Lu L, Stahl EA, Choi HK, So A, Merriman TR. The Toll-Like Receptor 4 (TLR4) Variant rs2149356 and Risk of Gout in European and Polynesian Sample Sets. PLoS One 2016; 11:e0147939. [PMID: 26808548 PMCID: PMC4726773 DOI: 10.1371/journal.pone.0147939] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/11/2016] [Indexed: 01/31/2023] Open
Abstract
Deposition of crystallized monosodium urate (MSU) in joints as a result of hyperuricemia is a central risk factor for gout. However other factors must exist that control the progression from hyperuricaemia to gout. A previous genetic association study has implicated the toll-like receptor 4 (TLR4) which activates the NLRP3 inflammasome via the nuclear factor-κB signaling pathway upon stimulation by MSU crystals. The T-allele of single nucleotide polymorphism rs2149356 in TLR4 is a risk factor associated with gout in a Chinese study. Our aim was to replicate this observation in participants of European and New Zealand Polynesian (Māori and Pacific) ancestry. A total of 2250 clinically-ascertained prevalent gout cases and 13925 controls were used. Non-clinically-ascertained incident gout cases and controls from the Health Professional Follow-up (HPFS) and Nurses Health Studies (NHS) were also used. Genotypes were derived from genome-wide genotype data or directly obtained using Taqman. Logistic regression analysis was done including age, sex, diuretic exposure and ancestry as covariates as appropriate. The T-allele increased the risk of gout in the clinically-ascertained European samples (OR = 1.12, P = 0.012) and decreased the risk of gout in Polynesians (OR = 0.80, P = 0.011). There was no evidence for association in the HPFS or NHS sample sets. In conclusion TLR4 SNP rs2143956 associates with gout risk in prevalent clinically-ascertained gout in Europeans, in a direction consistent with previously published results in Han Chinese. However, with an opposite direction of association in Polynesians and no evidence for association in a non-clinically-ascertained incident gout cohort this variant should be analysed in other international gout genetic data sets to determine if there is genuine evidence for association.
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Affiliation(s)
- Humaira Rasheed
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- University of Engineering and Technology, Lahore, Pakistan
| | - Cushla McKinney
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Lisa K. Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ruth K. Topless
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Richard Day
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Sydney, Australia
| | - Diluk Kannangara
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Sydney, Australia
| | - Kenneth Williams
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Sydney, Australia
| | - Malcolm Smith
- Department of Medicine, Flinders Medical Centre and Repatriation General Hospital, Adelaide, Australia
| | - Matthijs Janssen
- Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Tim L. Jansen
- Department of IQ HealthCare, VieCuri Medical Centre, Venlo, The Netherlands
| | - Leo A. Joosten
- Department of Internal Medicine and Radboud Institute of Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Timothy R. Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philip L. Riches
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic “Carl-Gustav-Carus”, Dresden, Germany
| | - Frederic Lioté
- INSERM, UMR-S 1132, Hospital Lariboisière, Paris, France
- University Paris Diderot (UFR de Médecine), Sorbonne Paris Cité, Paris, France
| | - Leo Lu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Eli A. Stahl
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alexander So
- DAL, Service of Rheumatology, Laboratory of Rheumatology, University of Lausanne, CHUV, Nestlé, Lausanne, Switzerland
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- * E-mail:
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32
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Neogi T, Jansen TLTA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJEM, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015; 74:1789-98. [PMID: 26359487 PMCID: PMC4602275 DOI: 10.1136/annrheumdis-2015-208237] [Citation(s) in RCA: 410] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multi-criterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (ie, synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy CT, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusions The new classification criteria, developed using a data-driven and decision-analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout.
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Affiliation(s)
- Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tim L Th A Jansen
- Viecuri Medical Center, Venlo, The Netherlands Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jaap Fransen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Hyon Choi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Frédéric Lioté
- INSERM UMR 1132, Hôpital Lariboisière, AP-HP, and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Raymond P Naden
- McMaster University Medical Centre, Hamilton, Ontario, Canada
| | | | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya, Spain
| | - Kenneth Saag
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John S Sundy
- Duke University and Duke University Medical Center, Durham, North Carolina, USA Gilead Sciences, Foster City, California, USA
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Taylor WJ, Fransen J, Dalbeth N, Neogi T, Ralph Schumacher H, Brown M, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Scire CA, Cavagna L, Lin C, Chou YY, Tausche AK, da Rocha Castelar-Pinheiro G, Janssen M, Chen JH, Slot O, Cimmino M, Uhlig T, Jansen TL. Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated. J Rheumatol 2015; 43:150-3. [PMID: 26628602 DOI: 10.3899/jrheum.150684] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the frequency of adverse events of diagnostic arthrocentesis in patients with possible gout. METHODS Consecutive patients underwent arthrocentesis and were evaluated at 6 weeks to determine adverse events. The 95% CI were obtained by bootstrapping. RESULTS Arthrocentesis was performed in 910 patients, and 887 (97.5%) were evaluated for adverse events. Any adverse event was observed in 12 participants (1.4%, 95% CI 0.6-2.1). There was 1 case (0.1%, 95% CI 0-0.34) of septic arthritis. CONCLUSIONS Diagnostic arthrocentesis is associated with a low frequency of adverse events. Septic arthritis rarely occurs.
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Affiliation(s)
- William J Taylor
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Jaap Fransen
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Nicola Dalbeth
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Tuhina Neogi
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - H Ralph Schumacher
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Melanie Brown
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Worawit Louthrenoo
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Janitzia Vazquez-Mellado
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Maxim Eliseev
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Geraldine McCarthy
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Lisa K Stamp
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Fernando Perez-Ruiz
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Francisca Sivera
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Hang-Korng Ea
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Martijn Gerritsen
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Carlo A Scire
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Lorenzo Cavagna
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Chingtsai Lin
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Yin-Yi Chou
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Anne-Kathrin Tausche
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Geraldo da Rocha Castelar-Pinheiro
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Matthijs Janssen
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Jiunn-Horng Chen
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Ole Slot
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Marco Cimmino
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Till Uhlig
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
| | - Tim L Jansen
- From the University of Otago, Wellington; University of Auckland, Auckland; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Radboud University Medical Centre, Nijmegen; Amsterdam Rheumatology Immunology Center (ARC), Department of Rheumatology, Westfries Gasthuis, Hoorn; Rijnstate Hospital, Arnhem, the Netherlands; Boston University School of Medicine, Boston, Massachusetts; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Servicio de Reumatología, Hospital General de México, México City, México; Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia; School of Medicine and Medical Science, University College Dublin; Mater Misericordiae University Hospital, Dublin, Ireland; Rheumatology Division, Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya; Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine; Institut national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan; Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Taichung Veterans' General Hospital; School of Medicine, China Medical University; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Division of Rheumatology, Department of In
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McKinney C, Stamp LK, Dalbeth N, Topless RK, Day RO, Kannangara DR, Williams KM, Janssen M, Jansen TL, Joosten LA, Radstake TR, Riches PL, Tausche AK, Lioté F, So A, Merriman TR. Multiplicative interaction of functional inflammasome genetic variants in determining the risk of gout. Arthritis Res Ther 2015; 17:288. [PMID: 26462562 PMCID: PMC4604627 DOI: 10.1186/s13075-015-0802-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/26/2015] [Indexed: 02/07/2023] Open
Abstract
Introduction The acute gout flare results from a localised self-limiting innate immune response to monosodium urate (MSU) crystals deposited in joints in hyperuricaemic individuals. Activation of the caspase recruitment domain-containing protein 8 (CARD8) NOD-like receptor pyrin-containing 3 (NLRP3) inflammasome by MSU crystals and production of mature interleukin-1β (IL-1β) is central to acute gouty arthritis. However very little is known about genetic control of the innate immune response involved in acute gouty arthritis. Therefore our aim was to test functional single nucleotide polymorphism (SNP) variants in the toll-like receptor (TLR)-inflammasome-IL-1β axis for association with gout. Methods 1,494 gout cases of European and 863 gout cases of New Zealand (NZ) Polynesian (Māori and Pacific Island) ancestry were included. Gout was diagnosed by the 1977 ARA gout classification criteria. There were 1,030 Polynesian controls and 10,942 European controls including from the publicly-available Atherosclerosis Risk in Communities (ARIC) and Framingham Heart (FHS) studies. The ten SNPs were either genotyped by Sequenom MassArray or by Affymetrix SNP array or imputed in the ARIC and FHS datasets. Allelic association was done by logistic regression adjusting by age and sex with European and Polynesian data combined by meta-analysis. Sample sets were pooled for multiplicative interaction analysis, which was also adjusted by sample set. Results Eleven SNPs were tested in the TLR2, CD14, IL1B, CARD8, NLRP3, MYD88, P2RX7, DAPK1 and TNXIP genes. Nominally significant (P < 0.05) associations with gout were detected at CARD8 rs2043211 (OR = 1.12, P = 0.007), IL1B rs1143623 (OR = 1.10, P = 0.020) and CD14 rs2569190 (OR = 1.08; P = 0.036). There was significant multiplicative interaction between CARD8 and IL1B (P = 0.005), with the IL1B risk genotype amplifying the risk effect of CARD8. Conclusion There is evidence for association of gout with functional variants in CARD8, IL1B and CD14. The gout-associated allele of IL1B increases expression of IL-1β – the multiplicative interaction with CARD8 would be consistent with a synergy of greater inflammasome activity (resulting from reduced CARD8) combined with higher levels of pre-IL-1β expression leading to increased production of mature IL-1β in gout. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0802-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cushla McKinney
- Department of Biochemistry, University of Otago, Box 56, Dunedin, 9054, New Zealand.
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Ruth K Topless
- Department of Biochemistry, University of Otago, Box 56, Dunedin, 9054, New Zealand.
| | - Richard O Day
- School of Medical Sciences, University of New South Wales, Sydney, Australia. .,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
| | - Diluk Rw Kannangara
- School of Medical Sciences, University of New South Wales, Sydney, Australia. .,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
| | - Kenneth M Williams
- School of Medical Sciences, University of New South Wales, Sydney, Australia. .,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
| | - Matthijs Janssen
- Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Timothy L Jansen
- Department of IQ HealthCare, VieCuri Medical Centre, Venlo, The Netherlands. .,Scientific Institute of Quality in HealthCare, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Leo A Joosten
- Department of Internal Medicine and Radboud Institute of Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands. .,Department of Immunology, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Philip L Riches
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl-Gustav-Carus", Dresden, Germany.
| | - Frederic Lioté
- INSERM, UMR-S 1132, Hospital Lariboisière, F-75010, Paris, France. .,University Paris Diderot (UFR de Médecine), Sorbonne Paris Cité, F-75205, Paris, France.
| | - Alexander So
- DAL, Service of Rheumatology, Laboratory of Rheumatology, University of Lausanne, CHUV, Nestlé 05-5029, 1011, Lausanne, Switzerland.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Box 56, Dunedin, 9054, New Zealand.
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Taylor WJ, Fransen J, Dalbeth N, Neogi T, Schumacher HR, Brown M, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Scire C, Cavagna L, Lin C, Chou YY, Tausche AK, da Rocha Castelar-Pinheiro G, Janssen M, Chen JH, Slot O, Cimmino M, Uhlig T, Jansen TL. Performance of classification criteria for gout in early and established disease. Ann Rheum Dis 2014; 75:178-82. [PMID: 25351521 DOI: 10.1136/annrheumdis-2014-206364] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/08/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the sensitivity and specificity of different classification criteria for gout in early and established disease. METHODS This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less. RESULTS Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease. CONCLUSIONS Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.
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Affiliation(s)
- William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - H Ralph Schumacher
- VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Brown
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
| | - Geraldine McCarthy
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Fernando Perez-Ruiz
- Rheumatology Division, Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain
| | - Francisca Sivera
- Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain
| | - Hang-Korng Ea
- University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France INSERM, UMR 1132, Hôpital Lariboisière, Paris, France Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, 2, Rue Ambroise Paré, Paris, France
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology Immunology Center (ARC), Westfries Gasthuis, Hoorn, the Netherlands
| | - Carlo Scire
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC
| | - Yin-Yi Chou
- Taichung Veterans' General Hospital, Taichung, Taiwan, ROC
| | - Anne-Kathrin Tausche
- Division of Rheumatology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Matthijs Janssen
- Department of Rheumatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jiunn-Horng Chen
- School of Medicine, China Medical University, Taichung, Taiwan, ROC Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Ole Slot
- Centre of Rheumatology and Spine Disorders, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - Marco Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Vinderen, Oslo, Norway
| | - Tim L Jansen
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands
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Richter U, Christoph M, Tausche AK, Boscheri A, Langer M, Ibrahim K, Günther M, H. Strasser R, Wunderlich C. Heart-type Fatty Acid-binding Protein Enables Rapid Risk Stratification In Patients With Pulmonary Embolism. ACTA ACUST UNITED AC 2013. [DOI: 10.14302/issn.2329-9487.jhc-12-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Khanna PP, Nuki G, Bardin T, Tausche AK, Forsythe A, Goren A, Vietri J, Khanna D. Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: Results from a cross-sectional survey. Health Qual Life Outcomes 2012; 10:117. [PMID: 22999027 PMCID: PMC3499162 DOI: 10.1186/1477-7525-10-117] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/20/2012] [Indexed: 01/04/2023] Open
Abstract
Background The prevalence of gout is increasing, and most research on the associated burden has focused on serum urate (sUA) levels. The present study quantifies the impact of the presence of tophi and frequency of acute gout attacks on health-related quality of life (HRQOL), productivity, and healthcare resource utilization. Methods Patients with self-reported gout (n = 620; 338 in US and 282 across France, Germany, and UK) were contacted based on inclusion in the 2010 US and EU National Health and Wellness Surveys (Kantar Health) and the Lightspeed Research ailment panel. Respondents were categorized into mutually-exclusive groups based on number of gout flares experienced in the past 12 months (0/don’t recall, 1–2, 3, 4–5, 6+), current presence of tophi (none, 1+, or not sure), and sUA level awareness (yes, no). HRQOL (SF-12v2), healthcare provider visits in the last 6 months, and work productivity and activity impairment (WPAI) were compared across groups. Results Most patients were males, mean age of 61 years, who reported experiencing at least one acute gout flare in the past 12 months, and 12.3% (n = 76) reported presence of tophi. Among the 27.7% (n = 172) of patients who were aware of their sUA levels, higher sUA was associated with more flares and tophi. Decreased HRQOL was associated with more frequent flares and presence of tophi. In multivariable models predicting outcomes based on presence of tophi and number of flares, both flares (≥4) and tophi (≥1) were associated with HRQOL decrements on physical and mental component summary scores and health utilities (all p < 0.05), after adjustment for age, gender, and time since diagnosis. Flares were also associated with greater activity impairment. Conclusions Impairments associated with gout flares and presence of tophi, across patients in the US and EU, underscore the importance of effective management of this potentially curable condition.
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Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M. “To Be or Not To Be,” Ten Years After: Evidence for Mixed Connective Tissue Disease as a Distinct Entity. Semin Arthritis Rheum 2012; 41:589-98. [DOI: 10.1016/j.semarthrit.2011.07.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Affiliation(s)
- A K Tausche
- Department of Internal Medicine, Section of Endocrinology and Rheumatology, University Clinic Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, Dresden, Germany.
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Tausche AK, Jansen TL, Schröder HE, Bornstein SR, Aringer M, Müller-Ladner U. Gout--current diagnosis and treatment. Dtsch Arztebl Int 2009; 106:549-55. [PMID: 19795010 DOI: 10.3238/arztebl.2009.0549] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 01/19/2009] [Indexed: 01/29/2023]
Abstract
BACKGROUND Because of the changing dietary habits of an aging population, hyperuricemia is frequently found in combination with other metabolic disorders. Longstanding elevation of the serum uric acid level can lead to the deposition of monosodium urate crystals, causing gout (arthritis, urate nephropathy, tophi). In Germany, the prevalence of gouty arthritis is estimated at 1.4%, higher than that of rheumatoid arthritis. There are no German guidelines to date for the treatment of gout. Its current treatment is based largely on expert opinion. METHODS Selective literature review on the diagnosis and treatment of gout. RESULTS AND CONCLUSIONS Asymptomatic hyperuricemia is generally not an indication for pharmacological intervention to lower the uric acid level. When gout is clinically manifest, however, acute treatment of gouty arthritis should be followed by determination of the cause of hyperuricemia, and long-term treatment to lower the uric acid level is usually necessary. The goal of treatment is to diminish the body's stores of uric acid crystal deposits (the intrinsic uric acid pool) and thereby to prevent the inflammatory processes that they cause, which lead to structural alterations. In the long term, serum uric acid levels should be kept below 360 micromol/L (6 mg/dL). The available medications for this purpose are allopurinol and various uricosuric agents, e.g., benzbromarone. There is good evidence to support the treatment of gouty attacks by the timely, short-term use of non-steroidal anti-inflammatory drugs (NSAID), colchicine, and glucocorticosteroids.
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Affiliation(s)
- Anne-Kathrin Tausche
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus an der TU Dresden, Dresden, Germany.
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Wunderlich C, Schober K, Schmeisser A, Heerwagen C, Tausche AK, Steinbronn N, Brandt A, Kasper M, Schwencke C, Braun-Dullaeus RC, Strasser RH. The adverse cardiopulmonary phenotype of caveolin-1 deficient mice is mediated by a dysfunctional endothelium. J Mol Cell Cardiol 2008; 44:938-47. [PMID: 18417152 DOI: 10.1016/j.yjmcc.2008.02.275] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 02/18/2008] [Accepted: 02/20/2008] [Indexed: 11/20/2022]
Abstract
Recently generated caveolin-1 deficient mice (cav-1(-/-)) display several physiological alterations such as severe heart failure and lung fibrosis. The molecular mechanisms how the loss of caveolin-1 (cav-1) mediates these alterations are currently under debate. A plethora of studies support a role of cav-1 as a negative regulator of endothelial nitric oxide synthase (eNOS). Accordingly, constitutive eNOS hyperactivation was observed in cav-1(-/-). Given the hyperactivated eNOS enzyme we hypothesized that disturbed eNOS function is involved in the development of the cardiopulmonary pathologies in cav-1(-/-). The present study argues that loss of cav-1 results in enhanced eNOS activity but not in increased vascular tetrahydrobiopterin (BH(4)) levels (which acts as an essential eNOS cofactor) thereby causing a stoichiometric discordance between eNOS activity and BH(4) sufficient to cause dysfunctional eNOS signaling. The resultant oxidative stress is largely responsible for major cardiac and pulmonary defects observed in cav-1(-/-). BH(4) donation to cav-1(-/-) led to a normalized BH(4)/BH(2) ratio, to reduced oxidant stress, to substantial improvements of both systolic and diastolic heart function and to marked amelioration of the impaired lung phenotype. Notably, the antioxidant tetrahydroneopterin which is not essential for eNOS function showed no relevant effect. Taken together these novel findings indicate that dysfunctional eNOS is of central importance in the genesis of the cardiopulmonary phenotype of cav-1(-/-). Additionally, these findings are generally of paramount importance since they underline the deleterious role of an uncoupled eNOS in cardiovascular pathology and they additionally suggest BH(4) as an effective cure.
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Affiliation(s)
- Carsten Wunderlich
- University of Technology Dresden, Department of Medicine and Cardiology, Medical Clinic, Fetscherstr. 76, Dresden 01307, Germany.
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Affiliation(s)
- C Wunderlich
- Department of Cardiology and medicine, Technical University of Dresden, Dresden, Germany
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Tausche AK, Sebastian G. Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrix. Int Wound J 2006; 2:253-7. [PMID: 16618330 PMCID: PMC7951749 DOI: 10.1111/j.1742-4801.2005.00120.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A case study reporting on the successful treatment of a patient affected by a basal cell carcinoma is submitted. Because the carcinoma had infiltrated deeply, a wide excision was necessary, including the removal of bone tissue. The deep tissue defect was treated with PROMOGRAN* Matrix, a protease-modulating matrix, to promote granulation and ensure that the skin graft do survive and heal successfully. In this case study, a rapid development of granulation tissue on the exposed surface of the bone was observed. The benefits of the dressing enabled a successful split-thickness skin grafting to be carried out which gave very good aesthetic and functional results.
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Affiliation(s)
- Anne-Kathrin Tausche
- Section of Internal Medicine, Department of Rheumatology, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, D-01307 Dresden, Germany.
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Abstract
In our modern society hyperuricemia is one of the most frequent metabolism disturbances. So far, every fourth man and every tenth woman suffer from an asymptomatic or a symptomatic hyperuricemia named gout. Mostly, over nutrition and malnutrition as well as other secondary factors with a genetically determined renal secretion disturbance of uric acid lead to an increase of serum uric acid. By deposition of uric acid crystals in tissues with intermittent immunologic activation of inflammation cells a manifestation of gout can be seen. The clinical image of gout varies widely. It may manifest as acute or chronic arthritis, tophi on the skin, subcutaneous tissue and the skeletal system as well as urate nephropathy. To eliminate the consequences of hyperuricemia in the long term, apart from a thorough anamnesis of nutritional habits a general examination of metabolic parameters is necessary to exclude a metabolic syndrome and other causes for a secondarily caused hyperuricemia. As gout is very often primarily caused by a renal secretion disturbance of uric acid special diagnostics should be done. Basing on literature research and inclusion of experts opinions this article represents the therapeutically options in treatment of hyperuricemia and gout with their resulting side effects and contraindications.
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Affiliation(s)
- A K Tausche
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III am Universitätsklinikum Carl Gustav Carus der TU Dresden
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Graessler J, Graessler A, Unger S, Kopprasch S, Tausche AK, Kuhlisch E, Schroeder HE. Association of the human urate transporter 1 with reduced renal uric acid excretion and hyperuricemia in a German Caucasian population. ACTA ACUST UNITED AC 2006; 54:292-300. [PMID: 16385546 DOI: 10.1002/art.21499] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Human urate transporter 1 (hURAT1) is a member of the organic anion transporter family (SLC22A12) that mainly regulates tubular urate reabsorption. Loss-of-function mutations result in idiopathic hypouricemia. The present case-control study was designed to analyze whether hURAT1 might also be a candidate gene for hyperuricemia with primary reduced renal urate excretion. METHODS DNA samples from 389 individuals with reduced fractional excretion of uric acid (FEUA) (< or =6.5%) and from 263 controls (FEUA >6.5%) were sequenced. Genotype frequencies between groups were compared by Cochran-Armitage trend test. RESULTS Significantly different genotype distributions could be demonstrated for the -788 T >A (promoter; P = 0.014), the C258T (exon 1; P = 0.006), and the C426T (exon 2; P = 0.0002) polymorphisms, but not for the T1309C (exon 8) and the +18 C >T (intron 9) polymorphisms. The strongest association with reduced FEUA was observed for the C426T polymorphism, with odds ratios (ORs) of 1.59 and 2.54 (P = 0.0002) for the CT and TT genotypes, respectively. Adjusted values for FEUA in the C426T genotype, were significantly reduced decreasing to 7.3%, 6.7%, and 6.3% in individuals with the CC, CT, and TT genotypes, respectively (P = 0.004). Haplotypes were constructed from the -788 T >A, C258T, and C426T polymorphisms. Individuals carrying at least 1 ACT haplotype (n = 349) had a significantly higher risk for reduced FEUA than individuals without any ACT haplotype (n = 303) (OR 1.39, P = 0.041). CONCLUSION These results indicate that polymorphisms in the N-terminus of the hURAT1 gene were significantly associated with reduced renal uric acid excretion. The main regulating factor seems to be located close to the C426T polymorphism or is in strong linkage disequilibrium.
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Affiliation(s)
- Juergen Graessler
- Department of Pathological Biochemistry, Clinic of Internal Medicine III, Carl Gustav Carus Medical School, University of Technology-Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
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Tausche AK, Conrad K, Seidel W, Roch B. Anti-midbody antibodies as a possible predictive factor for a special limited or abortive form of systemic sclerosis? Ann Rheum Dis 2005; 64:1237-8. [PMID: 16014688 PMCID: PMC1755607 DOI: 10.1136/ard.2004.034116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tausche AK, Richter K, Grässler A, Hänsel S, Roch B, Schröder HE. Severe gouty arthritis refractory to anti-inflammatory drugs: treatment with anti-tumour necrosis factor alpha as a new therapeutic option. Ann Rheum Dis 2004; 63:1351-2. [PMID: 15361402 PMCID: PMC1754753 DOI: 10.1136/ard.2003.015743] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tausche AK, Skaria M, Böhlen L, Liebold K, Hafner J, Friedlein H, Meurer M, Goedkoop RJ, Wollina U, Salomon D, Hunziker T. An autologous epidermal equivalent tissue-engineered from follicular outer root sheath keratinocytes is as effective as split-thickness skin autograft in recalcitrant vascular leg ulcers. Wound Repair Regen 2003; 11:248-52. [PMID: 12846911 DOI: 10.1046/j.1524-475x.2003.11403.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The outer root sheath of hair follicles plays an important role in epidermal regeneration in vivo. Keratinocytes isolated by explantation of outer root sheath tissue have extensive proliferative capacity irrespective of donor age, which probably depends on pluripotent epithelial stem cells residing in the outer root sheath. These keratinocytes can be organotypically grown to epidermal equivalents in vitro. We report here that in a multicenter, randomized phase II study, EpiDex trade mark, a tissue-engineered, fully differentiated autologous epidermal equivalent derived from keratinocytes of the outer root sheath of plucked anagen hair follicles, is as effective as split-thickness skin autografting in the promotion of healing and complete closure of recalcitrant vascular leg ulcers.
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Affiliation(s)
- Anne-Kathrin Tausche
- Klinik und Poliklinik für Dermatologie des Universitätsklinikum Carl Gustav Carusa, Technische Universität Dresden, Germany
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