Frequency and risk factors of gout flares in a large population-based cohort of incident gout

Rothenbacher, Dietrich; Primatesta, Paola; Ferreira, Alberto; Soriano, Lucía Cea; Rodrı́guez, Luis A. Garcı́a

doi:10.1093/rheumatology/keq363

Cited by 103 publications

(79 citation statements)

References 17 publications

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“…Encouragement to treat patients with high SUA level earlier is based on studies showing an association of high uricaemia with increased flare frequency 125–127. Similarly, early treatment in patients with comorbidities is supported by a study of a large cohort of gout patients finding hypertension, ischaemic heart disease and CKD all associated with increased risk of recurrence of flare 128. Young age at gout onset is also a marker of gout severity129 and should also prompt earlier treatment.…”

Section: Resultsmentioning

confidence: 98%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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BACKGROUND:\ud New 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.\ud METHODS:\ud \ud The 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.\ud RESULTS:\ud \ud Three 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.\ud CONCLUSIONS:\ud These 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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Section: Resultsmentioning

confidence: 98%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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“…The molecular and cellular responses in the acute gout flare are well characterised and stereotyped, with the central initiation role of NLRP3 inflammasome activation and release of mature IL-1β by resident macrophages, with an amplification phase characterised by neutrophil chemotaxis and release of additional proinflammatory mediators 18 19. After presentation of the first gout flare, further flares frequently occur,20 and in the presence of untreated hyperuricaemia, these flares become more frequent, prolonged and polyarticular over time. In addition to the recurrent acute inflammatory flares, chronic gouty arthritis and gouty tophi may also develop, with risk of bone and joint damage 21.…”

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confidence: 99%

Hyperuricaemia and gout: time for a new staging system?

2014

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The current widely used clinical staging system for hyperuricaemia and gout describes the symptomatology of gout, but does not capture key aspects of the pathological basis of the disease. We propose a new clinical staging system. Stage A: hyperuricaemia, but without evidence of monosodium urate (MSU) crystal deposition or symptoms of gout. Stage B: MSU crystal deposition by microscopy or advanced imaging, but without signs or symptoms of gout. Stage C: MSU crystal deposition with prior or current symptoms of acute gout flares. Stage D: advanced gout requiring specialist interventions. This proposed new staging system provides a clear focus on gout as a chronic disease of MSU crystal deposition, and provides a rational framework to test the role of screening and treatment of asymptomatic disease.

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“…Alcohol consumption is a well-recognized risk factor for hyperuricemia and gout (13)(14)(15). Recent studies have clarified that the impact on the risk of gout varies depending on the type and amount of alcoholic beverage consumed (14).…”

Section: N Resultsmentioning

confidence: 99%

Lifestyle and dietary habits of patients with gout followed in rheumatology settings

et al. 2016

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summary Diet and lifestyles modification are core aspects of the non-pharmacological management of gout, but a poor consistency with suggested guidelines is reported. This study aimed to investigate dietary and lifestyle habits of patients with gout followed in rheumatology settings. Data were retrieved from the baseline dataset of the KING study, a multicentre cohort study of patients with gout followed in rheumatology settings. Dietary habits were assessed with the Italian National Institute of Statistics (ISTAT) food-frequency questionnaire and compared with reported data about general population. The relative increase of exposure was estimated by standardized prevalence ratios adjusted for gender, age and geographical distribution. The study population included 446 patients, with a mean age of 63.9 years and a M/F ratio of 9:1. Compared to the Italian population, gouty patients showed a higher prevalence of obesity [1.82 (1.52-2.18)] and a higher consumption of wine [1.85 (1.48-2.32)] and beer [2.21 (1.68-2.90)], but a lower prevalence of smoking and a lower intake of liquor. They showed a lower intake of red meat [0.80 (0.71-0.91)], but a similar intake of other tested dietary factors. Gouty patients' lifestyle is still partially different from the recommended.

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Frequency and risk factors of gout flares in a large population-based cohort of incident gout

Abstract: Gout flares are relatively common among patients with gout. Some of the underlying cardiometabolic comorbid conditions are themselves independent risk factors for flares, which further contribute to the complexity of treatment of gout flares.

Cited by 103 publications

References 17 publications

2016 updated EULAR evidence-based recommendations for the management of gout

2016 updated EULAR evidence-based recommendations for the management of gout

Hyperuricaemia and gout: time for a new staging system?

Lifestyle and dietary habits of patients with gout followed in rheumatology settings

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