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Aim:
To assess the epidemiology of inpatient gout in Australia and New Zealand during the years 2009-2014.
Methods:
Using the Health Roundtable Limited (HRT) dataset, all patients with a coded ICD10 primary or secondary discharge diagnosis of gout from a HRT participating Australian or New Zealand hospital between the years 2009 and 2014 were id...
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In this systematic literature review, we update imaging modalities in gout, with a focus on newer technologies, particularly Dual-energy computed tomogra-phy (DECT). Conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and dual-energy CT (DECT) have been used to evaluate different stages an...
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Citations
... 1 In Australia, the prevalence of gout ranges from 1.6% 2 to 6.8%. 3 The incidence of gout is rising worldwide, including in both developing and, more dramatically, in developed nations. 2,4,5 Treatment for acute gout flares focuses on alleviating the pain due to the intense inflammation and includes short courses of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine or glucocorticosteroids. 6 6 Life-long treatment with ULT is recommended. Co-prescription of low dose colchicine or NSAIDs for 6 months on initiation of ULT is recommended to prevent a paradoxical increase in gout flares related to sudden ULT-induced reduction in SU. 7,8 Available ULTs in Australia include xanthine oxidoreductase inhibitors (allopurinol, febuxostat) and uricosuric agents (probenecid). ...
Aim:
Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate-lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia.
Methods:
A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. Allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan-Meier curves were used to examine persistence, while cox regression analyses were used to examine the influence of gender, concomitant colchicine, and age.
Results:
The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing the allopurinol 300 mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% CI 4.76-5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co-prescribed colchicine.
Conclusion:
Persistence with allopurinol was poor. More effective methods targeting prescribers, patients, and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.
... Type 2 diabetes is often associated with other diseases, such as cardiovascular disease (Chatterjee et al., 2017) and gout (Robinson et al., 2017). This study also explored the relationship of metformin data with the consumption data of cardiovascular and gout markers as well as 47 other health and lifestyle biomarkers in the same catchments. ...
Metformin is the most widely used drug to treat type 2 diabetes. Monitoring spatial patterns of metformin use could provide new insights into treatment of type 2 diabetes and the distribution among populations. This study applied a wastewater-based epidemiological (WBE) approach to estimate metformin use in different populations across Australia and compared these estimates with traditional approaches of surveys and prescription data. Twenty-four-hour influent samples were collected from 75 wastewater treatment plants (WWTPs) across Australia in 2016 and analysed for metformin. Metformin was detected in all samples ranging in concentration from 8.2 to 191 µg/L (median 58 µg/L). Concentrations were converted to population-weighted average consumption at the national level, resulting in an average consumption of 28.6 grams/day/1000 people across Australia, which was within 7% of estimates from national prescription statistics. In addition, results for five out of seven states had an estimated prevalence of type 2 diabetes within 20% compared to the traditional epidemiology surveys. Spatial patterns were also observed between urban and rural settings, with higher consumption rates of metformin found in Major Cities (22.5 ±10.9 g/d/1000 people) and Inner Regional cities (25.4±13.4 g/d/1000 people) than in Outer Regional (17.0±8.1 g/d/1000 people) and Remote areas (15.1±7.4 g/d/1000 people). Consumption estimates were also correlated against socioeconomic factors of the specific catchment areas. Greater metformin use was correlated with populations of lower education and income levels, while positive correlations were found between metformin consumption and consumption of allopurinol, caffeine and venlafaxine. Our study provides more evidence on the distribution of metformin use across Australia, which can be used to develop public health strategies to reduce the overall burden of type 2 diabetes in specific regions.
... A study from the USA found that 13% of hospitalizations were in the intensive care setting in a survey of 454 hospitalizations in patients with gout [3]. According to a study from Australia and New Zealand, cardiovascular disease, infection, stroke, and arrhythmia were the most common primary admission diagnoses in hospitalized patients with gout flare as a complicating diagnosis [4]. ...
Gout is the most common form of crystal-induced arthritis. Gout flares are a frequent complication during hospital admissions, including the critical care settings. Inpatient gout flare is a multifactorial event influenced by a combination of gout-and hospitalization-related factors. Several factors can trigger gout flares through altered renal urate handling, serum urate fluctuation, and macrophage priming. Early detection of gout flares can aid in the reduction of unnecessary antibiotics use, laboratory investigations, and diagnostic procedures, leading to improved hospital outcomes. Identification of crystals in synovial fluid or tophi is the gold standard for gout diagnosis, but the procedure is sometimes contraindicated in the critical care setting. Hospitalized patients with gout usually have multiple comorbidities contributing to challenges in the management of gout flares, which are not present in outpatient or noncritical inpatient settings. In this review, we discuss the unique characteristics and impact of gout flares in the critical care setting, as well as the diagnostic challenges and options for the treatment of gout flares and hyperuricemia in this setting.
... 5,6 Individuals with gout are more likely to possess various comorbidities, with increased prevalence of obesity, hypertension, diabetes, cardiovascular disease, chronic kidney disease and dyslipidaemia among those with gout compared to the general population. 7 The deposition of monosodium urate (MSU) crystals is dependent on elevated blood uric acid concentration. Uric acid is the final breakdown product of the purine nucleotides, guanine and adenine. ...
Gout is a form of arthritis, resulting from an inflammatory reaction to the deposition of monosodium urate (MSU) crystals in the synovial fluid of the joint space. It is characterised by periods of acute inflammation in the affected joint, or joints (known as gout flares), separated by asymptomatic periods. There seems to be substantial overlap between environmental triggers of gout flares and common environmental modifiers (diet, pharmaceuticals, and stress) of epigenetic markers (DNA methylation, histone modifications, and ncRNA). Very few studies have looked at whether environment is influencing gout through epigenetic mechanisms. The pathogenesis of gouty inflammation is well understood but understanding the variation of response to hyperuricaemia in terms of gout flare initiation is less well known. In this review, we will examine the potential of epigenomics in understanding how gout flares may occur, both in terms of development of hyperuricaemia and the inflammatory response. Looking at the epigenome and its intersection with lifestyle could help identify new targets and strategies for effective management of gout flares.
... Für die Differenzialdiagnose ist wichtig, dass bei einer akuten Arthritis im Zusammenhang mit einer COVID-19-Erkrankung ein Gelenkpunktat polarisationsoptisch auf Kristalle untersucht wird, da akute Krankheiten, einschließlich Infektionen, bekannte Risikofaktoren für Gicht-und Pseudogichtanfälle sind [23] und solche Fälle auch im Rahmen der COVID-19-Pandemie beschrieben wurden [24]. ...
Zusammenfassung
Es werden 13 Fallberichte einer reaktiven Arthritis im Zusammenhang mit einer Coronavirus-Krankheit-2019 (COVID‑19) referiert. Männer sind häufiger betroffen als Frauen. Die Arthritis manifestiert sich 4 bis 44 Tage nach der Infektion bzw. dem Auftreten der COVID‑19-Symptome. Die akute Arthritis ist monoartikulär oder oligoartikulär. Nur einer von 7 untersuchten Patienten war Humanes-Leukozyten-Antigen(HLA)-B27-positiv. Eine direkte virale Infektion des Gelenkes mit „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV‑2) wurde in der Synovialflüssigkeit nicht nachgewiesen und in der Synovialis nicht untersucht. Die Arthritis wurde mit nichtsteroidalen Antirheumatika und/oder intraartikulären oder systemischen Kortikosteroiden erfolgreich behandelt. Die Pathogenese der post-COVID‑19-reaktiven Arthritis ist ungeklärt.
... Importantly, four cases of acute arthritis developed during COVID-19 admissions have been reported, all due to crystalproven flares (gout and calcium pyrophosphate disease) [72]. Therefore, during the SARS-CoV-2 pandemic, it remains essential to check every case of acute arthritis by polarized microscopy since acute illnesses, including infections, are wellestablished risk factors for gout and pseudogout flares [73]. ...
Purpose of Review
This article presents a comprehensive narrative review of reactive arthritis (ReA) with focus on articles published between 2018 and 2020. We discuss the entire spectrum of microbial agents known to be the main causative agents of ReA, those reported to be rare infective agents, and those reported to be new candidates causing the disease. The discussion is set within the context of changing disease terminology, definition, and classification over time. Further, we include reports that present at least a hint of effective antimicrobial therapy for ReA as documented in case reports or in double-blind controlled studies. Additional information is included on microbial products detected in the joint, as well as on the positivity of HLA-B27.
Recent Findings
Recent reports of ReA cover several rare causative microorganism such as Neisseria meningitides, Clostridium difficile, Escherichia coli, Hafnia alvei, Blastocytosis, Giardia lamblia, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica/dispar, Strongyloides stercoralis, β-haemolytic Streptococci, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mycobacterium bovis bacillus Calmette-Guerin, and Rickettsia rickettsii. The most prominent new infectious agents implicated as causative in ReA are Staphylococcus lugdunensis, placenta- and umbilical cord–derived Wharton’s jelly, Rothia mucilaginosa, and most importantly the SARS-CoV-2 virus.
Summary
In view of the increasingly large spectrum of causative agents, diagnostic consideration for the disease must include the entire panel of post-infectious arthritides termed ReA. Diagnostic procedures cannot be restricted to the well-known HLA-B27-associated group of ReA, but must also cover the large number of rare forms of arthritis following infections and vaccinations, as well as those elicited by the newly identified members of the ReA group summarized herein. Inclusion of these newly identified etiologic agents must necessitate increased research into the pathogenic mechanisms variously involved, which will engender important insights for treatment and management of ReA.
... Ahmed et al. measured oxypurinol as a disease biomarker in wastewater to estimate the prevalence of treated gout in Australia (Ahmed et al., 2020). Gout prevalence was estimated to be 2.7% in this study, which was comparable to estimates from other epidemiologic studies (Proudman et al., 2019;Robinson et al., 2017). However, while defined daily doses (DDD) provided a good basis for comparing the consumption of pharmaceuticals between different countries, it might be more challenging to use it to estimate the prevalence of disease because of variations in doses prescribed per patient. ...
The medical and societal consequences of the misuse of pharmaceuticals clearly justifies the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals.
WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised loads or defined daily doses of pharmaceuticals were selected.
We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possiblity of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal comsumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.
... Moreover, our gender data for participants was more significant for females than males. This finding was contradictory to a previous study in which males were dominant among chronic gout patients [70], including in Northern Celebes, Indonesia [8]. In terms of gender issues in this study, it was also reported in the previous study that woman were proven to be the majority of the world's passive smokers [71]. ...
To analyze the association between smoking status (active smoking and exposure to Second-Hand Smoking (SHS)) and the synergistic effect of smoking status and BMI with gout risk, a community-based case-control design was undertaken among 385 participants, including 304 healthy controls and 81 gout patients from seven community health services. Adjusted Odd Ratios (AORs) and 95% Confidence Interval (CIs) of gout for active smoking and SHS were 3.26 (95% CI = 1.07~9.90) and 4.67 (95% CI = 2.18~10.00) compared to non-smokers. Time-dependent manner of active smoking and SHS significantly increased gout risk with AORs and 95% CIs of 5.95 (1.41~25.03) and 10.12 (3.51~29.14). Dose-dependency of active smokers and SHS showed AORs and 95% CIs of 5.15 (1.28~20.63) and 4.37 (1.33~14.28). Smoking 20 cigarettes (one pack) per day for one year is equivalent to one pack-year. Active smoking >20 pack-year and SHS > 26.5 pack-year increased gout risk with AORs and 95% CIs of 7.18 (1.53~33.67) and 9.95 (3.64~27.22). Participants who smoked (active smoking and SHS) and with Body Mass Index (BMI) of > 24.9 kg/m2 synergistically increased gout risk, with an AOR of 9.65 and 95% CI of 3.25~28.65, compared to BMI ≤ 24.9 kg/m2 and non-smoker. Smoking status (active smoking and SHS) and the synergistic effect of smoking status and BMI increased gout risk in Indonesia.
... Seasonally, allopurinol consumption in autumn and winter were significantly lower than in spring (p = 0.01; p = 0.04, respectively for ANOVA) (Fig. 2). One Australian study reported that there was no influence of season on the pattern of gout patient hospital admissions (Robinson et al., 2017). Other studies focussed on individual testing have found higher incidence of gout in spring which supports our findings via wastewater. ...
Gout is a rheumatic arthritis disease which poses a health burden. Monitoring the prevalence of gout is key to reduce the community burden of gout disease and associated health costs. Allopurinol has been used as a first line gout preventive medication in Australia which is metabolised into oxypurinol and excreted in urine. Wastewater-based epidemiology (WBE) was applied to estimate temporal trends of gout prevalence in an Australian community over eight-years via the quantification of oxypurinol in wastewater. A total of 180 wastewater samples collected between 2012 and 2019 were analysed for oxypurinol to estimate allopurinol consumption in a community in South East Queensland, Australia. Annual gout prevalence was estimated by daily defined doses (DDD) consumed and ranged from 24 to 32 DDD/day/1000, an equivalent gout prevalence of 2.3 to 3.2% over the eight-year period. A statistically significant increase in allopurinol consumption was observed over the period (Slope = 0.094, p = 0.0001), equating to year-on-year increases in gout prevalence of 3.6% per year. To the best of our knowledge, this is the first long-term gout prevalence study using wastewater, adding epidemiological and public health insights in the gout research field.
... DEAR EDITOR, Cardiac/renal disease, commonly associated with gout, and infections were the leading causes of nongout hospitalizations in people with gout in a 4-year Australian/New Zealand study [1]. In a US national study, 98% of hospitalizations in 2016 in people with gout were for non-gout diagnoses [2]. ...
... DEAR EDITOR, The lockdown measures imposed in multiple countries by healthcare authorities in response to the coronavirus disease 2019 (COVID-19) pandemic profoundly transformed the daily routine of individuals [1]. These disruptive effects are particularly worth evaluating in patients with FM, whose well-being is influenced by changes in the physical, psychological and behavioural domains [2]. ...
