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11. Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout

Author

Dalbeth Nicola, House Meaghan E, Horne Anne, Petrie Keith J, McQueen Fiona M, and Taylor William J

Subjects
Gout, Urate, Target, Allopurinol, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Long term serum urate (SU) lowering to a target of Methods Patients with gout for Results Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration Conclusions ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout.

Published
2012
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14. Tophus Measurement as an Outcome Measure for Clinical Trials of Chronic Gout: Progress and Research Priorities

Author

Dalbeth, Nicola, McQueen, Fiona M, Singh, Jasvinder, Macdonald, Patricia, Edwards, Larry, Schumacher, H Ralph, Simon, Lee, Stamp, Lisa, Neogi, Tuhina, Gaffo, Angelo, Khanna, Puja, Becker, Michael, Dabbous, Omar, and Taylor, William J

Subjects
medicine.medical_specialty, Gout, Immunology, MEDLINE, Appropriate use, Sensitivity and Specificity, Article, Gout Suppressants, Rheumatology, Chronic gout, Outcome Assessment, Health Care, medicine, Humans, Immunology and Allergy, Medical physics, Sensitivity to change, Reliability (statistics), Ultrasonography, Clinical Trials as Topic, business.industry, Outcome measures, Tophus, Reproducibility of Results, medicine.disease, Clinical trial, Treatment Outcome, Chronic Disease, Physical therapy, Joints, business
Abstract

Despite the recognition that tophus regression is an important outcome measure in clinical trials of chronic gout, there is no agreed method of tophus measurement. A number of methods have been used in clinical trials of chronic gout, from simple physical measurement techniques to complex advanced imaging methods. This paper summarises the methods of tophus measurement that have been used and discusses the properties of these methods. Physical measurement using Vernier calipers fulfils most aspects of the Outcomes Measures in Rheumatology (OMERACT) filter. Rigorous testing of the complex methods, particularly with respect to reliability and sensitivity to change is needed, to determine the appropriate use of these methods. Further information is also required regarding which method of physical measurement is best for use in future clinical trials. The need to develop and test a patient reported measure of tophus burden is also highlighted.

Published
2011

27. MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage

Author

Tan, Yu M, primary, Østergaard, Mikkel, additional, Doyle, Anthony, additional, Dalbeth, Nicola, additional, Lobo, Maria, additional, Reeves, Quentin, additional, Robinson, Elizabeth, additional, Taylor, William J, additional, Jones, Peter B, additional, Pui, Karen, additional, Lee, Jamie, additional, and McQueen, Fiona M, additional

Published
2009
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29. What is MRI bone oedema in rheumatoid arthritis and why does it matter?

Author

McQueen, Fiona M and Ostendorf, Benedikt

Subjects
musculoskeletal diseases, Arthritis, Rheumatoid, Bone Marrow, Animals, Edema, Humans, Review, Bone Diseases, Magnetic Resonance Imaging
Abstract

MRI bone oedema occurs in various forms of inflammatory and non-inflammatory arthritis and probably represents a cellular infiltrate within bone. It is common in early rheumatoid arthritis and is associated with erosive progression and poor functional outcome. Histopathological studies suggest that a cellular infiltrate comprising lymphocytes and osteoclasts may be detected in subchondral bone and could mediate the development of erosions from the marrow towards the joint surface. There is emerging evidence from animal models that such an infiltrate corresponds with MRI bone oedema, pointing towards the bone marrow as a site for important pathology driving joint damage in rheumatoid arthritis.

Published
2006

30. Exploratory Study of Radiographic Change in Patients With Tophaceous Gout Treated With Intensive Urate-Lowering Therapy.

Author

Dalbeth, Nicola, Doyle, Anthony J., McQueen, Fiona M., Sundy, John, and Baraf, Herbert S. B.

Abstract

Objective Tophi are strongly associated with structural damage in gout, and urate-lowering therapy reduces tophus size. Pegloticase leads to dramatic reductions in serum urate and subcutaneous tophi in treatment responders. The aim of this analysis was to examine whether profound urate lowering can alter radiographic findings in gout. Methods Serial plain radiographs of the hands and feet were obtained from 8 patients with tophaceous gout treated with pegloticase. Radiographs were scored for erosion and joint space narrowing (JSN) according to the gout-modified Sharp/van der Heijde method. Scorers were blinded to each other's scores and to the clinical characteristics of the patients (including the clinical response to pegloticase). A detailed qualitative site-by-site analysis was undertaken to define additional changes observed from baseline. Results All patients experienced a profound urate-lowering response (serum urate level <1 mg/dl) during pegloticase treatment. For the entire group, the median total radiographic scores reduced from 69.25 (range 1.5-138) at baseline to 57.25 (range 1.5-110) at 12 months ( P = 0.02). Median erosion scores reduced over 1 year ( P = 0.008), but JSN scores did not change ( P = 0.50). Further reductions were observed in total scores and erosion scores in 5 patients with 24-month followup films (one-way analysis of variance P = 0.009 for total score, 0.02 for erosion, and 0.95 for JSN). Qualitative site-by-site analysis identified regression of soft tissue masses, increased sclerosis, and filling in of erosions in the followup films. Conclusion This exploratory study suggests that profound urate lowering can lead to improvement in structural damage, particularly bone erosion, in patients with tophaceous gout. [ABSTRACT FROM AUTHOR]

Published
2014
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