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Compare characteristics, sex differences, and management of gout in Sweden and the UK. The results from two separate primary care gout surveys from Sweden and the UK were compared. Participants aged ≥18 years with gout were sent a questionnaire asking about lifestyle, gout characteristics, uratelowering therapy (ULT), comorbidities, disability, and disease impact. For sex comparison, participants were pooled across countries. In total, 784 (80% male) participants from Sweden and 500 (87% male) from the UK were included. Swedish patients were significantly older at gout onset, mean (SD) age 72 (12) versus 63 (13) years, (p<0.0001), with more comorbidities, and more frequent use of ULT (48% vs 35%, p=0.0005, age-adjusted). Use of alcohol and diuretics was significantly more common among UK patients, who also reported a higher number of gout flares, mean (SD) 2.2 (1.7) versus 1.6 (3.6), (p=0.003) age-adjusted. Females with gout were older at gout onset, mean (SD) age 67 (13) versus 56 (15), (p<0.0001), more often obese, and reported higher use of diuretics. Furthermore, females reported greater impact of gout, more pain and physical limitations, whereas no sex differences were seen in ULT or flares. In the UK, gout was more frequently associated with modifiable risk factors. People with gout in Sweden were more commonly taking ULT and had lower frequency of gout flares and impact of gout. Females with gout more commonly took diuretics, had higher body mass index, and reported greater physical disability, which should be considered when managing gout in women. [ABSTRACT FROM AUTHOR]

Inflammatory joint diseases (IJDs) substantially affect health-related quality of life (HRQoL). We aimed to compare HRQoL between patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS): (i) overall; (ii) stratified by sex; and (iii) between women and men with the same IJD diagnosis. A survey including the RAND36-Item Health Survey for assessing HRQoL was sent to patients with a diagnosis of gout, PsA, RA, or AS, registered at a rheumatology clinic or primary care centre during 2015–2017. HRQoL was compared across IJDs. Because of age differences between diagnoses, age-matched analyses were performed. In total, 2896/5130 (56.5%) individuals responded to the questionnaire. Of these, 868 had gout, 699 PsA, 742 RA, and 587 AS. Physical component summary (PCS) scores were more affected than mental component summary (MCS) scores for all diagnoses (PCS range: 39.7–41.2; MCS range: 43.7–48.9). Patients with gout reported better PCS scores than patients with PsA, RA, and AS, who reported similar scores in age-matched analysis. MCS scores were close to normative values for the general population and similar across IJDs. When comparing women and men with respective IJDs, women reported worse PCS (range, all IJDs: 34.5–37.4 vs 37.5–42.5) and MCS (PsA: 44.0 vs 46.8; RA: 46.1 vs 48.7) scores. We found that patients with gout reported better PCS scores than patients with other IJDs, for whom the results were similar. Women reported overall worse PCS and MCS scores than men. [ABSTRACT FROM AUTHOR]

This study aimed to describe the incidence and prevalence of gout, describe the use of allopurinol among prevalent gout cases, and determine persistence with allopurinol and degree of compliance with treat-to-target recommendations before and after the publication of Swedish national guidelines in 2016. Prospectively registered data on gout diagnoses and allopurinol prescriptions were used to calculate incidence and prevalence, and the proportion of prevalent patients on allopurinol. Gout patients starting allopurinol during 2013–2015 versus 2016–2018 were compared regarding persistence and compliance with treat-to-target principles. The incidence of gout was 221–247 per 100 000 person-years during 2014–2019, prevalence in 2018 was 2.45%. Among prevalent cases, the proportion on allopurinol ranged from 21% to 25%. Allopurinol persistence was better for individuals starting therapy during 2016–2018 compared with 2013–2015 (45% vs 39%, p = 0.031), as were several outcomes related to treat-to-target principles, e.g. measuring baseline serum urate (SU) (84% vs 77%, p < 0.001), follow-up SU (50% vs 36%, p < 0.001), and the proportion of patients reaching an SU level < 360 µmol/L (45% vs 30%, p < 0.001). Incidence and prevalence were slightly higher than in previous Swedish reports. Allopurinol use among prevalent gout patients did not increase during 2014–2019. Only a minor improvement in persistence was seen, and a moderate increase in compliance with guidelines, suggesting a need for improved management and extended patient involvement to increase and optimize the use of urate lowering therapy. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the prevalence of cardiovascular risk factors in patients with psoriatic arthritis (PsA) followed at a large Swedish Rheumatology Clinic, and to compare differences in cardiovascular risk factors between men and women with PsA and with the general population.Method: A questionnaire was sent to patients with PsA registered at the Rheumatology Clinic at Sahlgrenska University Hospital, Gothenburg (n = 982). Comparisons with the general population were made using data from the Swedish National Public Health Survey. Descriptive statistics are presented. Body mass index (BMI) was calculated using self-reported height and weight.Results: Overall, 692 (70.6%) of the patients with PsA responded. The mean ± sd age was 55.6 ± 11.4 years and 52% were women. Obesity (BMI ≥ 30 kg/m2) was more prevalent (p < 0.001) in patients with PsA (28.6%) than in matched subjects from the general population (16.3%). Hypertension was also more prevalent (p < 0.001) in PsA (40.3%) than in matched subjects from the general population (24.1%), as was diabetes, with a prevalence of 10.5% in the PsA population compared with 6.2% in matched subjects (p < 0.001).Conclusion: We found obesity to be highly overrepresented in patients with PsA compared with matched subjects from the general population. This difference was particularly seen in women with PsA. Hypertension and ever smoking were also more prevalent in women with PsA compared with matched subjects from the general population. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the incidence of septic arthritis across adult age groups in Västra Götaland Region (VGR) of Sweden, while also comparing disease characteristics among different age groups with hematogenous septic arthritis., Methods: Using ICD-10 codes for septic arthritis from 2016 to 2019, we identified 955 patients in VGR. We reviewed the medical records of 216 adult patients with hematogenous septic arthritis and compared data across age groups., Results: The overall incidence of septic arthritis in adults was 4 per 100,000 persons annually, rising to 14 per 100,000 in those ≥80 years. The median age of the 216 patients was 71. The comparison across age groups (18-64, 65-79, and ≥80) showed significantly longer hospital stays and higher mortality rate in the older groups. CRP levels were higher in the middle age group, SF-WBC counts were lower in the youngest age group, and synovial fluid crystals were more common in the oldest. No differences were found in joint involvement or the organisms isolated., Conclusion: The incidence of septic arthritis is 6.5 times higher in patients aged ≥ 80 compared to those under 65, highlighting the need to consider age-related differences in disease management., Competing Interests: The authors declare no conflicts of interest.

Background: Despite accumulating evidence of an association between air pollution and renal disease, studies on the association between long-term exposure to air pollution and renal function are still contradictory. This study aimed to investigate this association in a large population with relatively low exposure and with improved estimation of renal function as well as renal injury biomarkers., Methods: We performed a cross-sectional analysis in the middle-aged general population participating in the Swedish CardioPulmonary bioImaging Study (SCAPIS; n = 30 154). Individual 10-year exposure to total and locally emitted fine particulate matter (PM 2.5 ), inhalable particulate matter (PM 10 ), and nitrogen oxides (NO x ) were modelled using high-resolution dispersion models. Linear regression models were used to estimate associations between exposures and estimated glomerular filtration rate (eGFR, combined creatinine and cystatin C) and serum levels of renal injury biomarkers (KIM-1, MCP-1, IL-6, IL-18, MMP-2, MMP-7, MMP-9, FGF-23, and uric acid), with consideration of potential confounders., Results: Median long-term PM 2.5 exposure was 6.2 µg/m 3 . Almost all participants had a normal renal function and median eGFR was 99.2 mL/min/1.73 m 2 . PM 2.5 exposure was associated with 1.3% (95% CI 0.6, 2.0) higher eGFR per 2.03 µg/m 3 (interquartile range, IQR). PM 2.5 exposure was also associated with elevated serum matrix metalloproteinase 2 (MMP-2) concentration, with 7.2% (95% CI 1.9, 12.8) higher MMP-2 per 2.03 µg/m 3 . There was a tendency towards an association between PM 10 and higher levels of uric acid, but no associations were found with the other biomarkers. Associations with other air pollutants were null or inconsistent., Conclusion: In this large general population sample at low exposure levels, we found a surprising association between PM 2.5 exposure and a higher renal filtration. It seems unlikely that particle function would improve renal function. However, increased filtration is an early sign of renal injury and may be related to the relatively healthy population at comparatively low exposure levels. Furthermore, PM 2.5 exposure was associated with higher serum concentrations of MMP-2, an early indicator of renal and cardiovascular pathology., (© 2024. The Author(s).)

Objective: In this post hoc analysis of a previously published study, we compared cytokines and adipokine levels in women and men with psoriatic arthritis (PsA) at baseline (BL) and 6 months (M6) following a weight loss intervention., Methods: Patients with PsA (n=41) between 25 and 75 years of age, with body mass index (BMI)≥33 kg/m 2 were included in a weight loss intervention with a very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI<40 or ≥40 kg/m 2 . As controls (n=39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the patients with PsA. Cytokines and adipokines were measured at BL and M6., Results: At BL, serum levels of interleukin (IL)-23, leptin and high molecular weight-adiponectin were higher in women with PsA compared with men, whereas serum levels of interferon (IFN)-γ, IL-12/IL-23 p40 and IL-13 were significantly lower in women. Serum IL-23 was significantly reduced at M6 compared with BL in women but not in men with PsA. In women with PsA, the reduction in IL-23 at M6, ∆IL-23, were positively correlated with ∆Disease Activity Score 28 C reactive protein (CRP) (Spearman's correlation (r S )=0.486, p=0.016), ∆CRP (r S =0.468, p=0.021), ∆leptin (r S =0.683, p<0.001) and negatively correlated with ∆total-adiponectin (r S =-0.433, p=0.035). Also in women, ∆Disease Activity in Psoriatic Arthritis was positively correlated with ∆tumour necrosis factor-α (r S =0.417, p=0.034), ∆IL-1β (r S =0.550, p=0.034), ∆IFN-γ (r S =0.414, p=0.035) and ∆leptin (r S =0.410, p=0.038). None of these correlations were significant in men with PsA., Conclusions: Women and men with PsA differed with regard to serum levels of cytokines and adipokines before and after weight loss., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To investigate the risk of first-time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout compared to the general population., Methods: Using register data for the period 2007-2017, we conducted a prospective, population-based cohort with 20,146 patients with incident gout (mean age 65.6 years; 67.4% male) and 83,517 matched population controls without prior history of coronary heart disease. We calculated incidence rates (IRs) and hazard ratios (HRs) adjusted for baseline comorbidities and dispensed prescriptions. In a sensitivity analysis, we included gout cases and controls with no previously diagnosed comorbidity (6,075 cases and 44,091 controls)., Results: The IR of first-time ACS was significantly increased in the gout cohort compared to controls (9.1 versus 6.3 of 1,000 person-years). Unadjusted Cox regression showed that gout patients had higher risk of first-time ACS compared to controls (HR 1.44 [95% confidence interval (95% CI) 1.33-1.56]), with a higher HR in women (HR 1.64 [95% CI 1.41-1.90]) than in men (HR 1.36 [95% CI, 1.24-1.50]). In multivariable analysis, the risk diminished but remained significant (HR 1.15 [95% CI 1.06-1.25]). The risk was similar in the sensitivity analysis (HR 1.20 [95% CI 1.01-1.44]) and still higher in women (HR 1.34 [95% CI 0.86-2.08]) than in men (HR 1.18 [95% CI 0.97-1.44])., Conclusion: Patients with incident gout have a 44% increased risk of first-time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, but there is still a modestly increased risk that may be due to gout-related factors., (© 2022 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: Aims were to examine gender differences in patients with gout with regard to a) self-reported gout severity, b) illness perceptions (IP), c) impact on daily activities and Quality of Life (QoL), d) advice from healthcare professionals, e) having changed dietary- or alcohol habits., Methods: Adult patients with gout identified in primary and secondary care in Sweden between 2015 and 2017 (n = 1589) were sent a questionnaire about demographics, gout disease severity, IP (using the Brief Illness Perception Questionnaire, (B-IPQ)) and disease management. T-tests, Chi square tests, ANalysis Of VAriance (ANOVA) and linear regression models were used for gender comparisons., Results: Eight hundred sixty-eight patients responded to the questionnaire. Women, n = 177 (20%), experienced more severe gout symptoms (p = 0.011), albeit similar frequencies of flares compared to men. Women experienced modest but significantly worse IP with regard to consequences, identity, concerns and emotional response (p < 0.05) as well as daily activities such as sleeping (p < 0.001) and walking (p = 0.042) and QoL (p = 0.004). Despite this and a higher frequency of obesity in women (38 vs 21%, P < 0.001) and alcohol consumption in men (p < 0.001), obese women had received significantly less advice regarding weight reduction (47 vs 65%, p = 0.041) compared to obese men. On the other hand, women reported having acted on dietary advice to a larger degree., Conclusions: Despite only modestly worse gout severity and perception, women appear to have been given less information regarding self-management than men. These gender differences should be given attention and addressed in clinical care., (© 2023. The Author(s).)

Competing Interests: Tahzeeb Fatima, Lennart T.H. Jacobsson, Anna Zettergren, Mats Dehlin, and Ingmar Skoog declare no conflicts of interest. Silke Kern has served as a consultant, on advisory boards for Geras Solutions, unrelated to the results presented in this paper. Kaj Blennow has served as a consultant, on advisory boards, or on data‐monitoring committees for Abcam, Axon, Biogen, JOMDD/Shimadzu, Julius Clinical, Lilly, MagQu, Novartis, Roche Diagnostics, and Siemens Healthineers, and is a cofounder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, all unrelated to the results presented in this paper. Henrik Zetterberg has served on scientific advisory boards for Denali, Roche Diagnostics, Wave, Samumed, SiemensHealthineers, Pinteon Therapeutics, Nervgen, and CogRx; has given lectures in symposia sponsored by Fujirebio, Alzecure, and Biogen; and is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, all unrelated to the results presented in this paper.