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3. Improving adherence to gout therapy: an expert review

Author

Perez-Ruiz F and Desideri G

Subjects
treatment, gout suppressants, persistance, monitoring, Therapeutics. Pharmacology, RM1-950
Abstract

Fernando Perez-Ruiz,1 Giovambattista Desideri2 1Rheumatology Division, Cruces University Hospital, Baracaldo, Spain; 2Geriatric Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy Abstract: Gout is the most common form of inflammatory arthritis and is a considerable burden to patients and health care systems worldwide. Despite its clinical, economic, and social impact, patient persistence and adherence to prescribed urate-lowering therapies (ULT), ranging from 20% to 70%, is considered to be among the poorest of all chronic conditions. The majority of gout patients consequently receive suboptimal benefits of their prescribed pharmacotherapies. As gout is associated with several comorbidities along with an increased risk of premature mortality, achieving improved outcomes through adherence to ULT is crucial. Adherence to medication is complex and multidimensional and includes a combination of treatment-, patient-, and physician-related factors. This review explores the factors related to ULT adherence with the overall aim of helping health care providers better understand the barriers to adherence. Several interventions targeting pharmacists, nurses, and patients are being investigated to improve adherence. Furthermore, enhanced awareness and understanding of the need to treat-to-target in order to improve patient outcomes is needed among health care professionals. Greater understanding of the multidimensional nature of non-adherence can help physicians to treat gout more effectively and empower patients to improve self-management of this long-term disease. Keywords: treatment, gout suppressants, persistence, monitoring

Published
2018

6. OP0008 EULAR RECOMMENDATIONS FOR THE USE OF IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF CRYSTAL-INDUCED ARTHROPATHIES IN CLINICAL PRACTICE

Author

Mandl, P., primary, D’agostino, M. A., additional, Navarro-Compán, V., additional, Gessl, I., additional, Sakellariou, G., additional, Abhishek, A., additional, Becce, F., additional, Dalbeth, N., additional, Ea, H. K., additional, Filippucci, E., additional, Hammer, H. B., additional, Iagnocco, A., additional, De Thurah, A., additional, Naredo, E., additional, Ottaviani, S., additional, Pascart, T., additional, Perez-Ruiz, F., additional, Pitsillidou, I., additional, Proft, F., additional, Rech, J., additional, Schmidt, W. A., additional, Sconfienza, L. M., additional, Terslev, L., additional, Wildner, B., additional, Zufferey, P., additional, and Filippou, G., additional

Published
2023
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7. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease

Author

Abhishek, A, Tedeschi, S, Pascart, T, Latourte, A, Dalbeth, N, Neogi, T, Fuller, A, Rosenthal, A, Becce, F, Bardin, T, Hk, E, Filippou, G, Fitzgerald, J, Iagnocco, A, Lioté, F, Mccarthy, G, Ramonda, R, Richette, P, Sivera, F, Andres, M, Cipolletta, E, Doherty, M, Pascual, E, Perez-Ruiz, F, Alxd, S, Jansen, T, Kohler, M, Stamp, L, Yinh, J, Adinolfi, A, Arad, U, Aung, T, Benillouche, E, Bortoluzzi, A, Dau, J, Maningding, E, Fang, M, Figus, F, Filippucci, E, Haslett, J, Janssen, M, Kaldas, M, Kimoto, M, Leamy, K, Navarro, G, Sarzi-Puttini, P, Scirè, C, Silvagni, E, Sirotti, S, Stack, J, Truong, L, Xie, C, Yokose, C, Hendry, A, Terkeltaub, R, Taylor, W, Choi, H, Tedeschi, SK, Ea, HK, FitzGerald, J, McCarthy, GM, So, ALXD, Jansen, TL, Kohler, MJ, Stamp, LK, Fang, MA, Figus, FA, Navarro, GM, Scirè, CA, Stack, JR, Hendry, AM, Taylor, WJ, Choi, HK, Abhishek, A, Tedeschi, S, Pascart, T, Latourte, A, Dalbeth, N, Neogi, T, Fuller, A, Rosenthal, A, Becce, F, Bardin, T, Hk, E, Filippou, G, Fitzgerald, J, Iagnocco, A, Lioté, F, Mccarthy, G, Ramonda, R, Richette, P, Sivera, F, Andres, M, Cipolletta, E, Doherty, M, Pascual, E, Perez-Ruiz, F, Alxd, S, Jansen, T, Kohler, M, Stamp, L, Yinh, J, Adinolfi, A, Arad, U, Aung, T, Benillouche, E, Bortoluzzi, A, Dau, J, Maningding, E, Fang, M, Figus, F, Filippucci, E, Haslett, J, Janssen, M, Kaldas, M, Kimoto, M, Leamy, K, Navarro, G, Sarzi-Puttini, P, Scirè, C, Silvagni, E, Sirotti, S, Stack, J, Truong, L, Xie, C, Yokose, C, Hendry, A, Terkeltaub, R, Taylor, W, Choi, H, Tedeschi, SK, Ea, HK, FitzGerald, J, McCarthy, GM, So, ALXD, Jansen, TL, Kohler, MJ, Stamp, LK, Fang, MA, Figus, FA, Navarro, GM, Scirè, CA, Stack, JR, Hendry, AM, Taylor, WJ, and Choi, HK

Abstract

Objective: Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. Methods: Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. Results: Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). Conclusion: The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.

Published
2023

10. Gout, Hyperuricemia, and Crystal-Associated Disease Network Consensus Statement Regarding Labels and Definitions for Disease Elements in Gout

Author

Bursill, D, Taylor, W, Terkeltaub, R, Kuwabara, M, Merriman, T, Grainger, R, Pineda, C, Louthrenoo, W, Edwards, N, Andres, M, Vargas-Santos, A, Roddy, E, Pascart, T, Lin, C, Perez-Ruiz, F, Tedeschi, S, Kim, S, Harrold, L, Mccarthy, G, Kumar, N, Chapman, P, Tausche, A, Vazquez-Mellado, J, Gutierrez, M, da Rocha Castelar-Pinheiro, G, Richette, P, Pascual, E, Fisher, M, Burgos-Vargas, R, Robinson, P, Singh, J, Jansen, T, Saag, K, Slot, O, Uhlig, T, Solomon, D, Keenan, R, Scire, C, Biernat-Kaluza, E, Dehlin, M, Nuki, G, Schlesinger, N, Janssen, M, Stamp, L, Sivera, F, Reginato, A, Jacobsson, L, Liote, F, H. -K., E, Rosenthal, A, Bardin, T, Choi, H, Hershfield, M, Czegley, C, Choi, S, Dalbeth, N, Bursill D., Taylor W. J., Terkeltaub R., Kuwabara M., Merriman T. R., Grainger R., Pineda C., Louthrenoo W., Edwards N. L., Andres M., Vargas-Santos A. B., Roddy E., Pascart T., Lin C. -T., Perez-Ruiz F., Tedeschi S. K., Kim S. C., Harrold L. R., McCarthy G., Kumar N., Chapman P., Tausche A. -K., Vazquez-Mellado J., Gutierrez M., da Rocha Castelar-Pinheiro G., Richette P., Pascual E., Fisher M. C., Burgos-Vargas R., Robinson P. C., Singh J. A., Jansen T. L., Saag K. G., Slot O., Uhlig T., Solomon D. H., Keenan R. T., Scire C. A., Biernat-Kaluza E., Dehlin M., Nuki G., Schlesinger N., Janssen M., Stamp L. K., Sivera F., Reginato A. M., Jacobsson L., Liote F., Ea H. -K., Rosenthal A., Bardin T., Choi H. K., Hershfield M. S., Czegley C., Choi S. J., Dalbeth N., Bursill, D, Taylor, W, Terkeltaub, R, Kuwabara, M, Merriman, T, Grainger, R, Pineda, C, Louthrenoo, W, Edwards, N, Andres, M, Vargas-Santos, A, Roddy, E, Pascart, T, Lin, C, Perez-Ruiz, F, Tedeschi, S, Kim, S, Harrold, L, Mccarthy, G, Kumar, N, Chapman, P, Tausche, A, Vazquez-Mellado, J, Gutierrez, M, da Rocha Castelar-Pinheiro, G, Richette, P, Pascual, E, Fisher, M, Burgos-Vargas, R, Robinson, P, Singh, J, Jansen, T, Saag, K, Slot, O, Uhlig, T, Solomon, D, Keenan, R, Scire, C, Biernat-Kaluza, E, Dehlin, M, Nuki, G, Schlesinger, N, Janssen, M, Stamp, L, Sivera, F, Reginato, A, Jacobsson, L, Liote, F, H. -K., E, Rosenthal, A, Bardin, T, Choi, H, Hershfield, M, Czegley, C, Choi, S, Dalbeth, N, Bursill D., Taylor W. J., Terkeltaub R., Kuwabara M., Merriman T. R., Grainger R., Pineda C., Louthrenoo W., Edwards N. L., Andres M., Vargas-Santos A. B., Roddy E., Pascart T., Lin C. -T., Perez-Ruiz F., Tedeschi S. K., Kim S. C., Harrold L. R., McCarthy G., Kumar N., Chapman P., Tausche A. -K., Vazquez-Mellado J., Gutierrez M., da Rocha Castelar-Pinheiro G., Richette P., Pascual E., Fisher M. C., Burgos-Vargas R., Robinson P. C., Singh J. A., Jansen T. L., Saag K. G., Slot O., Uhlig T., Solomon D. H., Keenan R. T., Scire C. A., Biernat-Kaluza E., Dehlin M., Nuki G., Schlesinger N., Janssen M., Stamp L. K., Sivera F., Reginato A. M., Jacobsson L., Liote F., Ea H. -K., Rosenthal A., Bardin T., Choi H. K., Hershfield M. S., Czegley C., Choi S. J., and Dalbeth N.

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.

Published
2019

11. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout

Author

Bursill, D, Taylor, W, Terkeltaub, R, Abhishek, A, A. K., S, Vargas-Santos, A, Gaffo, A, Rosenthal, A, Tausche, A, Reginato, A, Manger, B, Scire, C, Pineda, C, Van Durme, C, Lin, C, Yin, C, Albert, D, Biernat-Kaluza, E, Roddy, E, Pascual, E, Becce, F, Perez-Ruiz, F, Sivera, F, Liote, F, Schett, G, Nuki, G, Filippou, G, Mccarthy, G, Da Rocha Castelar Pinheiro, G, H. -K., E, Tupinamba, H, Yamanaka, H, Choi, H, Mackay, J, Odell, J, Vazquez Mellado, J, Singh, J, Fitzgerald, J, Jacobsson, L, Joosten, L, Harrold, L, Stamp, L, Andres, M, Gutierrez, M, Kuwabara, M, Dehlin, M, Janssen, M, Doherty, M, Hershfield, M, Pillinger, M, Edwards, N, Schlesinger, N, Kumar, N, Slot, O, Ottaviani, S, Richette, P, Macmullan, P, Chapman, P, Lipsky, P, Robinson, P, Khanna, P, Gancheva, R, Grainger, R, Johnson, R, Te Kampe, R, Keenan, R, Tedeschi, S, Kim, S, Choi, S, Fields, T, Bardin, T, Uhlig, T, Jansen, T, Merriman, T, Pascart, T, Neogi, T, Kluck, V, Louthrenoo, W, Dalbeth, N, Bursill D., Taylor W. J., Terkeltaub R., Abhishek A., So A. K., Vargas-Santos A. B., Gaffo A. L., Rosenthal A., Tausche A. -K., Reginato A., Manger B., Scire CA., Pineda C., Van Durme C., Lin C. -T., Yin C., Albert D. A., Biernat-Kaluza E., Roddy E., Pascual E., Becce F., Perez-Ruiz F., Sivera F., Liote F., Schett G., Nuki G., Filippou G., Mccarthy G., Da Rocha Castelar Pinheiro G., Ea H. -K., Tupinamba H. D. A., Yamanaka H., Choi H. K., Mackay J., Odell J. R., Vazquez Mellado J., Singh J. A., Fitzgerald J. D., Jacobsson L. T. H., Joosten L., Harrold L. R., Stamp L., Andres M., Gutierrez M., Kuwabara M., Dehlin M., Janssen M., Doherty M., Hershfield M. S., Pillinger M., Edwards N. L., Schlesinger N., Kumar N., Slot O., Ottaviani S., Richette P., Macmullan P. A., Chapman P. T., Lipsky P. E., Robinson P., Khanna P. P., Gancheva R. N., Grainger R., Johnson R. J., Te Kampe R., Keenan R. T., Tedeschi S. K., Kim S., Choi S. J., Fields T. R., Bardin T., Uhlig T., Jansen T., Merriman T., Pascart T., Neogi T., Kluck V., Louthrenoo W., Dalbeth N., Bursill, D, Taylor, W, Terkeltaub, R, Abhishek, A, A. K., S, Vargas-Santos, A, Gaffo, A, Rosenthal, A, Tausche, A, Reginato, A, Manger, B, Scire, C, Pineda, C, Van Durme, C, Lin, C, Yin, C, Albert, D, Biernat-Kaluza, E, Roddy, E, Pascual, E, Becce, F, Perez-Ruiz, F, Sivera, F, Liote, F, Schett, G, Nuki, G, Filippou, G, Mccarthy, G, Da Rocha Castelar Pinheiro, G, H. -K., E, Tupinamba, H, Yamanaka, H, Choi, H, Mackay, J, Odell, J, Vazquez Mellado, J, Singh, J, Fitzgerald, J, Jacobsson, L, Joosten, L, Harrold, L, Stamp, L, Andres, M, Gutierrez, M, Kuwabara, M, Dehlin, M, Janssen, M, Doherty, M, Hershfield, M, Pillinger, M, Edwards, N, Schlesinger, N, Kumar, N, Slot, O, Ottaviani, S, Richette, P, Macmullan, P, Chapman, P, Lipsky, P, Robinson, P, Khanna, P, Gancheva, R, Grainger, R, Johnson, R, Te Kampe, R, Keenan, R, Tedeschi, S, Kim, S, Choi, S, Fields, T, Bardin, T, Uhlig, T, Jansen, T, Merriman, T, Pascart, T, Neogi, T, Kluck, V, Louthrenoo, W, Dalbeth, N, Bursill D., Taylor W. J., Terkeltaub R., Abhishek A., So A. K., Vargas-Santos A. B., Gaffo A. L., Rosenthal A., Tausche A. -K., Reginato A., Manger B., Scire CA., Pineda C., Van Durme C., Lin C. -T., Yin C., Albert D. A., Biernat-Kaluza E., Roddy E., Pascual E., Becce F., Perez-Ruiz F., Sivera F., Liote F., Schett G., Nuki G., Filippou G., Mccarthy G., Da Rocha Castelar Pinheiro G., Ea H. -K., Tupinamba H. D. A., Yamanaka H., Choi H. K., Mackay J., Odell J. R., Vazquez Mellado J., Singh J. A., Fitzgerald J. D., Jacobsson L. T. H., Joosten L., Harrold L. R., Stamp L., Andres M., Gutierrez M., Kuwabara M., Dehlin M., Janssen M., Doherty M., Hershfield M. S., Pillinger M., Edwards N. L., Schlesinger N., Kumar N., Slot O., Ottaviani S., Richette P., Macmullan P. A., Chapman P. T., Lipsky P. E., Robinson P., Khanna P. P., Gancheva R. N., Grainger R., Johnson R. J., Te Kampe R., Keenan R. T., Tedeschi S. K., Kim S., Choi S. J., Fields T. R., Bardin T., Uhlig T., Jansen T., Merriman T., Pascart T., Neogi T., Kluck V., Louthrenoo W., and Dalbeth N.

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.

Published
2019

12. Prevalence of symptomatic axial osteoarthritis phenotypes in Spain and associated socio-demographic, anthropometric, and lifestyle variables

Author

Silva-Diaz M, Blanco F, Vila V, Seoane-Mato D, Perez-Ruiz F, Juan-Mas A, Pego-Reigosa J, Narvaez J, Quilis N, Cortes R, Perez A, Canales D, Gaya T, Ferrer C, Prado-Galbarro F, Sanchez-Piedra C, Diaz-Gonzalez F, Bustabad-Reyes S, and Working Grp Proyecto EPISER2016

Subjects
Phenotypes, Osteoarthritis, Prevalence, Spine
Abstract

Objective Axial osteoarthritis (OA) is a common cause of back and neck pain, however, few studies have examined its prevalence. The aim was to estimate the prevalence and the characteristics of symptomatic axial OA in Spain. Methods EPISER2016 is a cross-sectional multicenter population-based study of people aged 40 years or older. Subjects were randomly selected using multistage stratified cluster sampling. Participants were contacted by telephone to complete rheumatic disease screening questionnaires. Two phenotypes were analyzed, patients with Non-exclusive axial OA (NEA-OA) and Exclusive axial OA (EA-OA). To calculate the prevalence and its 95% confidence interval (CI), the sample design was considered and weighting was calculated according to age, sex and geographic origin. Results Prevalence of NEA-OA by clinical or clinical-radiographic criteria was 19.17% (95% CI: 17.82-20.59). The frequency of NEA-OA increased with age (being 3.6 times more likely in patients aged 80 s or more than in those between 40 and 49 years) and body mass index. It was significantly more frequent in women, as well as in the center of Spain. It was less frequent in those with a higher level of education. Lumbar OA was more frequent than cervical OA. This difference grew with increasing age and was not associated with gender. It was also greater in overweight and obese subjects. Conclusions This is the first study on the prevalence of axial OA phenotypes in Europe describing the associated socio-demographic, anthropometric, and lifestyle variables.

Published
2021

13. POS1124 IDENTIFYING POTENTIAL CLASSIFICATION CRITERIA FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE (CPPD): RESULTS FROM THE INITIAL PHASES

Author

Tedeschi, S., primary, Pascart, T., additional, Latourte, A., additional, Godsave, C., additional, Kundaki, B., additional, Naden, R., additional, Taylor, W., additional, Dalbeth, N., additional, Neogi, T., additional, Perez-Ruiz, F., additional, Rosenthal, A., additional, Becce, F., additional, Pascual, E., additional, Andrés, M., additional, Bardin, T., additional, Doherty, M., additional, Ea, H. K., additional, Filippou, G., additional, Fitzgerald, J., additional, Gutierrez, M., additional, Iagnocco, A., additional, Jansen, T., additional, Kohler, M., additional, Lioté, F., additional, Matza, M., additional, Mccarthy, G., additional, Ramonda, R., additional, Reginato, A., additional, Richette, P., additional, Singh, J., additional, Sivera, F., additional, So, A., additional, Stamp, L., additional, Yinh, J., additional, Yokose, C., additional, Terkeltaub, R., additional, Choi, H., additional, and Abhishek, A., additional

Published
2021
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14. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

Author

Richette P, Doherty M, PASCUAL E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Liote F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So A, Tausche A, Uhlig T, Zavada J, Zhang W, Tubach F, and Bardin T

Subjects
musculoskeletal diseases, congenital, hereditary, and neonatal diseases and abnormalities, nutritional and metabolic diseases
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.

Published
2020

15. Systematic genetic analysis of early-onset gout: ABCG2 is the only associated locus

Author

Zaidi F, Narang R, Phipps-Green A, Gamble G, Tausche A, So A, Riches P, Andres M, Perez-Ruiz F, Doherty M, Janssen M, Joosten L, Jansen T, Kurreeman F, Torres R, McCarthy G, Miner J, Stamp L, Merriman T, and Dalbeth N

Subjects
musculoskeletal diseases, congenital, hereditary, and neonatal diseases and abnormalities, gout, nutritional and metabolic diseases, urate, genetics
Abstract

Objective. The aim of this study was to examine whether serum urate-associated genetic variants are associated with early-onset gout. Methods. Participants with gout in the Genetics of Gout in Aotearoa study with available genotyping were included (n = 1648). Early-onset gout was defined as the first presentation of gout

Published
2020

16. Systematic genetic analysis of early-onset gout: ABCG2 is the only associated locus

Author

Zaidi, F., Narang, R.K., Phipps-Green, A., Gamble, G.G., Tausche, A.K., So, A., Riches, P., Andres, M, Perez-Ruiz, F., Doherty, M., Janssen, M., Joosten, L.A.B., Jansen, T.L, Kurreeman, F., Torres, R.J., McCarthy, G.M., Miner, J.N., Stamp, L.K., Merriman, T.R., Dalbeth, N., Zaidi, F., Narang, R.K., Phipps-Green, A., Gamble, G.G., Tausche, A.K., So, A., Riches, P., Andres, M, Perez-Ruiz, F., Doherty, M., Janssen, M., Joosten, L.A.B., Jansen, T.L, Kurreeman, F., Torres, R.J., McCarthy, G.M., Miner, J.N., Stamp, L.K., Merriman, T.R., and Dalbeth, N.

Abstract

Item does not contain fulltext, OBJECTIVE: The aim of this study was to examine whether serum urate-associated genetic variants are associated with early-onset gout. METHODS: Participants with gout in the Genetics of Gout in Aotearoa study with available genotyping were included (n = 1648). Early-onset gout was defined as the first presentation of gout <40 years of age. Single nucleotide polymorphisms (SNPs) for the 10 loci most strongly associated with serum urate were genotyped. Allelic association of the SNPs with early-onset gout was tested using logistic regression in an unadjusted model and in a model adjusted for sex, body mass index, tophus presence, flare frequency, serum creatinine and highest serum urate. The analysis was also done in two replication cohorts: Eurogout (n = 704) and Ardea (n = 755), and data were meta-analysed. RESULTS: In the Genetics of Gout in Aotearoa study, there were 638 (42.4%) participants with early-onset gout. The ABCG2 rs2231142 gout risk T-allele was present more frequently in participants with early-onset gout compared with the later-onset group. For the other SNPs tested, no differences in risk allele number were observed. In the allelic association analysis, the ABCG2 rs2231142 T-allele was associated with early-onset gout in unadjusted and adjusted models. Analysis of the replication cohorts confirmed the association of early-onset gout with the ABCG2 rs2231142 T-allele, but not with other serum urate-associated SNPs. In the meta-analysis, the odds ratio (95% CI) for early-onset gout for the ABCG2 rs2231142 T-allele was 1.60 (1.41, 1.83). CONCLUSION: In contrast to other serum urate-raising variants, the ABCG2 rs2231142 T-allele is strongly associated with early-onset gout.

Published
2020

17. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

Author

Richette, P., Doherty, M., Pascual, E., Barskova, V., Becce, F., Castaneda, J., Coyfish, M., Guillo, S., Jansen, T., Janssens, H., Lioté, F., Mallen, C.D., Nuki, G., Perez-Ruiz, F., Pimentao, J., Punzi, L., Pywell, A., So, A.K., Tausche, A.K., Uhlig, T., Zavada, J., Zhang, W., Tubach, F., Bardin, T., Richette, P., Doherty, M., Pascual, E., Barskova, V., Becce, F., Castaneda, J., Coyfish, M., Guillo, S., Jansen, T., Janssens, H., Lioté, F., Mallen, C.D., Nuki, G., Perez-Ruiz, F., Pimentao, J., Punzi, L., Pywell, A., So, A.K., Tausche, A.K., Uhlig, T., Zavada, J., Zhang, W., Tubach, F., and Bardin, T.

Abstract

Contains fulltext : 225037.pdf (Publisher’s version ) (Closed access), 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.

Published
2020

25. EULAR evidence based recommendations for gout: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)

Author

Zhang, W., Doherty, M., Bardin, T., Pascual, E., Barskova, V., Conaghan, P., Gerster, J., Jacobs, J., Leeb, B., Liote, F., McCarthy, G., Netter, P., Nuki, G., Perez-Ruiz, F., Pignone, A., Pimentao, J., Punzi, L., Roddy, E., Uhlig, T., and Zimmermann-Gorska, I.

Subjects
Gout -- Research, Gout -- Diagnosis, Gout -- Care and treatment, Clinical trials -- Evaluation, Health
Published
2006

26. EULAR evidence based recommendations for gout: diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT)

Author

Zhang, W., Doherty, M., Pascual, E., Bardin, T., Barskova, V., Conaghan, P., Gerster, J., Jacobs, J., Leeb, B., Liote, F., McCarthy, G., Netter, P., Nuki, G., Perez-Ruiz, F., Pignone, A., Pimentao, J., Punzi, L., Roddy, E., Uhlig, T., and Zimmermann-Gorska, I.

Subjects
Gout -- Research, Gout -- Diagnosis, Gout -- Risk factors, Gout -- Care and treatment, Health
Published
2006

27. Gout

Author

Dalbeth, N., Choi, H.K., Joosten, L.A.B., Khanna, P.P., Matsuo, H., Perez-Ruiz, F., Stamp, L.K., Dalbeth, N., Choi, H.K., Joosten, L.A.B., Khanna, P.P., Matsuo, H., Perez-Ruiz, F., and Stamp, L.K.

Abstract

Item does not contain fulltext, Gout is a chronic disease caused by monosodium urate (MSU) crystal deposition. Gout typically presents as an acute, self-limiting inflammatory monoarthritis that affects the joints of the lower limb. Elevated serum urate level (hyperuricaemia) is the major risk factor for MSU crystal deposition and development of gout. Although traditionally considered a disorder of purine metabolism, altered urate transport, both in the gut and the kidneys, has a key role in the pathogenesis of hyperuricaemia. Anti-inflammatory agents, such corticosteroids, NSAIDs and colchicine, are widely used for the treatment of gout flare; recognition of the importance of NLRP3 inflammasome activation and bioactive IL-1beta release in initiation of the gout flare has led to the development of anti-IL-1beta biological therapy for gout flares. Sustained reduction in serum urate levels using urate-lowering therapy is vital in the long-term management of gout, which aims to dissolve MSU crystals, suppress gout flares and resolve tophi. Allopurinol is the first-line urate-lowering therapy and should be started at a low dose, with gradual dose escalation. Low-dose anti-inflammatory therapies can reduce gout flares during initiation of urate-lowering therapy. Models of care, such as nurse-led strategies that focus on patient engagement and education, substantially improve clinical outcomes and now represent best practice for gout management.

Published
2019

28. Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

Author

Dalbeth, N, Schumacher, H, Fransen, J, Neogi, T, Jansen, T, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Cimmino, M, Uhlig, T, Taylor, W, Dalbeth N., Schumacher H. R., Fransen J., Neogi T., Jansen T. L., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Cimmino M. A., Uhlig T., Taylor W. J., Dalbeth, N, Schumacher, H, Fransen, J, Neogi, T, Jansen, T, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Cimmino, M, Uhlig, T, Taylor, W, Dalbeth N., Schumacher H. R., Fransen J., Neogi T., Jansen T. L., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Cimmino M. A., Uhlig T., and Taylor W. J.

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.

Published
2016

29. Performance of classification criteria for gout in early and established disease

Author

Taylor, W, Fransen, J, Dalbeth, N, Neogi, T, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scirè, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Jansen, T, Taylor W. J., Fransen J., Dalbeth N., Neogi T., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scirè C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., Da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Slot O., Cimmino M., Uhlig T., Jansen T. L., Taylor, W, Fransen, J, Dalbeth, N, Neogi, T, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scirè, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Jansen, T, Taylor W. J., Fransen J., Dalbeth N., Neogi T., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scirè C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., Da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Slot O., Cimmino M., Uhlig T., and Jansen T. L.

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 nonrheumatology clinic populations.

Published
2016

30. Diagnostic arthrocentesis for suspicion of gout is safe and well tolerated

Author

Taylor, W, Fransen, J, Dalbeth, N, Neogi, T, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Jansen, T, Taylor W. J., Fransen J., Dalbeth N., Neogi T., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., Da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Slot O., Cimmino M., Uhlig T., Jansen T. L., Taylor, W, Fransen, J, Dalbeth, N, Neogi, T, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Jansen, T, Taylor W. J., Fransen J., Dalbeth N., Neogi T., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., Da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Slot O., Cimmino M., Uhlig T., and Jansen T. L.

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.

Published
2016

31. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises

Author

De Lautour, H, Taylor, W, Adebajo, A, Alten, R, Burgos-Vargas, R, Chapman, P, Cimmino, M, Da Rocha Castelar Pinheiro, G, Day, R, Harrold, L, Helliwell, P, Janssen, M, Kerr, G, Kavanaugh, A, Khanna, D, Khanna, P, Lin, C, Louthrenoo, W, Mccarthy, G, Vazquez-Mellado, J, Mikuls, T, Neogi, T, Ogdie, A, Perez-Ruiz, F, Schlesinger, N, Ralph Schumacher, H, Scire, C, Singh, J, Sivera, F, Slot, O, Stamp, L, Tausche, A, Terkeltaub, R, Uhlig, T, Van De Laar, M, White, D, Yamanaka, H, Zeng, X, Dalbeth, N, De Lautour H., Taylor W. J., Adebajo A., Alten R., Burgos-Vargas R., Chapman P., Cimmino M. A., Da Rocha Castelar Pinheiro G., Day R., Harrold L. R., Helliwell P., Janssen M., Kerr G., Kavanaugh A., Khanna D., Khanna P. P., Lin C., Louthrenoo W., McCarthy G., Vazquez-Mellado J., Mikuls T. R., Neogi T., Ogdie A., Perez-Ruiz F., Schlesinger N., Ralph Schumacher H., Scire C. A., Singh J. A., Sivera F., Slot O., Stamp L. K., Tausche A. -K., Terkeltaub R., Uhlig T., Van De Laar M., White D., Yamanaka H., Zeng X., Dalbeth N., De Lautour, H, Taylor, W, Adebajo, A, Alten, R, Burgos-Vargas, R, Chapman, P, Cimmino, M, Da Rocha Castelar Pinheiro, G, Day, R, Harrold, L, Helliwell, P, Janssen, M, Kerr, G, Kavanaugh, A, Khanna, D, Khanna, P, Lin, C, Louthrenoo, W, Mccarthy, G, Vazquez-Mellado, J, Mikuls, T, Neogi, T, Ogdie, A, Perez-Ruiz, F, Schlesinger, N, Ralph Schumacher, H, Scire, C, Singh, J, Sivera, F, Slot, O, Stamp, L, Tausche, A, Terkeltaub, R, Uhlig, T, Van De Laar, M, White, D, Yamanaka, H, Zeng, X, Dalbeth, N, De Lautour H., Taylor W. J., Adebajo A., Alten R., Burgos-Vargas R., Chapman P., Cimmino M. A., Da Rocha Castelar Pinheiro G., Day R., Harrold L. R., Helliwell P., Janssen M., Kerr G., Kavanaugh A., Khanna D., Khanna P. P., Lin C., Louthrenoo W., McCarthy G., Vazquez-Mellado J., Mikuls T. R., Neogi T., Ogdie A., Perez-Ruiz F., Schlesinger N., Ralph Schumacher H., Scire C. A., Singh J. A., Sivera F., Slot O., Stamp L. K., Tausche A. -K., Terkeltaub R., Uhlig T., Van De Laar M., White D., Yamanaka H., Zeng X., and Dalbeth N.

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.

Published
2016

32. Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice

Author

Perez Ruiz F, Sanchez-Piedra CA, Sanchez-Costa JT, Andrés M, Diaz-Torne C, Jimenez-Palop M, De Miguel E, Moragues C, and Sivera F

Subjects
Treatment, Gout management, Diagnosis, Audit
Abstract

The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. Menarini Espaa.

Published
2018

33. Validation of a Definition of Flare in Patients With Established Gout

Author

Gaffo AL, Dalbeth N, Saag KG, Singh JA, Rahn EJ, Mudano AS, Chen YH, Lin CT, Bourke S, Louthrenoo W, Vazquez-Mellado J, Hernández-Llinas H, Neogi T, Vargas-Santos AB, da Rocha Castelar-Pinheiro G, Amorim RBC, Uhlig T, Hammer HB, Eliseev M, Perez-Ruiz F, Cavagna L, McCarthy GM, Stamp LK, Gerritsen M, Fana V, Sivera F, and Taylor W

Abstract

Objective. To perform external validation of a provisional definition of disease flare in patients with gout. Methods. Five hundred nine patients with gout were enrolled in a cross-sectional study during a routine clinical care visit at 17 international sites. Data were collected to classify patients as experiencing or not experiencing a gout flare, according to a provisional definition. A local expert rheumatologist performed the final independent adjudication of gout flare status. Sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curves were used to determine the diagnostic performance of gout flare definitions. Results. The mean +/- SD age of the patients was 57.5 +/- 13.9 years, and 89% were male. The definition requiring fulfillment of at least 3 of 4 criteria (patient-defined gout flare, pain at rest score of >3 on a 0-10-point numerical rating scale, presence of at least 1 swollen joint, and presence of at least 1 warm joint) was 85% sensitive and 95% specific in confirming the presence of a gout flare, with an accuracy of 92%. The ROC area under the curve was 0.97. The definition based on a classification and regression tree algorithm (entry point, pain at rest score >3, followed by patient-defined flare "yes") was 73% sensitive and 96% specific. Conclusion. The definition of gout flare that requires fulfillment of at least 3 of 4 patient-reported criteria is now validated to be sensitive, specific, and accurate for gout flares, as demonstrated using an independent large international patient sample. The availability of a validated gout flare definition will improve the ascertainment of an important clinical outcome in studies of gout.

Published
2018

37. Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

Author

Dalbeth N., Schumacher H. R., Fransen J., Neogi T., Jansen T. L., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire C. A., Cavagna L., Lin C., Chou Y. -Y., Tausche A. -K., da Rocha Castelar-Pinheiro G., Janssen M., Chen J. -H., Cimmino M. A., Uhlig T., Taylor W. J., Dalbeth, N, Schumacher, H, Fransen, J, Neogi, T, Jansen, T, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, da Rocha Castelar-Pinheiro, G, Janssen, M, Chen, J, Cimmino, M, Uhlig, T, and Taylor, W

Subjects
Male, musculoskeletal diseases, Gout, Hyperuricemia, Sensitivity and Specificity, NO, Gout Suppressants, Uric Acid, Diagnostic Self Evaluation, Epidemiologic Studies, Logistic Models, Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5], Humans, Female, Symptom Assessment, Colchicine
Abstract

Item does not contain fulltext 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.

Published
2016

38. Study for updated gout classification criteria: Identification of features to classify gout

Author

Taylor, W, Fransen, J, Jansen, T, Dalbeth, N, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Vargas-Santos, A, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Neogi, T, Taylor W. J., Fransen J., Jansen T. L., Dalbeth N., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire CA., Cavagna L., Lin C., Chou Y. -Y., Tausche A. K., Vargas-Santos A. B., Janssen M., Chen J. -H., Slot O., Cimmino M. A., Uhlig T., Neogi T., Taylor, W, Fransen, J, Jansen, T, Dalbeth, N, Schumacher, H, Brown, M, Louthrenoo, W, Vazquez-Mellado, J, Eliseev, M, Mccarthy, G, Stamp, L, Perez-Ruiz, F, Sivera, F, H. -K., E, Gerritsen, M, Scire, C, Cavagna, L, Lin, C, Chou, Y, Tausche, A, Vargas-Santos, A, Janssen, M, Chen, J, Slot, O, Cimmino, M, Uhlig, T, Neogi, T, Taylor W. J., Fransen J., Jansen T. L., Dalbeth N., Schumacher H. R., Brown M., Louthrenoo W., Vazquez-Mellado J., Eliseev M., McCarthy G., Stamp L. K., Perez-Ruiz F., Sivera F., Ea H. -K., Gerritsen M., Scire CA., Cavagna L., Lin C., Chou Y. -Y., Tausche A. K., Vargas-Santos A. B., Janssen M., Chen J. -H., Slot O., Cimmino M. A., Uhlig T., and Neogi T.

Abstract

Objective To determine which clinical, laboratory, and imaging features most accurately distinguished gout from non-gout. Methods We performed a cross-sectional study of consecutive rheumatology clinic patients with ≥1 swollen joint or subcutaneous tophus. Gout was defined by synovial fluid or tophus aspirate microscopy by certified examiners in all patients. The sample was randomly divided into a model development (two-thirds) and test sample (one-third). Univariate and multivariate association between clinical features and monosodium urate-defined gout was determined using logistic regression modeling. Shrinkage of regression weights was performed to prevent overfitting of the final model. Latent class analysis was conducted to identify patterns of joint involvement. Results In total, 983 patients were included. Gout was present in 509 (52%). In the development sample (n = 653), the following features were selected for the final model: joint erythema (multivariate odds ratio [OR] 2.13), difficulty walking (multivariate OR 7.34), time to maximal pain <24 hours (multivariate OR 1.32), resolution by 2 weeks (multivariate OR 3.58), tophus (multivariate OR 7.29), first metatarsophalangeal (MTP1) joint ever involved (multivariate OR 2.30), location of currently tender joints in other foot/ankle (multivariate OR 2.28) or MTP1 joint (multivariate OR 2.82), serum urate level >6 mg/dl (0.36 mmoles/liter; multivariate OR 3.35), ultrasound double contour sign (multivariate OR 7.23), and radiograph erosion or cyst (multivariate OR 2.49). The final model performed adequately in the test set, with no evidence of misfit, high discrimination, and predictive ability. MTP1 joint involvement was the most common joint pattern (39.4%) in gout cases. Conclusion Ten key discriminating features have been identified for further evaluation for new gout classification criteria. Ultrasound findings and degree of uricemia add discriminating value, and will significantly contribute to mor

Published
2015

39. Potency on lowering serum uric acid in gout patients: a pooled analysis of registrative studies comparing febuxostat vs. allopurinol

Author

Cutolo, M, Cimmino, Ma, and Perez-Ruiz, F.

Subjects
Adult, Male, Gout, Allopurinol, Hyperuricemia, Middle Aged, Gout Suppressants, Uric Acid, Febuxostat, Treatment Outcome, Clinical Trials, Phase III as Topic, Humans, Female, Enzyme Inhibitors, Randomized Controlled Trials as Topic
Abstract

Hyperuricemia leading to urate crystal formation in tissues represents the pathophysiological mechanism of gout. Guidelines recommend a therapeutic target of serum urate concentration (sUA)6 mg/dL, or even lower (≤5 mg/dL) in patients with large deposits. We conducted an analysis with the aim to achieve additional insights into the urate-lowering efficacy of two xanthine oxidase inhibitors, allopurinol and febuxostat.This was a pooled analysis of phase III trials on allopurinol and febuxostat, including 4101 patients with gout and hyperuricemia. The efficacy outcomes were: mean reduction of sUA concentration from baseline; number of patients with target sUA levels (6.0 mg/dL or ≤5 mgdL); time to reach target sUA levels.Three registrative, phase III, randomized, multicenter, placebo-controlled/allopurinol-controlled trials assessing the efficacy of febuxostat, were included. The mean reduction of sUA concentration with any dose of febuxostat was higher (-2.92±2.87 mg/dL; -27%), with respect to placebo- (-0.62±1.84 mg/dL; -5%) and allopurinol-pooled groups (-2.41±2.20 mg/dL; -24%). Moreover, febuxostat showed a higher probability to achieve the recommended target sUA concentration than allopurinol [odds ratio: 2.43 (95% CI: 2.119-2.789) and 4.05 (95% CI: 3.41-4.82) for sUA levels6 mg/dL and ≤5 mg/dL, respectively]. Patients on any-dose febuxostat reached target sUA faster than allopurinol-treated patients (86.04±71.47 vs. 98.76±70.88 days and 52.08±49.97 vs. 90.42±68.03 days for reaching sUA levels6 mg/dL and ≤5 mg/dL, respectively; p0.001 for both comparisons).In patients with gout and hyperuricemia, febuxostat was significantly more effective and faster than allopurinol in obtaining the recommended target sUA levels, which were reached by a higher number of patients. Therefore, febuxostat was confirmed as an effective option for the treatment of hyperuricemia in gout.

Published
2017

49. 2016 updated EULAR evidence-based recommendations for the management of gout

Author

Richette, P., Doherty, M., Pascual, E., Barskova, V., Becce, F., Castaneda-Sanabria, J., Coyfish, M., Guillo, S., Jansen, T.L., Janssens, H., Liote, F., Mallen, C.D., Nuki, G., Perez-Ruiz, F., Pimentao, J., Punzi, L., Pywel, T., So, A., Tausche, A.K., Uhlig, T., Zavada, J., Zhang, W., Tubach, F., Bardin, T., Richette, P., Doherty, M., Pascual, E., Barskova, V., Becce, F., Castaneda-Sanabria, J., Coyfish, M., Guillo, S., Jansen, T.L., Janssens, H., Liote, F., Mallen, C.D., Nuki, G., Perez-Ruiz, F., Pimentao, J., Punzi, L., Pywel, T., So, A., Tausche, A.K., Uhlig, T., Zavada, J., Zhang, W., Tubach, F., and Bardin, T.

Abstract

Item does not contain fulltext

Published
2017

50. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: A systematic analysis for the Global Burden of Disease Study 2016.

Author

Shetty B.P., Tekle D.Y., Temam Shifa G., Temsah M.-H., Terkawi A.S., Tesema C.L., Tesssema B., Theis A., Thomas N., Thompson A.H., Thomson A.J., Tiruye T.Y., Tobe-Gai R., Tonelli M., Topor-Madry R., Topouzis F., Tortajada M., Tran B.X., Truelsen T., Trujillo U., Tsilimparis N., Tuem K.B., Tuzcu E.M., Tyrovolas S., Ukwaja K.N., Undurraga E.A., Uthman O.A., Uzochukwu B.S.C., Van Boven J.F.M., Varakin Y.Y., Varughese S., Vasankari T., Vasconcelos A.M.N., Venketasubramanian N., Vidavalur R., Violante F.S., Vishnu A., Vladimirov S.K., Vlassov V.V., Vollset S.E., Vos T., Waid J.L., Wakayo T., Wang Y.-P., Weichenthal S., Weiderpass E., Weintraub R.G., Werdecker A., Wesana J., Wijeratne T., Wilkinson J.D., Wiysonge C.S., Woldeyes B.G., Wolfe C.D.A., Workicho A., Workie S.B., Xavier D., Xu G., Yaghoubi M., Yakob B., Yalew A.Z., Yan L.L., Yano Y., Yaseri M., Ye P., Yimam H.H., Yip P., Yirsaw B.D., Yonemoto N., Yoon S.-J., Yotebieng M., Younis M.Z., Zaidi Z., El Sayed Zaki M., Zeeb H., Zenebe Z.M., Zerfu T.A., Zhang A.L., Zhang X., Zodpey S., Zuhlke L.J., Lopez A.D., Murray C.J.L., De Courten B., Singh A., Thrift A.G., Wang H., Abajobir A.A., Abate K.H., Abbafati C., Abbas K.M., Abd-Allah F., Abera S.F., Abraha H.N., Abu-Raddad L.J., Abu-Rmeileh N.M.E., Adedeji I.A., Adedoyin R.A., Adetifa I.M.O., Adetokunboh O., Afshin A., Aggarwal R., Agrawal A., Agrawal S., Ahmad Kiadaliri A., Ahmed M.B., Aichour A.N., Aichour I., Aichour M.T.E., Aiyar S., Akanda A.S., Akinyemiju T.F., Akseer N., Al-Eyadhy A., Al Lami F.H., Alabed S., Alahdab F., Al-Aly Z., Alam K., Alam N., Alasfoor D., Aldridge R.W., Alene K.A., Alhabib S., Ali R., Alizadeh-Navaei R., Aljunid S.M., Alkaabi J.M., Alkerwi A., Alla F., Allam S.D., Allebeck P., Al-Raddadi R., Alsharif U., Altirkawi K.A., Martin E.A., Alvis-Guzman N., Amare A.T., Ameh E.A., Amini E., Ammar W., Amoako Y.A., Anber N., Andrei C.L., Androudi S., Ansari H., Ansha M.G., Antonio C.A.T., Anwari P., Arnlov J., Arora M., Artaman A., Aryal K.K., Asayesh H., Asgedom S.W., Asghar R.J., Assadi R., Atey T.M., Atre S.R., Avila-Burgos L., Avokpaho E.F.G.A., Awasthi A., Ayala Quintanilla B.P., Babalola T.K., Bacha U., Badawi A., Balakrishnan K., Balalla S., Barac A., Barber R.M., Barboza M.A., Barker-Collo S.L., Barnighausen T., Barquera S., Barregard L., Barrero L.H., Baune B.T., Bazargan-Hejazi S., Bedi N., Beghi E., Bejot Y., Bekele B.B., Bell M.L., Bello A.K., Bennett D.A., Bennett J.R., Bensenor I.M., Benson J., Berhane A., Berhe D.F., Bernabe E., Beuran M., Beyene A.S., Bhala N., Bhansali A., Bhaumik S., Bhutta Z.A., Bikbov B., Birungi C., Biryukov S., Bisanzio D., Bizuayehu H.M., Bjerregaard P., Blosser C.D., Boneya D.J., Boufous S., Bourne R.R.A., Brazinova A., Breitborde N.J.K., Brenner H., Brugha T.S., Bukhman G., Bulto L.N.B., Bumgarner B.R., Burch M., Butt Z.A., Cahill L.E., Cahuana-Hurtado L., Campos-Nonato I.R., Car J., Car M., Cardenas R., Carpenter D.O., Carrero J.J., Carter A., Castaneda-Orjuela C.A., Castillo Rivas J., Castro F.F., Castro R.E., Catala-Lopez F., Chen H., Chiang P.P.-C., Chibalabala M., Chisumpa V.H., Chitheer A.A., Choi J.-Y.J., Christensen H., Christopher D.J., Ciobanu L.G., Cirillo M., Cohen A.J., Colquhoun S.M., Coresh J., Criqui M.H., Cromwell E.A., Crump J.A., Dandona L., Dandona R., Dargan P.I., Das Neves J., Davey G., Davitoiu D.V., Davletov K., De Leo D., Degenhardt L., Deiparine S., Dellavalle R.P., Deribe K., Deribew A., Des Jarlais D.C., Dey S., Dharmaratne S.D., Dherani M.K., Diaz-Torne C., Ding E.L., Dixit P., Djalalinia S., Do H.P., Doku D.T., Donnelly C.A., Dos Santos K.P.B., Douwes-Schultz D., Driscoll T.R., Duan L., Dubey M., Duncan B.B., Dwivedi L.K., Ebrahimi H., El Bcheraoui C., Ellingsen C.L., Enayati A., Endries A.Y., Ermakov S.P., Eshetie S., Eshrati B., Eskandarieh S., Esteghamati A., Estep K., Fanuel F.B.B., Faro A., Farvid M.S., Farzadfar F., Feigin V.L., Fereshtehnejad S.-M., Fernandes J.G., Fernandes J.C., Feyissa T.R., Filip I., Fischer F., Foigt N., Foreman K.J., Frank T., Franklin R.C., Fraser M., Friedman J., Frostad J.J., Fullman N., Furst T., Furtado J.M., Futran N.D., Gakidou E., Gambashidze K., Gamkrelidze A., Gankpe F.G., Garcia-Basteiro A.L., Gebregergs G.B., Gebrehiwot T.T., Gebrekidan K.G., Gebremichael M.W., Gelaye A.A., Geleijnse J.M., Gemechu B.L., Gemechu K.S., Genova-Maleras R., Gesesew H.A., Gething P.W., Gibney K.B., Gill P.S., Gillum R.F., Giref A.Z., Girma B.W., Giussani G., Goenka S., Gomez B., Gona P.N., Gopalani S.V., Goulart A.C., Graetz N., Gugnani H.C., Gupta P.C., Gupta R., Gupta T., Gupta V., Haagsma J.A., Hafezi-Nejad N., Haghparast Bidgoli H., Hakuzimana A., Halasa Y.A., Hamadeh R.R., Hambisa M.T., Hamidi S., Hammami M., Hancock J., Handal A.J., Hankey G.J., Hao Y., Harb H.L., Hareri H.A., Harikrishnan S., Haro J.M., Hassanvand M.S., Havmoeller R., Hay R.J., Hay S.I., He F., Heredia-Pi I.B., Herteliu C., Hilawe E.H., Hoek H.W., Horita N., Hosgood H.D., Hostiuc S., Hotez P.J., Hoy D.G., Hsairi M., Htet A.S., Hu G., Huang H., Huang J.J., Iburg K.M., Igumbor E.U., Ileanu B.V., Inoue M., Irenso A.A., Irvine C.M.S., Islam N., Jacobsen K.H., Jaenisch T., Jahanmehr N., Jakovljevic M.B., Javanbakht M., Jayatilleke A.U., Jeemon P., Jensen P.N., Jha V., Jin Y., John D., John O., Johnson S.C., Jonas J.B., Jurisson M., Kabir Z., Kadel R., Kahsay A., Kalkonde Y., Kamal R., Kan H., Karch A., Karema C.K., Karimi S.M., Karthikeyan G., Kasaeian A., Kassaw N.A., Kassebaum N.J., Kastor A., Katikireddi S.V., Kaul A., Kawakami N., Kazanjan K., Keiyoro P.N., Kelbore S.G., Kemp A.H., Kengne A.P., Keren A., Kereselidze M., Kesavachandran C.N., Ketema E.B., Khader Y.S., Khalil I.A., Khan E.A., Khan G., Khang Y.-H., Khera S., Khoja A.T.A., Khosravi M.H., Kibret G.D., Kieling C., Kim C.-I., Kim D., Kim P., Kim S., Kim Y.J., Kimokoti R.W., Kinfu Y., Kishawi S., Kissimova-Skarbek K.A., Kissoon N., Kivimaki M., Knudsen A.K., Kokubo Y., Kopec J.A., Kosen S., Koul P.A., Koyanagi A., Kravchenko M., Krohn K.J., Kuate Defo B., Kucuk Bicer B., Kuipers E.J., Kulikoff X.R., Kulkarni V.S., Kumar G.A., Kumar P., Kumsa F.A., Kutz M., Lachat C., Lagat A.K., Lager A.C.J., Lal D.K., Lalloo R., Lambert N., Lan Q., Lansingh V.C., Larson H.J., Larsson A., Laryea D.O., Lavados P.M., Laxmaiah A., Lee P.H., Leigh J., Leung J., Leung R., Levi M., Li Y., Liao Y., Liben M.L., Lim S.S., Linn S., Lipshultz S.E., Liu S., Lodha R., Logroscino G., Lorch S.A., Lorkowski S., Lotufo P.A., Lozano R., Lunevicius R., Lyons R.A., Ma S., Macarayan E.R.K., Machado I.E., Mackay M.T., Magdy Abd El Razek M., Magis-Rodriguez C., Mahdavi M., Majdan M., Majdzadeh R., Majeed A., Malekzadeh R., Malhotra R., Malta D.C., Mantovani L.G., Manyazewal T., Mapoma C.C., Marczak L.B., Marks G.B., Martinez-Raga J., Martins-Melo F.R., Massano J., Maulik P.K., Mayosi B.M., Mazidi M., McAlinden C., McGarvey S.T., McGrath J.J., McKee M., Mehata S., Mehndiratta M.M., Mehta K.M., Meier T., Mekonnen T.C., Meles K.G., Memiah P., Memish Z.A., Mendoza W., Mengesha M.M., Mengistie M.A., Mengistu D.T., Menon G.R., Menota B.G., Mensah G.A., Meretoja A., Meretoja T.J., Mezgebe H.B., Micha R., Mikesell J., Miller T.R., Mills E.J., Minnig S., Mirarefin M., Mirrakhimov E.M., Misganaw A., Mishra S.R., Mohammad K.A., Mohammadi A., Mohammed K.E., Mohammed S., Mohan M.B.V., Mohanty S.K., Mokdad A.H., Molla Assaye A., Mollenkopf S.K., Molokhia M., Monasta L., Montanez Hernandez J.C., Montico M., Mooney M.D., Moore A.R., Moradi-Lakeh M., Moraga P., Morawska L., Moreno Velasquez I., Mori R., Morrison S.D., Mruts K.B., Mueller U.O., Mullany E., Muller K., Murthy G.V.S., Murthy S., Musa K.I., Nachega J.B., Nagata C., Nagel G., Naghavi M., Naidoo K.S., Nanda L., Nangia V., Nascimento B.R., Natarajan G., Negoi I., Nguyen C.T., Nguyen G., Nguyen Q.L., Nguyen T.H., Ningrum D.N.A., Nisar M.I., Nomura M., Nong V.M., Norheim O.F., Norrving B., Noubiap J.J.N., Nyakarahuka L., Obermeyer C.M., O'Donnell M.J., Ogbo F.A., Oh I.-H., Okoro A., Oladimeji O., Olagunju A.T., Olusanya B.O., Olusanya J.O., Oren E., Ortiz A., Osgood-Zimmerman A., Ota E., Owolabi M.O., Oyekale A.S., Mahesh P.A., Pacella R.E., Pakhale S., Pana A., Panda B.K., Panda-Jonas S., Park E.-K., Parsaeian M., Patel T., Patten S.B., Patton G.C., Paudel D., Pereira D.M., Perez-Padilla R., Perez-Ruiz F., Perico N., Pervaiz A., Pesudovs K., Peterson C.B., Petri W.A., Petzold M., Phillips M.R., Piel F.B., Pigott D.M., Pishgar F., Plass D., Polinder S., Popova S., Postma M.J., Poulton R.G., Pourmalek F., Prasad N., Purwar M., Qorbani M., Rabiee R.H.S., Radfar A., Rafay A., Rahimi-Movaghar A., Rahimi-Movaghar V., Rahman M., Rahman M.H.U., Rahman S.U., Rai R.K., Rajsic S., Ram U., Rana S.M., Ranabhat C.L., Rao P.V., Rawaf S., Ray S.E., Rego M.A.S., Rehm J., Reiner R.C., Remuzzi G., Renzaho A.M.N.N., Resnikoff S., Rezaei S., Rezai M.S., Ribeiro A.L., Rokni M.B., Ronfani L., Roshandel G., Roth G.A., Rothenbacher D., Roy A., Rubagotti E., Ruhago G.M., Saadat S., Sabde Y.D., Sachdev P.S., Sadat N., Safdarian M., Safi S., Safiri S., Sagar R., Sahathevan R., Sahebkar A., Sahraian M.A., Salama J., Salamati P., Salomon J.A., Salvi S.S., Samy A.M., Sanabria J.R., Sanchez-Nino M.D., Santos I.S., Santric Milicevic M.M., Sarmiento-Suarez R., Sartorius B., Satpathy M., Sawhney M., Saxena S., Saylan M.I., Schmidt M.I., Schneider I.J.C., Schutte A.E., Schwebel D.C., Schwendicke F., Seedat S., Seid A.M., Sepanlou S.G., Servan-Mori E.E., Shackelford K.A., Shaheen A., Shahraz S., Shaikh M.A., Shamsipour M., Shamsizadeh M., Islam S.M.S., Sharma J., Sharma R., She J., Shen J., Shi P., Shibuya K., Shigematsu M., Shiri R., Shiue I., Shrime M.G., Sigfusdottir I.D., Silberberg D.H., Silpakit N., Silva D.A.S., Silva J.P., Silveira D.G.A., Sindi S., Singh J.A., Singh P.K., Singh V., Sinha D.N., Skiadaresi E., Sligar A., Smith D.L., Sobaih B.H.A., Sobngwi E., Soneji S., Soriano J.B., Sreeramareddy C.T., Srinivasan V., Stathopoulou V., Steel N., Stein D.J., Steiner C., Stockl H., Stokes M.A., Strong M., Sufiyan M.B., Suliankatchi R.A., Sunguya B.F., Sur P.J., Swaminathan S., Sykes B.L., Szoeke C.E.I., Tabares-Seisdedos R., Tadakamadla S.K., Tadese F., Tandon N., Tanne D., Tarajia M., Tavakkoli M., Taveira N., Tehrani-Banihashemi A., Tekelab T., Shetty B.P., Tekle D.Y., Temam Shifa G., Temsah M.-H., Terkawi A.S., Tesema C.L., Tesssema B., Theis A., Thomas N., Thompson A.H., Thomson A.J., Tiruye T.Y., Tobe-Gai R., Tonelli M., Topor-Madry R., Topouzis F., Tortajada M., Tran B.X., Truelsen T., Trujillo U., Tsilimparis N., Tuem K.B., Tuzcu E.M., Tyrovolas S., Ukwaja K.N., Undurraga E.A., Uthman O.A., Uzochukwu B.S.C., Van Boven J.F.M., Varakin Y.Y., Varughese S., Vasankari T., Vasconcelos A.M.N., Venketasubramanian N., Vidavalur R., Violante F.S., Vishnu A., Vladimirov S.K., Vlassov V.V., Vollset S.E., Vos T., Waid J.L., Wakayo T., Wang Y.-P., Weichenthal S., Weiderpass E., Weintraub R.G., Werdecker A., Wesana J., Wijeratne T., Wilkinson J.D., Wiysonge C.S., Woldeyes B.G., 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Abstract

Background: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Method(s): We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, t

Published
2017

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