Gout: Neogi T

Neogi T. · No affiliation provided · J Rheumatol. · Pubmed #18464314 links to  free full text

This publication has no abstract.

Neogi T, Hunter DJ, Chaisson CE, Allensworth-Davies D, Zhang Y. · Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts 02118, USA. · J Rheumatol. · Pubmed #16267879 No free full text.

Abstract: OBJECTIVE: To evaluate the patterns and determinants of medication use during recurrent gout attacks. METHODS: We followed participants with documented gout in an online prospective case-crossover study. During an attack, subjects were asked if they had consulted a physician for the attack and what medications they were using. Definitely inappropriate therapy was defined as use of allopurinol or a uricosuric agent acutely without having used it as a prophylactic. Potentially inappropriate therapy was defined as use of analgesics alone, alternative remedies, or no medications. We estimated the risk of having >or= 1 attack in 1 year using life table methods. We examined the relation of various risk factors to the risk of inappropriate therapy using Poisson regression. RESULTS: Among 232 participants (mean age 52 yrs, 81% male) with documented gout, the risk of having >or= 1 attack in a year was 69%. One hundred ten participants consulted a physician for each attack, 49 did so for only some attacks, while 43 never consulted a physician for any attack. Fifty-three participants had definitely (n = 10) or potentially (n = 43) inappropriate therapy for their recurrent attacks. Physician consultation for an attack was associated with increased risk of inappropriate therapy (risk ratio, RR, 2.5, p = 0.006), whereas an increasing number of gout attacks was associated with lower risk of inappropriate therapy (RR 0.8, p = 0.01). CONCLUSION: Given the high risk of recurrent attacks and the substantial number of persons whose attacks are not appropriately managed, further education about management of gout attacks for both patients and physicians may be warranted.

Zhang Y, Chaisson CE, McAlindon T, Woods R, Hunter DJ, Niu J, Neogi T, Felson DT. · Boston University Clinical Epidemiology Research and Training Unit, The Department of Medicine at Boston Medical Center, A203, Boston University School of Medicine, Boston, MA 02118, USA. · J Clin Epidemiol. · Pubmed #17161754 No free full text.

Abstract: OBJECTIVES: To evaluate the feasibility of conducting an online case-crossover study of triggers for recurrent disease flares. METHODS: We conducted an online case-crossover study of triggers for recurrent flares using gout as a paradigm. We constructed a Web site and recruited individuals with history of gout via the Internet. We confirmed gout diagnosis by reviewing each subject's medical records. We collected via the Internet exposure information during the intercritical period using a scheduled Control-period Questionnaire, and prior to recurrent gout attacks using a Hazard-period Questionnaire. RESULTS: Over 10 months we recruited 197 subjects with a history of gout from 41 states and the District of Columbia. We obtained medical records from 172 subjects. All participants had experienced at least one recurrent attack and filled out required questionnaires. The median time between the date of an attack and the date of logging on to the Web site was 2 days. The incidence rate of recurrent gout attacks was 1.03 per person-year. Longer disease duration and presence of comorbidities appeared to increase the risk of recurrent flares. CONCLUSION: The results of this study demonstrate that a case-crossover study can be successfully conducted through the Internet. This approach has broad applicability to other diseases typified by recurrent attacks.

Zhang Y, Woods R, Chaisson CE, Neogi T, Niu J, McAlindon TE, Hunter D. · Boston University Clinical Epidemiology Research and Training Unit, the Department of Medicine at Boston Medical Center, Boston, Mass 02118, USA. · Am J Med. · Pubmed #16945617 No free full text.

Abstract: BACKGROUND: Alcohol consumption has long been considered a trigger for recurrent gout attacks; however, this hypothesis has not been formally tested. METHODS: We conducted an Internet-based case-crossover study to assess several putative risk factors, including alcohol consumption, thought to trigger recurrent gout attacks. Subjects who had an attack within the past year were recruited online and asked to provide access to medical records pertaining to their gout. Data were obtained on the amount and type of alcoholic beverage consumed on each day over the 2-day period before a gout attack and on each day over a 2-day period during the intercritical period. We examined the amount and type of alcohol consumption and the risk of recurrent gout attacks using a conditional logistic regression adjusting for diuretic use and purine intake. RESULTS: A total of 197 subjects were recruited online over a 10-month period. Of those, 179 (91%) fulfilled the American College of Rheumatology Criteria for gout. Compared with no alcohol consumption, odds ratios for recurrent gout attacks were 1.1, 0.9, 2.0, and 2.5 for 1 to 2, 3 to 4, 5 to 6, and 7 or more drinks consumed over the 2-day period, respectively (P<.005). A dose-response relationship of risk of gout attacks was more evident for alcohol consumed over the last 24 hours. An increased risk of recurrent gout attacks was found for each type of beverage consumed. CONCLUSION: Alcohol consumption triggers recurrent gout attacks. This effect was likely to occur within 24 hours after its consumption.