Recent advances in the epidemiology of gout

Gout remains among the most common of all inflammatory arthridities with an incidence that appears to have risen. Evidence is accumulating to support lifestyle and dietary factors, such as heavy consumption of beer and liquor as well as diets rich in meats and seafood as important gout risk factors. There is also a renewed interest in important associations between gout and other comorbidities like hypertension and cardiovascular disease. The importance of hyperuricemia on health considerations beyond the musculoskeletal system is an area worthy of even more study.     

Recent updates on worldwide gout epidemiology

Clinical Rheumatology - To provide recent statistics on worldwide gout epidemiology. Current and prediction data on gout epidemiology were retrieved from the Global Health Data Exchange (GHDx)...     

Recent advances in the management of gout and hyperuricemia

PURPOSE OF REVIEW: To review the recent advances in the management of gout and hyperuricemia. RECENT FINDINGS: The first quality indicators for gout management have been proposed. Selective COX II inhibitors, as well as traditional NSAIDs, are effective in acute gout. A new xanthine oxidase inhibitor, febuxostat, and pegylated uricases are in clinical trials. SUMMARY: The therapeutic aims in gout include termination of the acute attack as promptly and gently as possible, prevention of future attacks, prevention or reversal of complications of the, and prevention or reversal of associated features such as obesity, hypertriglyceridemia, hypertension, or alcoholism.     

Recent advances in the epidemiology of primary biliary cirrhosis

Since initial reports in the mid-1970s provided epidemiology data on primary biliary cirrhosis (PBC), many studies have characterized the variable frequency of this disease in diverse populations worldwide and sought to identify associated risk factors. Recent research confirms earlier work suggesting that the incidence and prevalence of PBC are on the rise, although geographic variation persists. Analysis of familial and geographic clustering supports the hypothesis that development and progression of the disease hinge on a complex interplay between genetic and environmental risk factors. International clinical data systems are needed to advance PBC epidemiologic research. Given this complexity, international clinical data systems are needed to advance PBC epidemiologic research.     

脂肪性肝病流行病学研究进展

脂肪性肝病的发病率在全球呈现逐年上升趋势.此文就酒精性与非酒精性脂肪性肝病的流行病学及其可能的危险因素作一综述.     

Treatment advances in gout

The purpose of gout treatment is to alleviate symptoms of flares, prevent flares from recurring by lowering serum urate, and minimize structural joint damage and functional impairment. In recent years, several new medications to treat gout have been developed, and novel agents continue to be investigated, in addition to several long-established treatments. Although a number of effective therapies are available, optimal management and outcomes are frequently not achieved due to physician under prescribing of urate-lowering therapy (ULT) and poor adherence with therapy when it is prescribed. This article reviews recent developments in the management of gout with reference to recently published clinical guidelines, outlines some important questions regarding the safety and efficacy of particular agents, and remaining gaps in our knowledge about the most effective strategies for using currently available treatments.     

Therapeutic advances in gout

PURPOSE OF REVIEW: The purpose of this review is to highlight the recent developments in the management of gout. RECENT FINDINGS: Guidelines for the diagnosis and management of gout from EULAR, quality of care indicators, and outcome measures for clinical trials have been published. The standards of gout diagnosis and management are very low. Allopurinol remains the mainstay for serum uric acid lowering therapy. In an important percentage of patients receiving allopurinol, serum uric acid levels are insufficient to promote crystal dissolution. Febuxostat, a new serum uric acid lowering drug, has shown good results. Information on uricase continues to appear. For treatment of gouty inflammation, etoricoxib (a new cyclooxygenase 2 inhibitor) has been shown to be as effective as indomethacin. Finally, the association of gout with the metabolic syndrome and its comorbidities, and the newly described association of gout with myocardial infarction, bring lifestyle and dietary modifications to the front in the management of gout. SUMMARY: Proper gout management requires changes to the physician's attitude towards the disease; essentially: (1) an unequivocal diagnosis based in urate crystal identification, (2) a clearly settled aim of the treatment: crystal elimination from the joints and elsewhere, and (3) proper use of the available therapeutic alternatives. Promoting a proper lifestyle appears to be especially important.     

Recent advances in epidemiology and prevention of gastrointestinal endoscopy related infections

PURPOSE OF REVIEW: This article reviews recent publications relevant to endoscope reprocessing and the potential for transmission of infection during gastrointestinal endoscopy. RECENT FINDINGS: There have been a number of established reprocessing failures of gastrointestinal endoscopes at various healthcare facilities across the US resulting in patient notifications. These episodes have been associated with user errors and reprocessing equipment failures, highlighting the need for increased compliance with established guidelines. Surveillance cultures may be useful to monitor the outcome of reprocessing, although their use is controversial. New technology to allow point-of-use monitoring is promising. Biofilm accumulation may be an issue when reprocessing gastrointestinal endoscopes. Although peracetic acid has been promoted as superior to aldehyde-type liquid chemical germicides with regard to soil fixation, it may only be a modest improvement. Electrolyzed acid water is an emerging liquid chemical germicide that may be equivalent to currently accepted disinfectants. There appears to be no benefit to an additional reprocessing cycle before use for endoscopes that have been appropriately cleaned, disinfected, and stored. SUMMARY: With the recent media attention on gastrointestinal endoscope reprocessing failures, despite the absence of documented transmission of infection, increased compliance with existing guidelines and new initiatives to enhance endoscope reprocessing are increasingly important to maintain public confidence.     

The changing epidemiology of gout

Gout is one of the most common inflammatory arthritides, which is considered to be a true crystal deposition disorder caused by the formation of monosodium urate crystals in and around joints. A number of epidemiological studies from a diverse range of countries suggest that gout has increased in prevalence and incidence in recent years and that the clinical pattern of gout is becoming more complex. In particular, the greatest increase has been observed in primary gout in older men. Robust epidemiological studies have established risk factors for gout including genetic factors, excess alcohol consumption, purine-rich diet, the metabolic syndrome (obesity, hypertension, hyperlipidemia and insulin resistance), use of diuretics and chronic renal failure. Trends in alcohol use, diet, obesity and the metabolic syndrome in the general population might explain changes in the prevalence and incidence of gout in the community. Osteoarthritis, which is thought to predispose patients to monosodium urate crystal deposition in their joints, is becoming more prevalent as a consequence of increased longevity. In hospital settings, widespread diuretic use, increasing prevalence of end-stage renal failure and the success of organ transplant programmes have led to an increase in clinical complexity. Suboptimal management of gout is likely to have contributed to the rise in the prevalence of clinically overt, symptomatic, chronic gout.     

New developments in the epidemiology and genetics of gout

The prevalence of gout appears to be rapidly increasing worldwide and is no longer a disorder suffered primarily by over-fed alcohol consumers. Emerging risk factors include longevity, metabolic syndrome, and new classes of pharmacologic agents. In some ethnic populations, no obvious risk factors can explain the high incidence of hyperuricemia and gout, suggesting a genetic liability. Studies to identify genes associated with gout have included families with defects in purine metabolism, as well as families in whom the occurrence of gout is secondary to renal disorders such as juvenile hyperuricemic nephropathy and medullary cystic kidney disease. Case-control studies of isolated aboriginal cohorts suffering from primary gout have revealed several chromosomal loci that may harbor genes that are important to the development and/or progression of gout.     

New developments in the epidemiology and genetics of gout

The prevalence of gout appears to be rapidly increasing worldwide and is no longer a disorder suffered primarily by over-fed alcohol consumers. Emerging risk factors include longevity, metabolic syndrome, and new classes of pharmacologic agents. In some ethnic populations, no obvious risk factors can explain the high incidence of hyperuricemia and gout, suggesting a genetic liability. Studies to identify genes associated with gout have included families with defects in purine metabolism, as well as families in whom the occurrence of gout is secondary to renal disorders such as juvenile hyperuricemic nephropathy and medullary cystic kidney disease. Case-control studies of isolated aboriginal cohorts suffering from primary gout have revealed several chromosomal loci that may harbor genes that are important to the development and/or progression of gout.     

Recent advances in the epidemiology, prevention, diagnosis, and treatment of fungal pneumonia

Although pneumonia caused by fungi is not a common occurrence in the general population, disease in an enlarging immunocompromised population is encountered with increasing frequency. Fungal pneumonias are most frequently caused by Aspergillus spp., dimorphic fungi and Cryptococcus neoformans. Recent studies have identified risk factors of thrombocytopenia, environmental events (such as construction or renovation) and immunosuppressive drug therapies as being specific risk factors for invasive fungal disease in select patient populations. Diagnostic strategies to detect circulating antigens and polymerase chain reaction based detection systems have been explored to improve identification prior to the progressive advanced disease. Advances in prophylactic strategies include increased use of aerosolized formulations of amphotericin B, usually in conjunction with new and old systemic antifungal agents. Despite recent published guidelines for treatment of fungal pneumonia based on etiology, mortality remains high in some infections with advanced disease. Caspofungin, a new echinocandin antifungal, has recently been approved by the US Food and Drug Administration for the treatment of invasive Aspergillus infections in patients unresponsive to or unable to receive amphotericin B. A triazole antifungal, voriconazole, has shown promise in phase III clinical trials in patients with refractory fungal infections and is expected to be available in early 2002. Other echinocandin and triazole antifungals are under development in attempts to provide improved effective therapy for fungal pneumonia.     

痛风的影像学研究进展

影像学检查可以帮助临床医师评价痛风.X线成像只能显示慢性痛风进展期的典型变化.CT可能是评价痛风骨改变和痛风石的最好方法,双源CT可以评估全身周围关节的尿酸盐总沉积量.MRI适合评估软组织、滑膜厚度和炎性反应,对痛风的早期病变敏感性很高,也能够较好的显示痛风石.超声检查可以评价软骨、软组织、尿酸盐沉积和滑膜炎性反应.核医学有助于在细胞和分子层面理解痛风性关节炎的发病机制.     

痛风的影像学研究进展

影像学检查可以帮助临床医师评价痛风.X线成像只能显示慢性痛风进展期的典型变化.CT可能是评价痛风骨改变和痛风石的最好方法,双源CT可以评估全身周围关节的尿酸盐总沉积量.MRI适合评估软组织、滑膜厚度和炎性反应,对痛风的早期病变敏感性很高,也能够较好的显示痛风石.超声检查可以评价软骨、软组织、尿酸盐沉积和滑膜炎性反应.核医学有助于在细胞和分子层面理解痛风性关节炎的发病机制.

Abstract：

Imaging is a helpful tool for clinicians to evaluate gout. Plain radiographs show typical changes only in advanced chronic gout. Computed tomography may best evaluate bone changes and tophi. Dual energy CT can measure the total urate burden in general periphery joints. Magnetic resonance imaging is suitable to evaluate soft tissues,synovial membrane thickness,and inflammatory changes,which is also sensitive to early change of gout,and even well show the tophi. Ultrasonography may be used in evaluation of cartilage, soft tissues, urate crystal deposition, and synovial membrane inflammation. Nuclear medicine may be helpful to investigate the pathogenesis of gouty arthritis in the field of cell and molecule.     

Recent developments in diet and gout

PURPOSE OF REVIEW: Gout is the most common inflammatory arthritis in men, affecting approximately 1-2% of adult men in Western countries. United States gout prevalence has approximately doubled over the past two decades. In recent years, key prospective epidemiological and open-labeled dietary studies, coupled with recent advances in molecular biology elucidating proximal tubular urate transport, have provided novel insights into roles of diet and alcohol in hyperuricemia and gout. This review focuses on recent developments and their implications for clinical practice, including how we advise patients on appropriate diets and alcoholic beverage consumption. RECENT FINDINGS: Studies have observed an increased risk of gout among those who consumed the highest quintile of meat, seafood and alcohol. Although limited by confounding variables, low-fat dairy products, ascorbic acid and wine consumption appeared to be protective for the development of gout. SUMMARY: The most effective forms of dietary regimen for both hyperuricemia and gout flares remains to be unidentified. Until confirmed by a large, controlled study, it is prudent to advise patients to consume meat, seafood and alcoholic beverages in moderation, with special attention to food portion size and content of non-complex carbohydrates which are essential for weight loss and improved insulin sensitivity.     

The epidemiology of hyperuricaemia and gout in Taiwan aborigines

To determine the prevalence of hyperuricaemia, gout and gout-related factors in Central Taiwan Atayal aborigines, 342 subjects over 18 yr old were interviewed and examined. A questionnaire was designed to screen for signs and symptoms of gout and gout-related risk factors. Serum uric acid, triglyceride and creatinine were measured in all subjects. The prevalence of hyperuricaemia was 41.4% and that of gout 11.7% in aborigines. The uric acid level was 7.9+/-1.7 mg/dl in males and 5.7+/-1.5 in females, and differed significantly under age 70 yr (P < 0.001). Significantly increased triglyceride, creatinine and alcoholism was found in gouty patients compared with non-gouty patients. In 40 cases with gout, 54% had tophi and 35% of their first- degree relatives had gout. The high prevalence of hyperuricaemia and gout in Taiwan Atayal aborigines, a significant family predisposition, increased creatinine level and alcoholism suggest multiple factors affecting the hyperuricaemia.