Case report of a tibial fracture in a patient suffering from gout: An atypical site, the importance of differential diagnosis

We present the case of a 60-year-old man with a history of severe tophaceous gout with polyarticular involvement who came to the emergency room due to direct trauma to the right forearm and knee. The knee X-ray and CT scan showed a lateral tibial plateau fracture characterized by the presence of a lytic bone lesion. The presence of a solid neoplasm was ruled out and a CT-guided biopsy was performed.
Histological evaluation revealed findings typical for an advanced intraosseous gout. As there was no significant risk of progression of the lytic lesion, the fracture site was treated conservatively. This case is unique in the literature in terms of location and should be considered as an atypical site of intraosseous gout. Proper differentiation of a pathological fracture on an intraosseous gout location from a neoplastic lesion is essential to choose the correct therapy.

Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study

Background: There is a paucity of data on outcomes for people with gout and COVID-19. We aimed to assess whether gout is a risk factor for diagnosis of COVID-19 and COVID-19-related death, and to test for sex- and drug-specific differences in risk.
Methods: We used data from the UK Biobank, which included 15 871 people with gout. We used multivariable-adjusted logistic regression in the following analyses using a case-control study design: to test for an association between gout and COVID-19 diagnosis in the entire UK Biobank cohort (n=459 837); to test for an association between gout and COVID-19-related death in people who were known to have died or survived with COVID-19 (n=15 772); to test for an association between gout and COVID-19-related death in the entire UK Biobank cohort (n=459 837); and to assess risk of COVID-19-related death in a subset of patients from the UK Biobank cohort with prescription data, stratified by prescription of urate-lowering therapy and colchicine (n=341 398). Models 1 and 2 were adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, and smoking status. Model 2 was also adjusted for diagnosis of 16 other diseases that are established comorbidities of gout or established risk factors for COVID-19-related death.
Findings: Gout was associated with diagnosis of COVID-19 (odds ratio [OR] 1·20, 95% CI 1·11-1·29) but not with risk of COVID-19-related death in the cohort of patients diagnosed with COVID-19 (1·20, 0·96-1·51). In the entire cohort, gout was associated with COVID-19-related death (1·29, 1·06-1·56); women with gout had an increased risk of COVID-19-related death (1·98, 1·34-2·94), whereas men with gout did not (1·16, 0·93-1·45). We found no significant differences in the risk of COVID-19-related death according to prescription of urate-lowering therapy or colchicine. When patients with gout were stratified by vaccination status, the risk of diagnosis with COVID-19 was significant in the non-vaccinated group (1·21, 1·11-1·30) but not the vaccinated group (1·09, 0·65-1·85).
Interpretation: Gout is a risk factor for COVID-19-related death in the UK Biobank cohort, with an increased risk in women with gout, which was driven by risk factors independent of the metabolic comorbidities of gout.

Effect of Clinical Typing on Serum Urate Targets of Benzbromarone in Chinese Gout Patients: A Prospective Cohort Study

Introduction: Achieving a goal of serum urate levels in patients with gout is an important way to prevent gout and its complications while it remains difficult with a low targeting rate worldwidely. Currently, hyperuricemia classification has not been widely applied to the management of gout owing to insufficient clinical evidences. This study aimed to evaluate the effectiveness of achieving target urate based on hyperuricemia classification in Chinese patients with gout.
Methods: In this prospective study, patients with gout receiving urate lowering therapy with benzbromarone were assigned to two groups, a renal underexcretion and an unclassified type. The primary endpoint was the proportion of patients achieving the serum urate target (<360 μmol/L) during the 12-week study. The frequency of acute gout attacks as well as physical and chemical indicators were secondary endpoints.
Results: Target serum urate level was achieved in 60.5% of underexcretors compared with 39.0% of patients of the unclassified type at week 12 (P = 0.002). Blood glucose and cholesterol levels were lower in the underexcretor group compared with the unclassified type group at the end of the trial, without significant different frequencies in gout flare during the study. In subgroup analysis, stratified by body mass index and estimated glomerular filtration rate, the proportion of patients with serum urate <360 μmol/L was greater in the underexcretion compared with the unclassified type group.
Conclusions: The increased achievement of target serum urate in the underexcretion group supports the use of a clinical hyperuricemia typing treatment strategy for gout.

The burden of low back pain, rheumatoid arthritis, osteoarthritis, and gout and their respective attributable risk factors in Brazil: results of the GBD 2017 study

Introduction: Musculoskeletal (MSK) disorders are a major cause of disability worldwide. Different modifiable risk factors are associated to these disorders. The objective of this study was to analyze the burden of low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), and gout, attributable to risk factors, in 2017.
Methods: The burden of LBP, RA, OA, and gout, and attributable risk factors were analyzed using data extracted from the Global Burden of Disease (GBD) Brasil-2017 study. Descriptive analysis was conducted to compare disability-adjusted life years (DALY) rates between sexes and age groups (15-49 and 50-69 years), in 2017.
Results: The highest rates of DALY due to LBP were attributed to occupational ergonomic factors in the 15-49-year group, regardless of sex and males aged 50-69 years, whereas smoking was the major contributor in the 50-69-year female group. RA-related DALY rates were attributed to smoking and were higher among women aged 50-69 years. High body mass index (BMI) was the most relevant risk factor for the burden of OA, with higher rates detected in the 50-69-year group, and it was the most significant risk factor for DALY rate attributed to gout, regardless of sex or age group.
Conclusions: Occupational surveillance measures are indicated to prevent LBP. Actions to decrease smoking and overweight, and the surveillance of weight gain are warranted to decrease the burden of LBP, RA and OA, and gout, respectively. These actions will be more effective if age and sex differentials are considered in planning.

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Modifiable Factors and Incident Gout across Ethnicity within a Large Multiethnic Cohort of Older Adults

Objective: Gout disproportionately affects older Pacific Islander and Black populations, relative to Whites; however, the ethnic-specific determinants remain understudied within these groups, as well as within other ethnicities. We examined gout incidence and associations with behavioral factors, including diet, alcohol, and smoking, within a large multiethnic population of older adults from the Multiethnic Cohort Study, which linked prospective cohort data to Medicare gout claims between 1999-2016.
Methods: Using samples of Black (N=12,370), Native Hawaiian (N=6,459), Japanese (N=29,830), Latino (N=17,538), and White (N=26,067) participants, we conducted multiple Cox regressions, producing hazard ratios (HR) and 95% confidence intervals (CI).
Results: Relative to Whites, Native Hawaiians had the highest risk of gout (HR:2.21, 95%CI:2.06,2.38), followed successively by Black and Japanese participants; whereas Latinos had a lower risk of gout (HR:0.78, 95%CI:0.73,0.83). Alcohol use was associated with an increased risk, with significantly greater effects observed among Japanese drinking three or more drinks per day (HR:1.46, 95%CI:1.27,1.66), or greater than five beers per week (HR:1.29, 95%CI:1.17,1.43), compared to Whites (Pinteraction<0.001). Former smokers with 20 or more pack-years had an increased risk (HR:1.14, 95%CI:1.06,1.22). Higher dietary quality was associated with a decreased gout risk, with the largest effect observed among Whites (HRQ5vsQ1:0.84, 95%CI:0.79,0.90), while vitamin C was weakly associated with a decreased risk of gout only among Japanese (HR:0.91, 95%CI:0.85,0.98).
Conclusion: Overall, notable ethnic differences were observed in both gout risk and associations with modifiable behavioral factors. Our findings offer crucial insights that may improve precision in preventing and managing gout.

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