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Gout

Cool NEJM Case of Spinal Gout in 82-yr-old woman with 3-wk hx of severe LBP, rigors, anorexia, incomplete urination. Hx of PsA, CKD, CHF treated w/ Humira, HCQ, diuretics. Imaging tophi in spine, responded to steroids and allopurinol. https://t.co/JgH2bPsDeu https://t.co/RAPNxohe55
Dr. John Cush @RheumNow( View Tweet )
May 16, 2022
Making You the Expert of You! (Smart Rules for Patients) You’ve scheduled an appointment with your medical provider - how do you make the most of it?https://t.co/62mTqk4ksL https://t.co/gr7Hvt7EI3
Dr. John Cush @RheumNow( View Tweet )
May 12, 2022
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Making You the Expert of You! (Smart Rules for Patients)

May 10, 2022

You’ve scheduled an appointment with your medical provider - how do you make the most of it? We've gathered these tips and suggestions to share with patients.

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Allopurinol Use Does Not Increase Mortality in Gout w/ Chronic Kidney Disease A trial has shown that allopurinol use dose escalation and achieving target uric acid levels, was not associated w/ increased mortality in patients with gout and concurrent CKD.https://t.co/8LHlRyTgS0 https://t.co/4Hu9cTwptO
Dr. John Cush @RheumNow( View Tweet )
May 09, 2022
Gout affects >10 million (4%) in USA, but now w/ more ethnicity, with highest risk in Native Hawaiians (HR 2.21), followed by Black (1.34) and Japanese (1.14); but lower in Latinos (HR 0.78) compared to whites. https://t.co/lQiSx0ExAM https://t.co/bVx41mbquW

Dr. John Cush @RheumNow( View Tweet )

May 06, 2022
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What is JAKne? (5.6.2022)

May 06, 2022

Dr. Jack Cush reviews the news, journal reports, FDA actions, new side effects and changing prevalence of Gout.




  1. Gout affects >10 million (4%) in USA, but now w/ more ethnicity, with highest risk in Native Hawaiians (HR 2.21), followed by Black (1.34) and Japanese (1.14);

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There is 1.4 million transgender persons in the US. ACP has published a guideline "Care of the Transgender Patient" addressing health disparities, certain cancers, substance abuse, mental health conditions, infections, and chronic diseases. https://t.co/AoBeOzv9YH https://t.co/jKabVELPxH
Dr. John Cush @RheumNow( View Tweet )
May 06, 2022
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Allopurinol Use Does Not Increase Mortality in Gout with Chronic Kidney Disease

May 03, 2022

A population based trial has shown that allopurinol use dose escalation and achieving target uric acid levels (with allopurinol), was not associated with increased mortality in patients with gout and concurrent CKD



To examine the relation of allopurinol initiation, allopurinol dose

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COVID-19 Vaccination Uptake and Perceptions in Rheumatic Patients Putman et al has reported vaccine survey results from the C19-GRA in Lancet Rheumatology showing the uptake and vaccine hesitancy among people with rheumatic diseases (RMD).https://t.co/sqsOHGThzV https://t.co/zeZrlDeQ9Z
Dr. John Cush @RheumNow( View Tweet )
Apr 25, 2022
2 studies from NKF meeting shows gout occurs in 13.5% of CKD on dialysis; and seen in 17-28% of Stg 3,4 CKD pts. CKD w/ Gout has more bone/mineral Dz (40 vs 26%), CHF (21 vs 14%), DJD (17 vs 9%); >1/3 NOT on urate lowering therapy https://t.co/sn40xqxRyg https://t.co/ewb0tpWukw

Dr. John Cush @RheumNow( View Tweet )

Apr 19, 2022
No Benefit to More Intensive Urate Lowering in Gout While treat-to-target (T2T) is commonly advocated in gout management, it is unknown if T2T (or more intensive T2T) may result in less bony erosions in gout. https://t.co/uag4fJ4FSi https://t.co/djniwFl491
Dr. John Cush @RheumNow( View Tweet )
Apr 15, 2022
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Male vs. Female Responders (4.15.2022)

Apr 15, 2022

Dr. Jack Cush reviews the news and journal Reports from the past week on RheumNow.com - including fellowship COVID-19 concerns, the limits of T2T in gout and the real odds of RA remission with your first biologic. 




  1. Downward Effects! Real world data from 22,934 UK #RA pts

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No Benefit to More Intensive Urate Lowering in Gout

Apr 14, 2022

While treat-to-target (T2T) is commonly advocated in gout management, it is unknown if T2T (or more intensive T2T) may result in less bony erosions in gout. Dalbeth et al has studied this is a prospective trial noted that more intensive serum urate lowering is difficult to achieve (orally),

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211 pts presenting w/ hot swollen joint to the ER; 28 w/ septic arthritis; pseudogout 32; gout 50; & others: 101. Predictors of Septic Arthritis: RA (OR 3.4); skin infx (OR 3.3); liver Dz (OR 9.9); knee involv (OR 3.5); immunosuppressive use (OR 3.5) https://t.co/uASovNVOWb https://t.co/Fq3obVDavm
Dr. John Cush @RheumNow( View Tweet )
Apr 05, 2022
Japanese study using Mendelian randomization (MR) analysis of the association between coffee consumption, gout & uric acid levels - showing coffee consumption can causally reduce gout risk (OR = 0.50), independent of SUA levels https://t.co/ymovYj5y40 https://t.co/uI7OqY9FcU
Dr. John Cush @RheumNow( View Tweet )
Mar 31, 2022
Ask Cush Anything! Have a rheumatology question or case for Dr. Cush? Submit it here and we may feature it on an upcoming podcast. https://t.co/KgPIeScthr https://t.co/nk4re9mlcH
Dr. John Cush @RheumNow( View Tweet )
Mar 25, 2022
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Comorbidity Drives Risk of Death in Gout Patients

Mar 24, 2022

A study of men with gout from the US Veteran’s Health Administration (VHA) shows that excess mortality in gout could be attributed to comorbidities.



A matched cohort study done between 1999 - 2015, compared gout and non-gout patients, looking at clinical variables and mortality rates

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Consequences of TNF inhibition (3.18.2022)

Mar 18, 2022

This week we're going to talk about the downside of TNF inhibitors, a few interesting observations in gout, and yes, kids do get COVID. We're also going to preview what's coming in April (hint: it's about PsA). This and more as Dr. Jack Cush reviews the news and journal articles from the past

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Disappointment Behind Acute Gout Hospitalizations

Mar 16, 2022

Analysis of emergency department visits from two UK hospitals shows a high rate of hospitalization, and low use of urate-lowering therapies (ULT) and treat-to-target (T2T) management. 



Between 2017 and 2020 there were 1,220 emergency attendances for gout flares -  23.5% required

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Gout is common but disproportionately affects certain groups (e.g., the elderly, Pacific Islander, Blacks). Ethnic links to gout were also recently shown to be linked to modifiable behavioral factors that may prove useful in managing gout patients.https://t.co/uvIuw3zFnq https://t.co/EZomBGQIyt
Dr. John Cush @RheumNow( View Tweet )
Mar 08, 2022
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Ethnic and Behavioral Drivers of Gout Risk

Mar 07, 2022

Gout is common but disproportionately affects certain groups (e.g., the elderly, Pacific Islander, Blacks). Ethnic links to gouts were also shown to be linked to modifiable behavioral factors and such information maybe useful in managing gout patients.

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An odd association - Swedish Registry analysis matched incident gout (1:5) w/ non-gout & looked for birth associations. Future gout risk was assoc w/ maternal diabetes ( https://t.co/Tsz72SeTC8 3.1), congenital malformation (OR 1.33), $ small gestational (OR 1.75) https://t.co/r9dGMzBopK
Dr. John Cush @RheumNow( View Tweet )
Mar 04, 2022
Polarized microscopy of synovial fluid to identify uric acid crystals was shown to high utility and reliability in a study of 5 rheumatologists (4 consultants, 1 registrar). 50 SF samples - good agreement w/ κ = 0.71 for MSU, 0.88 for CPP https://t.co/5c7N7spc0t https://t.co/9wXsHuCY6D
Dr. John Cush @RheumNow( View Tweet )
Mar 03, 2022
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Low COVID-19 Vaccine Risks in Rheumatic Patients

Feb 23, 2022

Data from the European Alliance of Associations for Rheumatology Coronavirus Vaccine registry shows that patients with with inflammatory or noninflammatory rheumatic and musculoskeletal disease have similar adverse event rates as the general public.



Data from this registry was

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Taiwan study of 12,786 pre-dialysis advanced CKD patients with gout shows that use of febuxostat or allopurinol was assoc w/ a reduced sepsis/infection risk - most w/ FEB (HR, 0.68; 0.52–0.87), but no signif difference in MACE or CVA https://t.co/zp7JLwzah8

Dr. John Cush @RheumNow( View Tweet )

Feb 15, 2022
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