Background: Gout is the most common inflammatory arthritis worldwide. The hallmarks of initial gout presentation are acute pain, swelling, erythema and tenderness in peripheral joints but eventually unremitting arthritis, joint deformity and tophus deposition may develop with long-standing hyperuricaemia. Patients with gout suffer not only arthritis but also cardiovascular, renal, metabolic and other comorbidities. Since gout is the consequence of chronic hyperuricaemia, urate-lowering treatments (ULT) helps prevent the formation of urate crystals and promote dissolution of existing crystals. Methods: This thesis contained results from a series of observational studies relating to gout. The data sources included the Clinical Practice Research Data-link in the UK and the National Health Insurance Database in Taiwan, both of which are representative of the general population in these two countries. Six different analyses were carried out: (1) epidemiology of gout in the UK (chapter 3); (2) epidemiology of gout in Taiwan (chapter 4); (3) Nature history of gout following diagnosis in the UK (chapter 5); (4) familial aggregation and heritability of gout in Taiwan (chapter 6); (5) risk of comorbidities occurring before gout diagnosis (chapter 7) and (6) Effects of allopurinol on all-cause mortality (chapter 8). Results: This study estimated that the prevalence of gout was 2.49% in the UK in 2012 and 6.24% in Taiwan. Incidence of gout was also higher in Taiwan (3.47 per 1,000 person years in 2010) than in the UK (1.77 per 1,000 person years in 2012). The prevalence and incidence were increasing in the UK in the past decade, however, both of which remained stable in the period 2005-2010 in Taiwan. Compared with the general population, individuals with a family history of gout had a two-fold increased risk of the disease. The relative contributions of heritability, shared and non-shared environmental factors to explain phenotypic variance of gout were 35.1%, 28.1% and 36.8% in men and 17.0%, 18.5% and 64.5% in women, respectively. Patients with gout were already at higher risk of multiple comorbidities at diagnosis, furthermore, gout was associated with higher all-cause mortality. In both countries, the management of gout remains poor. Most gout patients were eligible for ULT at diagnosis or shortly after. Allopurinol, the most commonly prescribed ULT in primary care in the UK, exerted a neutral effect on all-cause mortality, which reassures the safety of the drug in terms of all-cause mortality. Conclusions: Gout is the most common inflammatory arthritis affecting one in 40 people in the UK and one in 16 people in Taiwan. It is influenced by both environmental and genetic factors. Both incidence and prevalence keep rising in the UK whilst they remain comparatively stable in Taiwan. The management in the UK remains poor. Primary care physicians should be encouraged to screen for possible existing comorbidities at diagnosis. Most patients are eligible for ULT at diagnosis or shortly after diagnosis, and given the many benefits of ULT for gout patients, early discussion of ULT with patients seems reasonable practice. Allopurinol is not associated with heightened mortality which should reassure practitioners who avoid ULT for fear of serious adverse events.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:666894 |
| Date | January 2014 |
| Creators | Kuo, Chang-Fu |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/27828/ |
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