Survey of Australasian renal and rheumatology specialists investigating topical NSAID use and adverse renal outcomes

A survey investigated physician reported use, prescribing practices and adverse renal events of topical NSAIDs.This survey was sent to members of the Australian Rheumatology Association and the Australian and New Zealand Society of Nephrology.Sixty physicians responded, 55% (n = 33) were nephrologists; 45% (n = 27) rheumatologists. Nearly all (n = 56, 93.3%) had managed at least one patient using topical NSAIDs, including those with an eGF

Prevalence of comorbidities and management of gout in a tropical city in Australia

To examine the management of gout in general practice in Townsville, Australia, and to explore comorbid conditions in patients with gout. Study will also explore how closely guidelines are being followed in managing gout. Retrospective chart review was conducted from May to November 2014 in three general practices in Townsville. Registers for patients were established by searching "gout" and "gouty arthritis". Three hundred and twenty-one patients were included in the study after excluding inactive patients, patients below age of 18 and patients with cancer. Main outcome measures were prevalence of comorbidities in gout patients, gout medications and adequate serum urate control (≤0.36 mmol/l). Multivariate logistic regression was used to study the relationship between serum urate level, comorbid conditions and lifestyle factors. Hypertension was the most common comorbid condition with 60.8 % of patients followed by obesity and dyslipidaemia. In terms of medication, 46.7 % of patients were on allopurinol, 12.8 % on indomethacin and 13.4 % on diuretics. Eighty-six percentage of patients had serum urate level (sUA) recorded in the previous year. Of these, 32.2 % had a serum urate level below or equal to 0.36 mmol/l. Moreover, 17.4 % of patients had lifestyle advice documented in chart. Male gender was the most influential factor in having poor uric acid control (p < 0.01), followed by not being on allopurinol (p < 0.01) and patients older than 50 years (p = 0.02). Management of gout in this study sample was not entirely concordant with guidelines. The study also suggests a need for possible tighter monitoring and allopurinol dosing regime in older, male patients

Management of gout in general practice: a systematic review

This systematic review aims to summarise published evidence that assessed the management of gout in regard to the following: prescription of urate lowering therapy (ULT), monitoring of serum urate levels (sUA) and allopurinol dosing in patients with renal impairment, lifestyle advice and acute management of gout. Studies investigating the management of gout in general practice (GP) were identified by searching PubMed and Scopus databases. To be eligible for inclusion, studies had to be focused on the GP setting alone. Studies were also excluded if they examined diagnosis without exploring management of gout. Editorials and reviews were excluded. A total of nine studies were identified. Eight studies explored the proportion of gout patients currently on ULT. Six out of the eight studies revealed that ULT was prescribed in less than 50 % of gout patients. Four studies considered the monitoring of sUA levels in gout patients. The results were generally similar throughout studies indicating sub-optimal management. Only two studies examined the monitoring of sUA levels specifically in patients who were prescribed ULT. The two studies showed 28 and 38 % of patients on ULT had their sUA levels monitored. Two studies examined the dosing of allopurinol in renally impaired patients and revealed that 74–78 % of renally impaired patients had an appropriate allopurinol dose of less than 300 mg. This systematic review suggests that gout is sub-optimally managed in general practice. However, more studies with a larger sample size focusing on active patients are required to provide more definitive evidence

General practitioners' perspectives on the management of gout: a qualitative study

Background: Many quantitative studies globally have identified suboptimal management of gout. Purpose: To explore management of gout from the perspective of general practitioners (GPs), while identifying the barriers and possible strategies for improvement. Study design: This descriptive qualitative study used semistructured interviews with 14 purposely selected GPs from four separate general practices in Townsville. The questions focused on management strategies, practicalities in managing gout, barriers and possible strategies to improve management. Results: Indomethacin was commonly reported to be used in acute gout with progression to allopurinol after the acute stage had subsided. There were differences with the initial allopurinol dose and follow-up periods. GPs reported lack of patient adherence to allopurinol and lifestyle modifications, mainly due to lack of education. Most suggested the need for allied health input and improved patient education. Conclusions: Tailor-made plan in terms of education and lifestyle advice could help adherence to gout management

Nodular rheumatoid arthritis resembling gout

A 57-year-old man presented for review in the rheumatology outpatients clinic. He had a 30-year history of rheumatoid arthritis and was known to be positive for rheumatoid factor and anticitrullinated protein antibodies (anti-CCP antibodies). He had been treated over the past 30 years with various immunosuppression regimens, including long-term methotrexate, leflunomide and sulfasalazine. His disease had been stable for the past 2 years with no recent increase in nodules or episodes of acute synovitis. Several times in the past 15 years his diagnosis of rheumatoid arthritis had come into question due to the atypical appearance of his hands which closely resembled gout (figures 1 and 2). On two occasions, excision of rheumatoid nodules was sent for histology to exclude other diagnoses such as gout and multicentric reticulohistiocytosis

Complementing a clinical trial with human-computer interaction: Patients' user experience with telehealth

Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial—the telehealth technology remains as a “black box.” Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation. Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research. Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth. Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients’ experiences and emotions while using the device, patients’ perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients’ awareness, family involvement, and design implications for telehealth for T2D. Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients’ UX and future design implications. Through HCI we can look into the “black box” phenomenon of clinical trials and create patient-centered telehealth solutions.</p

Epidemiology of systemic vasculitis: A ten-year study in the United Kingdom

Objective\ud To document the histology of Ross River virus (RRV) arthritis and to examine inflamed synovium for viral RNA.\ud \ud Methods\ud Biopsy tissue from the inflamed knees of 12 patients with RRV infection was studied using conventional and immunostaining techniques. Reverse transcriptase–polymerase chain reaction technology was used to probe for the presence of viral RNA in the synovial biopsy samples and in serum.\ud \ud Results\ud Hyperplasia of the synovial lining layer, vascular proliferation, and mononuclear cell infiltration were the main histologic changes. RRV RNA was found in knee biopsy tissue that was obtained from 2 patients at 5 weeks after the onset of symptoms.\ud \ud Conclusion\ud RRV RNA was identified in inflamed synovium more than a month after symptoms began. Inflammation was apparent in the absence of detectable virus in the majority of patients