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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article reviews gout and other crystal-induced diseases, in which he reviewed important and recent publications about gout and chondrocalcinosis.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFernando Perez-Ruiz, MD, PhD, Cruces University Hospital and BioCruces Health Research Institute, Biscay, Spain, presented a year-in-review look at gout and other crystal-induced diseases, in which he reviewed important and recent publications about gout and chondrocalcinosis (CC). He briefly discussed the role of calcium pyrophosphate (CPP) in the pathogenesis of CC. The GOAL database (Genetics of Osteoarthritis and Lifestyle)\u2014which showed low cortical bone mineral density, vascular calcification, and soft tissue calcification associated with CC\u2014suggested a generalized constitutional predisposition to calcium crystal formation [Abhishek A et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2013]. An analysis of GOAL and the Nottingham Osteoarthritis Case-Control study supports the role of extracellular inorganic pyrophosphate in the pathogenesis of CC [Abhishek A et al. \u003Cem\u003EArthritis Res Ther\u003C\/em\u003E 2014]. A retrospective analysis showed that CPP and monosodium urate crystals can be detected more frequently than expected in synovial fluid (SF) from patients previously diagnosed with arthritis, gout, or other arthropathies, suggesting SF should be analyzed to diagnose associated comorbidities linked to the presence of crystals [Oliviero F et al. \u003Cem\u003EJoint Bone Spine\u003C\/em\u003E 2013]. CPP deposits can be detected with ultrasound, radiograph, or computed tomography (CT), with the knee being the most useful joint for detection [Filippou G et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2013] and ultrasound the most sensitive modality [Barskova VG et al. \u003Cem\u003ERheumatology\u003C\/em\u003E 2013]. Currently, no publications mention treatment for CPP-associated CC.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDr. Perez-Ruiz then turned to gout, which evolves from asymptomatic hyperuricemia (\u0026gt;6 mg\/dL) to asymptomatic urate crystal deposits in tissues and, if not treated, worsens to intermittent flares to clinical gout and, finally, to refractory gout [Bardin T, Richette P. \u003Cem\u003ECurr Opin Rheumatol\u003C\/em\u003E 2014]. A revised staging system has been proposed for hyperuricemia and gout that addresses pathology in addition to symptoms [Dalbeth N, Stamp L. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2014]. This system is illustrated in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. Dr. Perez-Ruiz would like to see definitions of risk added to this schema, and he disagrees that the presence of tophi in Stage B would be asymptomatic.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022A Proposed Revised Staging System for Hyperuricemia and Gout\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-176715530\u0022 data-figure-caption=\u0022A Proposed Revised Staging System for Hyperuricemia and Gout\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14603\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EA Proposed Revised Staging System for Hyperuricemia and Gout\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDCET=dicarboxyethoxythiamine; MSU=monosodium urate; US=ultrasound.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EStaging system based on the American Heart Association staging for heart failure.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced from Dalbeth N et al. Hyperuricaemia and gout: time for a new staging system? \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2014; 0:1\u20133. doi:10.1136\/annrheumdis-2014-20530. With permission from the BMJ Publishing Group.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003ERecent studies are clarifying the pathophysiology of gout. Dysfunction of ABCG2, a transporter that regulates serum uric acid levels, is associated with early-onset gout, at least in male Japanese patients [Matsuo H et al. \u003Cem\u003ESci Rep\u003C\/em\u003E 2013]. Ultrasound appears promising for diagnosis and management of gout, but further studies are needed. Dual-energy CT has been used, but it detects only dense tophi in later stages of disease [Melzer R et al. \u003Cem\u003ESemin Arthritis Rheum\u003C\/em\u003E 2013] and appears most effective in detection in lower limbs [Mallinson PI et al. \u003Cem\u003ESkeletal Radiol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ENew therapies to decrease hyperuricemia are being investigated\u2014for example, combination febuxostat plus lesinurad, which is in an early-phase trial and shows some efficacy [Fleischmann R et al. \u003Cem\u003ERheumatol\u003C\/em\u003E 2014]. Patient education has been shown in a proof-of-concept study to increase adherence to curative therapy and reduce adverse events and drug interactions [Rees F et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAccording to the authors, the treatment of CPP deposition disease needs further development. Current gout therapy focuses on treating episodes of acute inflammation. New treatments for gout are needed to achieve target serum uric acid levels, and lower targets should be considered to reduce crystal deposition.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp3uq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp3uq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}