Risk Factors for Gout Attacks: A Case-crossover Study

痛风影响超过510万美国人，最近的研究表明， 在美国（US），痛风的发病率正在增加。痛风的特点是反复发作; 这些攻击导致疼痛、残疾，并最终导致关节损伤。痛风的复发是 通常归因于“触发因素”，即在袭击发生前立即出现的风险因素。避免 这些风险因素是痛风患者的主要预防策略。然而，大部分数据 确定可能引发痛风复发的风险因素， 当代人口。我们建议进行一项基于互联网的病例交叉研究，以测试一组 痛风的潜在危险因素与当代成年人有很大的相关性。 我们将建立一个互动网站，用于受试者招募和数据收集。我们将招募700多名 诊断为痛风的人，通过获取和审查他们的医疗信息来确认他们的诊断。 记录利用互联网，我们将系统地收集有关风险因素的信息， 痛风发作（危险期）和一天前48小时未发生痛风发作（对照 期间）。每例受试者的研究持续时间为1年。评估的风险因素包括乳制品 产品摄入量、酒精消费量和类型;急性感染和免疫接种、天气因素 (i.e.,温度、气压和湿度），和药物使用（即，低剂量阿司匹林他汀类药物 氯沙坦和别嘌呤醇）。将使用痛风症状和体征的标准化问卷， 确定在研究期间参与者中发生的复发性发作。我们会研究 通过比较危险期内各因素的频率， 在对照期间，并使用Mantel-Haenszel方法计算比值比。我们将执行 多个条件Logistic回归模型，以检查每个因素与复发风险的关系， 同时调整其他潜在的混杂因素。然后我们将评估A的影响是否 痛风复发风险的特定风险因素被其他风险因素改变。 这项研究的发现将对预防复发性痛风发作具有重要意义，因为所有风险 我们建议研究的因素在痛风患者中很常见。如果这些复发性耀斑被阻止， 痛风对社会的负担将大大减轻。此外，在关注具体风险因素的同时， 对于复发性痛风发作，目前的建议也代表了方法策略的发展 以更好地理解为什么复发性风湿病患者会出现疾病发作。

Gout affects over 5.1 million Americans, and recent studies have shown that the prevalence and incidence of gout in the United States (US) are increasing. Gout is characterized by recurrent attacks; these attacks cause pain, disability, and can eventually lead to joint damage. Recurrent gout attacks are often attributed to "triggers," precipitating risk factors that immediately precede an attack. Avoidance of these risk factors is a central preventive strategy for patients with gout. Nevertheless, much of the data identifying risk factors that may trigger recurrent gout attacks are either conjectural or irrelevant to contemporary populations. We propose to conduct an Internet-based case-crossover study to test a set of potential risk factors of gout with great relevance for contemporary adults. We will construct an interactive website for subject recruitment and data collection. We will recruit over 700 individuals who have a diagnosis of gout, confirming their diagnosis by obtaining and reviewing their medical records. Using the Internet, we will systematically collect information on risk factors 48 hours preceding a gout attack (hazard period) and 48 hours preceding a day when no gout attack was experienced (control period). The study duration for each subject will be one year. Risk factors to be assessed include dairy product intake, quantity and type of alcohol consumption; acute infection and immunization, weather factors (i.e., temperature, barometric pressure, and humidity), and medication use (i.e., low-dose aspirin, statins, losartan, and allopurinol). A standardized questionnaire of gout symptoms and signs will be used to ascertain recurrent attacks that occur among participants during the study period. We will examine the relation of each factor to the risk of recurrent attack by comparing its frequency over the hazard period with that over the control period, and calculating odds ratio using the Mantel-Haenszel method. We will perform multiple conditional logistic regression models to examine the relation of each factor to the risk of recurrent attack while adjusting for other potential confounding factors. We will then assess whether the effect of a particular risk factor on the risk of recurrent gout attacks is modified by other risk factors. The findings from this study will have important implications for preventing recurrent gout flares as all risk factors we propose to study are common among patients with gout. If these recurrent flares were prevented, the burden of gout on society would be greatly alleviated. In addition, while focusing on specific risk factors for recurrent gout flares, the current proposal also represents the development of a methodological strategy to better understand why patients with recurrent rheumatic diseases experience disease flares.