Risk Factors for Gout Attacks: A Case-crossover Study

痛风影响着超过510万美国人，最近的研究表明，痛风的患病率 在美国，痛风的发病率正在增加。痛风的特点是反复发作； 这些攻击会导致疼痛、残疾，并最终可能导致关节损伤。反复的痛风发作有 通常被归因于“触发因素”，即在攻击之前立即引发的风险因素。避免 这些危险因素是痛风患者的中心预防策略。尽管如此，很多数据 确定可能引发反复痛风发作的风险因素要么是猜测，要么与 当代人口。我们建议进行一项基于互联网的案例交叉研究，以测试一组 痛风的潜在危险因素与当代成年人密切相关。 我们将建设一个互动网站，用于学科招募和数据收集。我们将招募700多人 被诊断为痛风的个人，通过获取并回顾其体检来确认其诊断 唱片。利用互联网，我们将有系统地收集有关风险因素的信息，在 痛风发作(危险期)和未经历痛风发作的前一天48小时(对照 句号)。每个科目的学习时间为一年。需要评估的风险因素包括乳制品 产品摄入量、饮酒数量和类型；急性感染和免疫、天气因素 (即温度、气压和湿度)和药物使用(即小剂量阿司匹林、他汀类药物、 氯沙坦和别嘌醇)。将使用痛风症状和体征的标准化问卷来 确定在研究期间参与者之间反复发生的攻击。我们将研究 每个因素与复发风险的关系，通过比较其在危险期内的频率 并使用Mantel-Haenszel方法计算优势比。我们将表演 多条件Logistic回归模型检验各因素与复发风险的关系 攻击，同时调整其他潜在的混杂因素。然后，我们将评估一项 痛风复发风险的特定风险因素被其他风险因素所修正。 这项研究的发现将对预防痛风复发具有重要意义。 我们建议研究的因素在痛风患者中是常见的。如果这些反复出现的耀斑被阻止， 痛风给社会带来的负担将大大减轻。此外，在关注具体风险因素的同时， 对于反复发作的痛风耀斑，目前的提议也代表了一种方法学战略的发展。 为了更好地了解为什么反复发作的风湿病患者会经历疾病发作。

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.