human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: T HE characteristics of a disease as it appears in the general population are likely to be quite different from its characteristics in a hospital population , since only patients who are severely afflicted or in whom complications have developed are likely to be found in the hospital population . Analysis of a hospital population , therefore , will give an exaggerated idea of the usual severity of the disease and of the frequency with which complications occur . A similar bias may be introduced when patients coming to the hospital with other complaints are used as controls , and an even greater bias introduced when autopsy series are used . This paper presents some observations of a forward-going study of an adult population sample in respect to the characteristics of hyperuricemia and gouty arthritis . The characteristics investigated include ( 1 ) the prevalence of hyperuricemia and its relationship to age ; ( 2 ) the prevalence of secondary hyperuricemia ; ( 3 ) the prevalence of gouty arthritis ; ( 4 ) the incidence of gouty arthritis and its relationship to age ; ( 5 ) the relationship of gouty arthritis to hyperuricemia and the risk of developing gouty arthritis for each uric acid level ; ( 6 ) the clinical features of gouty arthritis in this population ; and ( 7 ) the prevalence of complications related to gouty arthritis and to hyperuricemia . In the Town of Framingham , Massachusetts , a population was selected by r and om sampling for the studp of coronaryartery disease and hJ , pertension . This population has been described in detail elsewhere [ /--31 . A total of 5,127 subjects ( 2,283 men and 2,844 women ) , age thirtythrough fifty-nine , free of evidence of coronary heart disease on initial examination , were included in the sample ( hereinafter referred to as the population ) . The mean age on admission was forty-four . Biennial examination included history , physical examination , electrocardiogram , roentgenograms and various laboratory tests . The results of these examinations , transcripts of admission to the community hospital , and information obtained from physicians and hospitals outside the community formed the record of each subject . At the time of this report the population had been examined an average of seven times for a follow-up period of twelve years . A few subjects have died , moved away or have missed one or two examinations for various reasons . Some have had eight examinations . The current health status of approxiluately 95 per cent of the original 5,127 subjects is known and only 0.7 per cent are considered lost to follow-up [ J ] This study aim ed at determining whether lowering serum urate ( SU ) to less than 6 mg/dl in patients with gout affects ultrasonographic findings . Seven joints in five patients with monosodium urate ( MSU ) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography . Four of the five patients were treated with urate lowering drugs ( ULDs ) ( allopurinol , n = 3 ; probenecid , n = 1 ) . One patient was treated with colchicine alone . Attention was given to changes in a hyperechoic , irregular coating of the hyaline cartilage in the examined joints ( double contour sign or “ urate icing ” ) . This coating was considered to represent precipitate of MSU crystals . Index joints included metacarpophalangeal ( MCP ) joints ( n = 2 ) , knee joints ( n = 3 ) , and first metatarsophalangeal ( MTP ) joints ( n = 2 ) . The interval between baseline and follow-up images ranged from 7 to 18 months . Serial SU levels were obtained during the follow-up period . During the follow-up period , three patients treated with ULD ( allopurinol , n = 2 ; probenecid , n = 1 ) achieved a SU level of < 6 mg/dl . In two patients , SU levels remained above 6 mg/dl ( treated with allopurinol , n = 1 ; treated with colchicine , n = 1 ) . At baseline , the double contour sign was seen in all patients . In those patients who achieved SU levels of < 6 ml/dl , this sign had disappeared at follow-up . Disappearance of the double contour sign was seen in two knee joints , two first MTP joints , and one MCP joint . In contrast , disappearance of the double contour sign was not seen in patients who maintained a SU level ≥7 mg/dl . In one patient treated with allopurinol  , SU levels improved from 13 to 7 mg/dl during the follow-up period . Decrease , but not resolution of the hyperechoic coating was seen in this patient . In the patient treated with colchicine alone , SU levels remained > 8 mg/dl , and no sonographic change was observed . In our patients , sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved . This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain ≤6 mg/dl for 7 months or more . Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool . Larger prospect i ve studies are needed to further assess these potentially important findings Introduction Gout is the most prevalent arthritis and significantly impacts on function and quality of life . Given that gout associates with disabling comorbid conditions , it is not clear whether such a complex of diseases accounts for the increased disability or if gout may play a role by itself . This study aims to evaluate the specific influence of gout and disease-related features on functional disability and health-related quality of life ( HRQoL ) in patients with gout followed in rheumatology clinics . Methods A r and om sample of patients was drawn from clinical registries of 30 rheumatology clinics across Italy . Sociodemographic , general health and gout-specific variables were collected . Functional disability and HRQoL were assessed by the  health assessment question naire ( HAQ )  and the Physical and Mental Component Summary scores ( PCS and MCS ) of the Short Form-36 ( SF-36 ) . Crude and adjusted ordinal logistic and linear regression models were applied to investigate the specific contribution of different variables on HAQ and SF-36 scores . Results are presented as odds ratio ( OR ) or mean difference ( MD ) and 95 % confidence intervals . Results Out of 446 patients with gout , 90 % were males with a mean age of 63.9 years and median disease duration of 3.8 years ; the majority of patients were overweight or obese , and with several comorbidities ; 21.1 % showed at least moderate disability ; the PCS score was significantly lower than expected age- and gender-matched sample s in the general population , while MCS score was not . After adjusting for potential sociodemographic and general-health confounders , gout-specific variables significantly impacted on HAQ , including polyarticular involvement OR 3.82 ( 1.63 , 8.95 ) , presence of tophi OR 1.92 ( 1.07 , 3.43 ) and recent attacks OR 2.20 ( 1.27 , 3.81 ) . Consistent results were found for PCS . The impairment of PCS compared to the general population was limited to patients with features of chronic gout . MCS was only affected by recent attacks ( MD -2.72 [ -4.58 , -0.86 ] ) and  corticosteroid  treatment ( -3.39 [ -5.30,-1.48 ] ) . Conclusions The data from the KING study confirm that gout impacts on disability and provide evidence for an independent association of gout and gout-related features with functional outcome and HRQoL. This result supports the need to improve specific treatment in gout Background There is limited evidence on non-pharmacological interventions for gout . The aim of the study was to determine whether a footwear intervention can reduce foot pain and musculoskeletal disability in people with gout . Methods Thirty-six people with gout participated in a prospect i ve intervention study over 8 weeks . Participants selected one of 4 pairs of shoes and thereafter wore the shoes for 8 weeks . The primary outcome was foot pain using a 100 mm visual analogue scale . Secondary outcomes related to function and disability were also analysed . Results The Cardio Zip shoe was selected by 58 % of participants . Compared with baseline , overall scores for all shoes at 8-weeks demonstrated a decrease in foot pain ( p = 0.03 ) , general pain ( p = 0.012 ) , Health Assessment Question naire (HAQ)-II ( p = 0.016 ) and Leeds Foot Impact Scale ( LFIS ) impairment subscale ( p = 0.03 ) . No significant differences were observed in other patient reported outcomes including patient global assessment , LFIS activity subscale , and Lower Limb Task Question naire subscales ( all p > 0.10 ) . We observed significant improvements between baseline measurements using the participants ’ own shoes and the Cardio Zip for foot pain ( p = 0.002 ) , general pain ( p = 0.001 ) , HAQ-II ( p = 0.002 ) and LFIS impairment subscale ( p = 0.004 ) after 8 weeks . The other three shoes did not improve pain or disability . Conclusions Footwear with good cushioning , and motion control may reduce foot pain and disability in people with gout OBJECTIVES To develop a method of scoring bone erosion in the feet of patients with gout using CT as an outcome measure for chronic gout studies , consistent with the components of the OMERACT filter . METHODS Clinical assessment , plain radiographs and CT scans of both feet were obtained from 25 patients with chronic gout .  CT scans were scored for bone erosion using a semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring System ( RAMRIS ) .  CT bone erosion was assessed at 22 bones in each foot ( total 1100 bones ) by two independent radiologists . A number of different models were assessed to determine the optimal CT scoring system for bone erosion , incorporating the frequency of involvement and inter-reader reliability for individual bones . RESULTS An optimal model was identified with low number of bones required for scoring ( seven bones/foot ) , inclusion of bones over the entire foot , high reliability and ability to capture a high proportion of disease . This model included the following bones in each foot : first metatarsal ( MT ) head , second to fourth MT base , cuboid , middle cuneiform and distal tibia ( range 0 - 140 ) . Scores from this model correlated with plain radiographic damage scores ( r = 0.86 , P < 0.0001 ) and disease duration ( r = 0.42 , P < 0.05 ) . Scores were higher in those with clinical ly apparent tophaceous disease than in those without tophi ( P < 0.0001 ) . CONCLUSIONS We have developed a preliminary method of assessing bone erosion in gout using conventional CT . Further testing of this method is now required , ideally in prospect i ve studies to allow analysis of the sensitivity to change of the measure Objective The primary objective of this prospect i ve case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)-detected abnormalities in the upper and lower limbs in gout . The secondary objective was to test the concurrent validity of US abnormalities using as gold st and ard the microscopic demonstration of monosodium urate ( MSU ) crystals . Methods Ninety-one men with gout and 42 age-matched controls were prospect ively recruited . All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints , six bursae , eight tendons , 20 tendon compartments , four ligaments , and 18 articular cartilages by experts in US blinded to the patients ’ group . Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals . Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise . Results The assessment of one joint ( ie , radiocarpal joint ) for hyperechoic aggregates ( HAGs ) , two tendons ( ie , patellar tendon and triceps tendon ) for HAGs and three articular cartilages ( ie , first metatarsal , talar and second metacarpal/femoral ) for double contour sign showed the best balance between sensitivity and specificity ( 84.6 % and 83.3 % , respectively ) . Intraobserver reliability was good ( mean κ 0.75 ) and interobserver reliability was moderate ( κ 0.52 ) . The aspirated material from HAGs was positive for MSU crystals in 77.6 % of patients with gout and negative in all controls . Conclusions Our results suggest that US bilateral assessment of one joint , three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity OBJECTIVES To establish the usefulness of ultrasonography ( US ) for diagnosing gout and to determine whether there are sonographic features that are characteristic for gout but not for other arthropathies . METHODS We retrospectively compared joint images of gout patients with matching images from patients with other rheumatic conditions . Images of 37 joints of 23 patients with monosodium urate ( MSU ) crystal-proven gout were review ed . MSU crystals were identified in at least one joint in each patient . Our control group had 23 r and omly selected patients with 33 examined joints with rheumatic conditions other than gout . RESULTS Specific diagnostic features included a hyperechoic , irregular b and over the superficial margin of the articular cartilage described as a double contour sign in 92 % of gouty joints and in none of the controls ( P < 0.001 ) ; hypoechoic 
    Output:
    
agent
1st MTP pain was a prominent feature in people with gout .
Imaging features were common at the 1st MTP including the double contour sign , tophi and erosions .
Conclusions 1st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability .
Gout affects the structure and function of the 1st MTP .
Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1st MTP in people with gout
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: T HE characteristics of a disease as it appears in the general population are likely to be quite different from its characteristics in a hospital population , since only patients who are severely afflicted or in whom complications have developed are likely to be found in the hospital population . Analysis of a hospital population , therefore , will give an exaggerated idea of the usual severity of the disease and of the frequency with which complications occur . A similar bias may be introduced when patients coming to the hospital with other complaints are used as controls , and an even greater bias introduced when autopsy series are used . This paper presents some observations of a forward-going study of an adult population sample in respect to the characteristics of hyperuricemia and gouty arthritis . The characteristics investigated include ( 1 ) the prevalence of hyperuricemia and its relationship to age ; ( 2 ) the prevalence of secondary hyperuricemia ; ( 3 ) the prevalence of gouty arthritis ; ( 4 ) the incidence of gouty arthritis and its relationship to age ; ( 5 ) the relationship of gouty arthritis to hyperuricemia and the risk of developing gouty arthritis for each uric acid level ; ( 6 ) the clinical features of gouty arthritis in this population ; and ( 7 ) the prevalence of complications related to gouty arthritis and to hyperuricemia . In the Town of Framingham , Massachusetts , a population was selected by r and om sampling for the studp of coronaryartery disease and hJ , pertension . This population has been described in detail elsewhere [ /--31 . A total of 5,127 subjects ( 2,283 men and 2,844 women ) , age thirtythrough fifty-nine , free of evidence of coronary heart disease on initial examination , were included in the sample ( hereinafter referred to as the population ) . The mean age on admission was forty-four . Biennial examination included history , physical examination , electrocardiogram , roentgenograms and various laboratory tests . The results of these examinations , transcripts of admission to the community hospital , and information obtained from physicians and hospitals outside the community formed the record of each subject . At the time of this report the population had been examined an average of seven times for a follow-up period of twelve years . A few subjects have died , moved away or have missed one or two examinations for various reasons . Some have had eight examinations . The current health status of approxiluately 95 per cent of the original 5,127 subjects is known and only 0.7 per cent are considered lost to follow-up [ J ] This study aim ed at determining whether lowering serum urate ( SU ) to less than 6 mg/dl in patients with gout affects ultrasonographic findings . Seven joints in five patients with monosodium urate ( MSU ) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography . Four of the five patients were treated with urate lowering drugs ( ULDs ) ( allopurinol , n = 3 ; probenecid , n = 1 ) . One patient was treated with colchicine alone . Attention was given to changes in a hyperechoic , irregular coating of the hyaline cartilage in the examined joints ( double contour sign or “ urate icing ” ) . This coating was considered to represent precipitate of MSU crystals . Index joints included metacarpophalangeal ( MCP ) joints ( n = 2 ) , knee joints ( n = 3 ) , and first metatarsophalangeal ( MTP ) joints ( n = 2 ) . The interval between baseline and follow-up images ranged from 7 to 18 months . Serial SU levels were obtained during the follow-up period . During the follow-up period , three patients treated with ULD ( allopurinol , n = 2 ; probenecid , n = 1 ) achieved a SU level of < 6 mg/dl . In two patients , SU levels remained above 6 mg/dl ( treated with allopurinol , n = 1 ; treated with colchicine , n = 1 ) . At baseline , the double contour sign was seen in all patients . In those patients who achieved SU levels of < 6 ml/dl , this sign had disappeared at follow-up . Disappearance of the double contour sign was seen in two knee joints , two first MTP joints , and one MCP joint . In contrast , disappearance of the double contour sign was not seen in patients who maintained a SU level ≥7 mg/dl . In one patient treated with allopurinol  , SU levels improved from 13 to 7 mg/dl during the follow-up period . Decrease , but not resolution of the hyperechoic coating was seen in this patient . In the patient treated with colchicine alone , SU levels remained > 8 mg/dl , and no sonographic change was observed . In our patients , sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved . This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain ≤6 mg/dl for 7 months or more . Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool . Larger prospect i ve studies are needed to further assess these potentially important findings Introduction Gout is the most prevalent arthritis and significantly impacts on function and quality of life . Given that gout associates with disabling comorbid conditions , it is not clear whether such a complex of diseases accounts for the increased disability or if gout may play a role by itself . This study aims to evaluate the specific influence of gout and disease-related features on functional disability and health-related quality of life ( HRQoL ) in patients with gout followed in rheumatology clinics . Methods A r and om sample of patients was drawn from clinical registries of 30 rheumatology clinics across Italy . Sociodemographic , general health and gout-specific variables were collected . Functional disability and HRQoL were assessed by the  health assessment question naire ( HAQ )  and the Physical and Mental Component Summary scores ( PCS and MCS ) of the Short Form-36 ( SF-36 ) . Crude and adjusted ordinal logistic and linear regression models were applied to investigate the specific contribution of different variables on HAQ and SF-36 scores . Results are presented as odds ratio ( OR ) or mean difference ( MD ) and 95 % confidence intervals . Results Out of 446 patients with gout , 90 % were males with a mean age of 63.9 years and median disease duration of 3.8 years ; the majority of patients were overweight or obese , and with several comorbidities ; 21.1 % showed at least moderate disability ; the PCS score was significantly lower than expected age- and gender-matched sample s in the general population , while MCS score was not . After adjusting for potential sociodemographic and general-health confounders , gout-specific variables significantly impacted on HAQ , including polyarticular involvement OR 3.82 ( 1.63 , 8.95 ) , presence of tophi OR 1.92 ( 1.07 , 3.43 ) and recent attacks OR 2.20 ( 1.27 , 3.81 ) . Consistent results were found for PCS . The impairment of PCS compared to the general population was limited to patients with features of chronic gout . MCS was only affected by recent attacks ( MD -2.72 [ -4.58 , -0.86 ] ) and  corticosteroid  treatment ( -3.39 [ -5.30,-1.48 ] ) . Conclusions The data from the KING study confirm that gout impacts on disability and provide evidence for an independent association of gout and gout-related features with functional outcome and HRQoL. This result supports the need to improve specific treatment in gout Background There is limited evidence on non-pharmacological interventions for gout . The aim of the study was to determine whether a footwear intervention can reduce foot pain and musculoskeletal disability in people with gout . Methods Thirty-six people with gout participated in a prospect i ve intervention study over 8 weeks . Participants selected one of 4 pairs of shoes and thereafter wore the shoes for 8 weeks . The primary outcome was foot pain using a 100 mm visual analogue scale . Secondary outcomes related to function and disability were also analysed . Results The Cardio Zip shoe was selected by 58 % of participants . Compared with baseline , overall scores for all shoes at 8-weeks demonstrated a decrease in foot pain ( p = 0.03 ) , general pain ( p = 0.012 ) , Health Assessment Question naire (HAQ)-II ( p = 0.016 ) and Leeds Foot Impact Scale ( LFIS ) impairment subscale ( p = 0.03 ) . No significant differences were observed in other patient reported outcomes including patient global assessment , LFIS activity subscale , and Lower Limb Task Question naire subscales ( all p > 0.10 ) . We observed significant improvements between baseline measurements using the participants ’ own shoes and the Cardio Zip for foot pain ( p = 0.002 ) , general pain ( p = 0.001 ) , HAQ-II ( p = 0.002 ) and LFIS impairment subscale ( p = 0.004 ) after 8 weeks . The other three shoes did not improve pain or disability . Conclusions Footwear with good cushioning , and motion control may reduce foot pain and disability in people with gout OBJECTIVES To develop a method of scoring bone erosion in the feet of patients with gout using CT as an outcome measure for chronic gout studies , consistent with the components of the OMERACT filter . METHODS Clinical assessment , plain radiographs and CT scans of both feet were obtained from 25 patients with chronic gout .  CT scans were scored for bone erosion using a semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring System ( RAMRIS ) .  CT bone erosion was assessed at 22 bones in each foot ( total 1100 bones ) by two independent radiologists . A number of different models were assessed to determine the optimal CT scoring system for bone erosion , incorporating the frequency of involvement and inter-reader reliability for individual bones . RESULTS An optimal model was identified with low number of bones required for scoring ( seven bones/foot ) , inclusion of bones over the entire foot , high reliability and ability to capture a high proportion of disease . This model included the following bones in each foot : first metatarsal ( MT ) head , second to fourth MT base , cuboid , middle cuneiform and distal tibia ( range 0 - 140 ) . Scores from this model correlated with plain radiographic damage scores ( r = 0.86 , P < 0.0001 ) and disease duration ( r = 0.42 , P < 0.05 ) . Scores were higher in those with clinical ly apparent tophaceous disease than in those without tophi ( P < 0.0001 ) . CONCLUSIONS We have developed a preliminary method of assessing bone erosion in gout using conventional CT . Further testing of this method is now required , ideally in prospect i ve studies to allow analysis of the sensitivity to change of the measure Objective The primary objective of this prospect i ve case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)-detected abnormalities in the upper and lower limbs in gout . The secondary objective was to test the concurrent validity of US abnormalities using as gold st and ard the microscopic demonstration of monosodium urate ( MSU ) crystals . Methods Ninety-one men with gout and 42 age-matched controls were prospect ively recruited . All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints , six bursae , eight tendons , 20 tendon compartments , four ligaments , and 18 articular cartilages by experts in US blinded to the patients ’ group . Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals . Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise . Results The assessment of one joint ( ie , radiocarpal joint ) for hyperechoic aggregates ( HAGs ) , two tendons ( ie , patellar tendon and triceps tendon ) for HAGs and three articular cartilages ( ie , first metatarsal , talar and second metacarpal/femoral ) for double contour sign showed the best balance between sensitivity and specificity ( 84.6 % and 83.3 % , respectively ) . Intraobserver reliability was good ( mean κ 0.75 ) and interobserver reliability was moderate ( κ 0.52 ) . The aspirated material from HAGs was positive for MSU crystals in 77.6 % of patients with gout and negative in all controls . Conclusions Our results suggest that US bilateral assessment of one joint , three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity OBJECTIVES To establish the usefulness of ultrasonography ( US ) for diagnosing gout and to determine whether there are sonographic features that are characteristic for gout but not for other arthropathies . METHODS We retrospectively compared joint images of gout patients with matching images from patients with other rheumatic conditions . Images of 37 joints of 23 patients with monosodium urate ( MSU ) crystal-proven gout were review ed . MSU crystals were identified in at least one joint in each patient . Our control group had 23 r and omly selected patients with 33 examined joints with rheumatic conditions other than gout . RESULTS Specific diagnostic features included a hyperechoic , irregular b and over the superficial margin of the articular cartilage described as a double contour sign in 92 % of gouty joints and in none of the controls ( P < 0.001 ) ; hypoechoic 
    Output:
    