Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians

Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout. Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout. Recommendation 1: ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence). Recommendation 2: ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence). Recommendation 3: ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence). Recommendation 4: ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence)

Extension in Mona Passage, Northeast Caribbean

This paper is not subject to U.S. copyright. The definitive version was published in Tectonophysics 493 (2010): 74-92, doi:10.1016/j.tecto.2010.07.002.As shown by the recent Mw 7.0 Haiti earthquake, intra-arc deformation, which accompanies the subduction process, can present seismic and tsunami hazards to nearby islands. Spatially-limited diffuse tectonic deformation within the Northeast Caribbean Plate Boundary Zone likely led to the development of the submerged Mona Passage between Puerto Rico and the Dominican Republic. GPS geodetic data and a moderate to high level of seismicity indicate that extension within the region is ongoing. Newly-collected high-resolution multibeam bathymetry and multi-channel seismic reflection profiles and previously-collected samples are used here to determine the tectonic evolution of the Mona Passage intra-arc region. The passage is floored almost completely by Oligocene–Pliocene carbonate platform strata, which have undergone submarine and subaerial erosion. Structurally, the passage is characterized by W- to NNW-trending normal faults that offset the entire thickness of the Oligo–Pliocene carbonate platform rocks. The orientation of these faults is compatible with the NE-oriented extension vector observed in GPS data. Fault geometry best fits an oblique extension model rather than previously proposed single-phase, poly-phase, bending-moment, or rotation extension models. The intersection of these generally NW-trending faults in Mona Passage with the N–S oriented faults of Mona Canyon may reflect differing responses of the brittle upper-crust, along an arc–forearc rheological boundary, to oblique subduction along the Puerto Rico trench. Several faults within the passage, if ruptured completely, are long enough to generate earthquakes with magnitudes on the order of Mw 6.5–7

Gravity modeling of the Muertos Trough and tectonic implications (north-eastern Caribbean)

The Muertos Trough in the northeast Caribbean has been interpreted as a subduction zone from seismicity, leading to infer a possible reversal subduction polarity. However, the distribution of the seismicity is very diffuse and makes definition of the plate geometry difficult. In addition, the compressive deformational features observed in the upper crust and sandbox kinematic modeling do not necessarily suggest a subduction process. We tested the hypothesized subduction of the Caribbean plate’s interior beneath the eastern Greater Antilles island arc using gravity modeling. Gravity models simulating a subduction process yield a regional mass deficit beneath the island arc independently of the geometry and depth of the subducted slab used in the models. This mass deficit results from sinking of the less dense Caribbean slab beneath the lithospheric mantle replacing denser mantle materials and suggests that there is not a subducted Caribbean plateau beneath the island arc. The geologically more realistic gravity model which would explain the N–S shortening observed in the upper crust requires an overthrusted Caribbean slab extending at least 60 km northward from the deformation front, a progressive increase in the thrusting angle from 8 to 30 reaching a maximum depth of 22 km beneath the insular slope. This new tectonic model for the Muertos Margin, defined as a retroarc thrusting, will help to assess the seismic and tsunami hazard in the region. The use of gravity modeling has provided targets for future wide-angle seismic surveys in the Muertos Margin

Earthquake Potential Along the Northern Hayward Fault, California

The Hayward fault slips in large earthquakes and by aseismic creep observed along its surface trace. Dislocation models of the surface deformation adjacent to the Hayward fault measured with the global positioning system and interferometric synthetic aperture radar favor creep at ∼7 millimeters per year to the bottom of the seismogenic zone along a ∼20-kilometer-long northern fault segment. Microearthquakes with the same waveform repeatedly occur at 4- to 10-kilometer depths and indicate deep creep at 5 to 7 millimeters per year. The difference between current creep rates and the long-term slip rate of ∼10 millimeters per year can be reconciled in a mechanical model of a freely slipping northern Hayward fault adjacent to the locked 1868 earthquake rupture, which broke the southern 40 to 50 kilometers of the fault. The potential for a major independent earthquake of the northern Hayward fault might be less than previously thought.</jats:p