Wednesday, 22 May 2019

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Gout Takeaways

The annual EULAR meeting just came to an end today. Rooms are gradually emptying out. People look both content to have updated their knowledge and relieved that four very busy days have concluded. Time to summarize.

It is incredible how much information can be shared in four short days at a meeting like this. Just pick a topic, day and time and voila! Take gout for example; I strolled through the poster aisle today and here’s what I learned:

  1. Most gout patients are quite noncompliant with their uric acid lowering therapy. As outlined in abstract sat0357, after one year of treatment only 42.7% still continue ULT. This same study concludes men, older patients and patients whose first prescriber was a rheumatologist were more persistent.

  2. Patients with other comorbidities tend to have worse outcomes. From the survey of physicians and patient chart audits in the US ( ABST sat0358) we learn that patients with gout and T2DM had longer mean duration of gout (63 vs 41 months), were more likely to have tophi (37% vs 20%), joint damage (24% vs 13%), and clinician-rated severe gout (27% vs 13%) than those without T2DM (all p<0.01). Patients with gout and T2DM were also more likely to receive ULT than those without T2DM (86% vs 71%; p<0.01), and yet perform worse in terms of outcomes. What causes that? Could it be additional comorbidities (cardiovascular disease, kidney disease, COPD, depression, diabetes, hyperlipidemia, hypertension)? Same authors conclude patient with gout and T2DM vs. those without T2DM reported more office visits (4.1 vs 3.5), were more likely to have an emergency department visit (17% vs 9%) and were more likely to have a hospitalisation (5% vs 2%) (all p<0.01). What do we learn from these results? Patients with gout and other comorbidities would certainly benefit from more aggressive gout management.

  3. Next in line, a study on evolution of kidney function in gout after introduction of ULT ( sat 0359). In this study after ULT, mean eGFR differed significantly:+2.6 [IC95%: −0.279; 5.484; p=0.08],+3 [IC95%: 0.167; 5.794; p=0.04] and +2,7 [IC95%: 0.490; 4.960; p=0.02] ml/min/1,73 m2. Most efficacy was seen in patients with baseline GFR at the level of CKD stage 3 and higher. As a result, the rationale is to treat high sUA as soon as possible.

I could go on and on for hours listing all of the great educational materials presented during this meeting. If you could not attend, follow us on rheumnow.com. All you need is your laptop or mobile device, and you can enjoy the meeting through the eyes of RheumNow reporters. 

That's all for now. See you at the next meeting. 

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