Tuesday, 15 Oct 2019

You are here

Ideal Outcomes are Seldom Achieved in Gout

Studies from a cohort of gout patients in Mexico shows that long-term goals of a target serum urate (sUA) < 6 mg/dL and remission are rare, especially for those with severe gout. 

The GRESGO (gout) cohort of 500 patients compared outcomes in 221 with severe gout (44%) and 279 with non-severe gout (56%). Patients were followed at 6-month intervals. 

Ssevere gout patients were younger, with lower educational and socioeconomic status, longer disease duration, more absenteeism, more hypertension and chronic renal failure, more affected joints and tophi, and more activity limitations. Predictors of severe gout were disease duration (p=0.008) and gout flares (p=0.055).

While there were no significant differences between these groups in achieving an sUA U 6 mg/dL or 5 mg/dL (non-severe and severe gout, respectively), target urate < 6 mg/dL was achieved in 50-70% of the patients followed for 3-5 years and less than 50% of patients achieved TU < 5mg/dL during 5 years of follow-up.

Remission (no flares, SUA < 6.0, Pain < 2.0; no tophi) was achieved less often: 9.1% at year 1; 30% at year 2; 28% at year 3 and 28% after 5 years. None of the patients with severe gout achieved remission.

Patients with severe gout were unlikely to achieve both target sUA and remission. Hence, there exists many obstacles to achieving a target sUA and remission in gout. include poor medication adherence, persistent tophi and loss to follow-up.

These findings are in line with multiple studies showing that the target sUA is only achieved in 30-40% of gout patients.  However, many recent gout management studies have shown far better (80-80%) rates of remission and target sUA < 6.0 when patients are managed by nurses or pharmacists using a treat to target protocol, usually at more frequent intervals (every1-2 mos.).

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Anakinra Use in Hospitalized Gout Patients

While the efficacy and safety of interleukin 1 (IL-1) inhibitors (e.g., anakinra) in the acute management of gout and pseudogout has been repeatedly shown, the cost efficacy of such biologic therapy has rendered it impractical for most. A new retrospective study has shown that IL-1 inhibitors may be effective and appropriate for some medically complex, hospitalized patients with acute gout or calcium pyrophosphate crystal arthritis.

Higher Rates of Venous Thromboembolism in Gout

A Canadian administrative claims analysis has shown that gout-associated inflammation increases the risk of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) before and after the diagnosis of gout.

Modifiable Risk Factors for Hyperuricemia

Choi and colleagues have shown that four modifiable risk factors (BMI, the DASH diet, alcohol use, and diuretic use) could individually account for a notable proportion of observed hyperuricemia. 

Researchers examine modifiable risk factors for hyperuricemia and how this could be prevented through risk factor modification in the general population.

Opioids Overused in Acute Gout

Opioids were commonly given to patients as a treatment for acute gout attacks, despite the availability of other effective and appropriate therapies, a retrospective study found.

Allopurinol Fails to Curtail Hypertension

Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. A novel trial presented at EULAR 2019 last week assessed whether the use of urate-lowering therapy (ULT) would control hypertension in those at risk; however, results of this trial were largely negative.

Hypertension is one of the many comorbidities that plagues gout patients.