Monday, 20 May 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

Coexistent Gout Increases Risk in Rheumatoid Arthritis

It his often said that gout and rheumatoid arthritis (RA) cannot coexist and where confusion exists, a good history and testing for serum urate (SUA) and rheumatoid factor (RF) can usually clarify the dominant disorders. A recent study shows that hyperuricemia and gout are uncommon in RA, but when present shows an increased risk of comorbidities and cardiovascular (CV) mortality.

Less Structural Damage with T2T in Gout

A two‐year randomized clinical trial has demonstrated that allopurinol dose escalation to a target serum urate (SU) results in less bone erosion, structural damage and urate crystal deposition in patients with gout.

Omega-3 Rich Fish Lowers Gout Flares

Boston researchers have shown that consumption of fish rich in omega‐3 polyunsaturated fatty acids (n‐3 PUFA) leads to a lower risk of recurrent gout flares.

Chronic Kidney Disease Augments Gout Risks

A population based cohort analysis shows that patients with incident gout and chronic kidney disease (CKD) have far worse outcomes than those without CKD.

A retrospective population-based cohort study of incident gout between 2006-2009 identified those with CKD; defined as a pre-existing diagnosis of chronic kidney disease, chronic renal failure, kidney transplantation, or dialysis at index date.

Ironwood Retreats from the US Gout Market

Ironwood Pharmaceuticals discontinued the marketing and sales of both lesinurad (Zurampic) the combination drug of lesinurad and allopurinol (Duzallo) in the United States effective February 1, 2019. In addition the Duzallo and Zurampic Patient Savings Program were also discontinued on December 31, 2018.

The company stated that this was a financial decision unrelated to the efficacy or safety of lesinurad.