Tuesday, 12 Nov 2019

You are here

T2T Lowers Mortality in Gout

A Spanish prospective cohort of active, uncontrolled gout patients were followed and showed that failure to reach a target serum uric acid (sUA) level of 6 mg/dl (0.36 mmol/L) or less was associated with a 2-3 fold increase in mortality.

Researchers enrolled 1193 gout patients between 1992 -2017, 92% were male, with a mean age of 60 years, and a disease duration of 6.8 years. They had a mean sUA of 9.1 mg/dL at baseline and in the prior year, they had an average of three to four flares. With a mean follow-up 48 months, 158 gout patients died.

Mortality rates were significantly higher in patients sUA remained > 6.0 mg/dl (0.36 mmol/L) with a mortality rate of 80.9 per 1000 patient-years (95% CI 59.4 to 110.3), compared to those with a sUA <6.0 mg/dl (<0.36 mmol/L) who had a lower mortality rate of 25.7 per 1000 patient-years (95% CI 21.3 to 30.9).

A significantly higher overall mortality rate was seen in those with an sUA of ≥0.36 mmol/L (adjusted HR=2.33, 95% CI 1.60 to 3.41) and CV mortality (HR=2.05, 95% CI 1.21 to 3.45).

Other studies have shown that hyperuricaemia in gout is an independent predictor of overall and CV-related mortality. Treating to a targeting sUA levels of <0.36 mmol/L (< 6 mg/dl) should be a principal goal in these patients at high risk for death and CV events.

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

Add new comment

More Like This

Novel Inhibition of MSU Crystal Inflammation

Researchers from Washington State University have shown that inhibition of tumor growth factor-β (TGF-β)-activated kinase 1 (TAK1) can effectively downregulate inflammatory mediators and suppress inflammation caused by gout.

Monosodium urate (MSU) crystals directly activate the inflammasome to produce a plethora of pro-inflammatory cytokines, including interleukin-1β (IL-1β). 

Patients Prefer Nurse Led Care for their Gout

Despite the well known, well publicized treat-to-target (T2T) goal of a serum uric acid (SUA) level < 6 mg/dl, this goal is seldom achieved (< 40%) in clinical practice and patient adherence has been unacceptably low. A recent study shows that nurse-led care led to better outcomes in gout including patient acceptability, long-term adherence, and less flares.

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.