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Gout Undertreatment Persists

Jack Cush, MD

Despite updated gout management guidelines from European (EULAR) and British (BSR) societies, treatment of gout is suboptimal with regard to the use of urate-lowering therapy (ULT) and normalizing serum uric acid (< 6.0 mg/dl) levels.

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Topical therapies take centre stage

Richard Conway, MBBChBAO, PhD

Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium. 

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Real World Data on Urate Lowering Therapy

Eric Dein, MD

Urate lowering therapy (ULT) is the backbone therapy for long-term gout treatment and maintenance, but real-world gout management is often imperfect and suboptimal. 

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EULAR 2022 – Day 2 Report

Jack Cush, MD

A full day at EULAR with oral and poster presentations of abstracts in the morning and a plethora of scientific (review) sessions in the afternoon. The latter covering topics like sarcoidosis, Still’s disease, fibromyalgia, back pain, sarcopenia, APS, IgG4 and imaging in vasculitis.

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Recommendations – Good & Bad (5.27.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news, regulatory updates and journal reports from the past week on RheumNow.com. This week gout worries, mortality risks, measuring anti-drug antibodies and a better way in lupus?

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#EULAR2022 has concluded but you can find all our coverage here https://t.co/s62OVJPQ86 https://t.co/QAvPQYCABj

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Dr. John Cush RheumNow ( View Tweet)
Gout Undertreatment Persists Despite updated gout management guidelines from EULAR and BSR, treatment of gout is suboptimal with regard to the use of urate-lowering therapy (ULT) and normalizing serum uric acid (< 6.0 mg/dl) levels. https://t.co/qW7ZaXbnx3 https://t.co/ZBKIjuQp10

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Dr. John Cush RheumNow ( View Tweet)
Topical therapies take centre stage Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium. #EULAR2022 https://t.co/V9plk1vAEd https://t.co/fyNWWtconi

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Dr. John Cush RheumNow ( View Tweet)
#EULAR2022 POS0285 130K UK patients had incident gout bw 2004-2020 ⭐️Only 29% started on ULT w/in 12 mos ⭐️Target urate level only 14% in 2004, only to 17% in 2020 Updated EULAR guidelines in 2016: No statistical difference in ULT Rx or target attainment @Rheumnow

Eric Dein ericdeinmd ( View Tweet)

#EULAR2022 POS0282 Febuxostat vs allopurinol: CV risk population study ⭐️16% reduction in all-cause mortality among febuxostat users, mostly non-CV death reduction ⭐️CV safety non-inferior to allopurinol @Rheumnow https://t.co/1oDSioQWPT
Eric Dein ericdeinmd ( View Tweet)
#EULAR2022 POS0283: Do Rheums have Gout Stigma? ⭐️Stereotypes about pt related factors ⭐️Rheumatologists feel diet, exercise, wt loss more important in gout than RA, pharmacologic therapies less important than RA @Rheumnow

Eric Dein ericdeinmd ( View Tweet)

#EULAR2022 POS0280 Gout is associated with higher mortality in Women ⭐️Higher all cause and CV mortality RR 1.28 risk of mortality in pts without CHD, with gout compared to controls (No CHD or gout) @Rheumnow https://t.co/6o1EKSp2F8
Eric Dein ericdeinmd ( View Tweet)
So what diet to follow with autoimmunity in mind? So many, all with different instructions. Let’s concentrate on where they agree: yes to fruits & vegetables no to emulsifiers & processed foods #EULAR2022 @RheumNow https://t.co/I9abweQOyZ
David Liew drdavidliew ( View Tweet)
Hilarious debate #EULAR2022 between Christian Dejaco and Robert Landewe on whether telemedicine is the future of rheumatology. In amongst the trash talking, here are some highlights @RheumNow

David Liew drdavidliew ( View Tweet)

#EULAR2022 POS0278: Proof of concept US study: 💎CPP crystals do NOT generate posterior shadowing 💎MSU and hydroxyapatite did have shadowing, proportional to concentration of crystals @Rheumnow @MymaAlbaydaMD @USSONAR_Rh

Eric Dein ericdeinmd ( View Tweet)

Dr Puja Khanna. Transdermal sodium bicarbonate for gout flare. WHAT!? It works as well! Double-blind RCT. All got colchicine also. Response rate 95% vs 79%. Resolution in 24 vs 72 hrs. Rescue meds 6% vs 20%. No adverse events! @RheumNow #EULAR2022 OP0170 https://t.co/INd4tMFVlV https://t.co/EyVjFLF72z

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Richard Conway RichardPAConway ( View Tweet)
Farshad et al. 17% of admissions on long-term allopurinol had it held. Reasons - acute gout flare, renal impairment, gastrointestinal issues, cytopenia, drug interactions, NPO status, and always discontinued the medication. @RheumNow #EULAR2022 OP0169 https://t.co/ADOomiOrRi https://t.co/nxAAOMWsJB

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Richard Conway RichardPAConway ( View Tweet)
Botson et al. 152 patient RCT. MTX combo with pegloticase (to decrease antidrug abs). 6-month response (sUA<6 mg/dL) 71% vs 39%. Infusion reactions 3% vs 31%. @RheumNow #EULAR2022 OP0171 https://t.co/N29kYT3xkR https://t.co/Z4dUMD4Tt3

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Richard Conway RichardPAConway ( View Tweet)
Dr. Jack Cush reviews the news, regulatory updates and journal reports from the past week on https://t.co/V10S4oVFsv. This week gout worries, mortality risks, measuring anti-drug antibodies and a better way in lupus? https://t.co/iaMQZtzdLm https://t.co/Zu9VwKoCAc

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Dr. John Cush RheumNow ( View Tweet)
To TDM or Not in Rheumatology? Therapeutic Drug Monitoring (TDM), especially for biologic therapies, has become a standard in gastroenterology, but shunned by most rheumatologists. But now, EULAR has a recommendation... https://t.co/u86Vd8bFGr #MedEdTwitter https://t.co/IpKqPoWM9R

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Dr. John Cush RheumNow ( View Tweet)
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