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RheumNow Podcast – Gout Guidelines (7.3.20)

Jack Cush, MD

Dr Jack Cush reviews the journal reports and news from RheumNow this past week. Highlights include:

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2020 ACR Gout Management Guideline

Jack Cush, MD

In May, the American College of Rheumatology (ACR) released the"2020 Guideline for the Management of Gout"reflecting new clinical evidence since the last guideline published in 2012.

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Coexistent Gout and Rheumatoid Arthritis

Jack Cush, MD

While it is often said there is a negative association between gout and rheumatoid arthritis (RA), cases of coexistent disorders are uncommonly seen. A recent VA study describes 121 patients whith both RA and gout.

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RheumNow Podcast – Lupus Mortality Declines, But… (6.26.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal articles from the past week on RheumNow.com

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Methotrexate May Enhance Pegloticase Response in Gout

RheumNow

For patients with gout exacerbations while on pegloticase (Krystexxa), adding methotrexate may help reduce uric acid levels, researchers suggested at the European League Against Rheumatism (EULAR) virtual meeting.

In a small open-label study of 14 patients experiencing acute gout attacks, use of the pegloticase/methotrexate combination reduced uric acid levels to near undetectable levels in 11 patients, reported John Botson, MD, medical director of Orthopedic Physicians Alaska in Anchorage. He noted that this was far below the 5 mg/dL level recognized as the threshold for development of inflammation that causes gout attacks.

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First Look at COVID-19 Global Rheumatology Alliance Registry

Jack Cush, MD

Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.

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EMR analysis of 453 gout pts D/C from ED or hospital , shows that 28.3% received opioids at discharge (~80% new pts). Average dose 38mg morphine equivalent for a median duration of 8 days - more common with polyarticular gout, DM, prior opioid use https://t.co/wKRT6ExuSD

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Dr. John Cush RheumNow ( View Tweet)

Open label, uncontrolled study shows that background use of azathioprine (2mg/kg) in Pegloticase treated refractory… https://t.co/uXQR8JE1he

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Dr. John Cush RheumNow ( View Tweet)

Rheumatology Round-Up from #EULAR2020 w/ Drs. Kavanaugh & Cush. Watch it on RheumNow https://t.co/5v9BTuLrPX or listen to the podcast on iTunes https://t.co/FHJv01AAbC or on Android Sound Cloud https://t.co/nb7iXdRMMb

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Dr. John Cush RheumNow ( View Tweet)

High uric acid is associated with a higher risk of kidney cancer, especially in women; Data from a UK biobank of 444 462 without cancer w/ 6.5 yrs F/U. Highest Urate quartile had increased risk of renal cancer (HR 1.45, 95%CI 1.08 to 1.93), only in women. https://t.co/APWxFkewoF

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is Up! Lupus Mortality Declines, But… Review of SUA and cancer; IL-12/23 and SLE; TCZ and Behcets, Pregnancy SI MRI, VTE w/ Jaks; COVID; Colchicine. Watch it here> https://t.co/2V7TbaAsOp or listen on iTunes or SoundCloud https://t.co/XMps2GTgeD

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Dr. John Cush RheumNow ( View Tweet)

#EULAR2020 #op0015 relationship btw sUA &mortality in the US: increased mortality in M w/ low sUA but not F. could be attributed to uricosuric effect of uncontrolled hyperglycemia ( high incidence of DM)? Lower Alzheimer’s mortality in M&F w/high sUA. @RheumNow https://t.co/E4HVXASKYy
Olga Petryna DrPetryna ( View Tweet)
#eular2020 #op0205 phase 1 trial of novel URAT1 inhibitor D-0120 in healthy adults: safe up to 20 mg/d after 7 days. Significant reduction of sUA peaks at 4-8h & lasts up to 24h @RheumNow

Olga Petryna DrPetryna ( View Tweet)

#EULAR2020 #op0169 US claims database analysis reveals that gout and DM make for a dangerous combination: significantly higher risk of amputations in pts with gout+DM at 0.77% as oppose to DM w/out gout 0.461% & gout w/out DM 0.162% @RheumNow

Olga Petryna DrPetryna ( View Tweet)

EULAR2020 #op0168 🇰🇷Population-based cohort study identifies both allopurinol& febuxostat associated with MI, cerebral infarction&cerebral hemorrhage. Fluctuation of sUA&potentially even cardiovascular gout attacks (urate crystals in vasculature) as possible causes @RheumNow https://t.co/mcb5NLnMq1
Olga Petryna DrPetryna ( View Tweet)
Behcet's ulcers can be a real pain. I've heard pentoxifylline gel be discussed before, here's some early data to back it up (need bigger trial). Tastes terrible, though - so maybe this? https://t.co/TrSlIKdWX3 (or a commercial prep might solve it) SAT0260 #EULAR2020 @RheumNow https://t.co/lvDY39ZbIH

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David Liew drdavidliew ( View Tweet)
#EULAR2020goesvirtual @eular_org should future giant medical meetings be a hybrid of virtual & viewed for months post meeting & live where there is networking & audience participation? Less cost and time for some attendees. Like cable TV vs Netflix @CRASCRRheum @RheumNow https://t.co/WqYQTpicAs

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Janet Pope Janetbirdope ( View Tweet)

When starting IV Pegloticase in #Gout, Do you start a DMARD too? #EULAR2020

Dr. John Cush RheumNow ( View Tweet)

#EULAR2020 ABST#OP0015Plenary session: very low serum urate < 4 mg/dL in men assc w/increased CV mortality; 40,000 pt study. NOTE: this may be driven by poorly controlled diabetes as hyperglycemia has a uricosuric effect; from NHANES database @MassGeneralNews @RheumNow https://t.co/jnhkS436JZ

k dao KDAO2011 ( View Tweet)

When starting IV Pegloticase in #Gout, Do you start a DMARD too? #EULAR2020

Dr. John Cush RheumNow ( View Tweet)

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