Gout Cavalcade (7.10.2026) Save

Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week. July is Gout: More than Flares month.

1. NEJM Retracts Pivotal ADVOCATE Trial of FDA-Approved Avacopan
2. FDA Delays Gout Drug NASP with Complete Response Letter
3. Raynauds: Using the Clinical Practice Research Datalink Aurum (PCP) database (1998 - 2023) the prevalence of Raynaud’s 894/100 000, or 158449 cases in 2023. More in elderly & females, less in blacks. Incidence rate 46/100K https://buff.ly/TLjMy21
4. Whats the BEST FIRST Rx in DMARD-Naive #RA - Tofacitinib or MTX. RCTs (ORAL Start, RA-BEGIN, SELECT-EARLY, FINCH 3) prove JAKi > MTX. A recent 116 RCT from China also shows Tofa > MTX by SDAI50 (94% v 75%) @3 mos & Tofa was more cost effective. https://t.co/KL2qlDgF6D
5. Prosthetic Jt Infections after prior Septic Arthritis? Systematic review of 35 retro studies/7,447 pts (4,896 TKA, 2,564 THA). PJI rate = 2.6%, more after TKA (9.8%) than THA (1.1%). Lower rates w/ longer intervals between TJA and septic arthritis. 2 stage procedures increased https://t.co/M425Xuc7Z4
6. A federal judge has blocked the Department of Education new rule restricting graduate school loans for NPs and PAs. DEA plan does not qualify NP & PA degrees as "professional", & loans were to be limited to $20,500 annually ($100K lifetime) https://t.co/5eIcFgbbx6
7. American Gastroenterological Association announced the launch of AGA APP GI Readiness and Credentialing, a professional development initiative fir advanced practice providers throughout their careers. Establishes structured professional pathways for APP https://t.co/k3pC7HazMt https://t.co/8wT4ltIsSC
8. JAMA HBV review - Worldwide, HBV affects ~254 million, causing 1.1 million deaths. In 2022, 14k new HBV infx in the US. HBsAg = ongoing infxn; HBsAb indicates immunity; HBcAg=ongoing or past infection. Do HBV DNA for virus-replication activity https://t.co/Yvdx09DrQ5
9. New spatial transcriptomic research shows synovial lining enriched in macrophages expressing secreted phosophoprotein-1 SPP1 (encoding osteopontin) in proximity to fibroblasts and fibrin deposits. SPP1+ macrophages degrade fibrin & promote fibroblast proliferation that deposit collagen & does the damage, joint remodeling. A new potential target? https://buff.ly/FRvT27T
10. The global Chronic Refractory Gout Market is projected to grow from ~$2.94 billion USD in 2022 to nearly $10.07 billion USD by 2036, reflecting introduction of innovative therapies. Chronic Refractory Gout in the 7Major Markets exceeded 400,000 pts in 2025 (>200K in USA) https://t.co/MSzBNTXTPj
11. Long term F/U of Gout (CARES) trial (febuxostat vs allopurinol) shows remission increased from 37% (1,593/4,259) 1st Yr to 63% (322/510) at year 6. Over the 6 years, ~60 achieved remission at least once; more likely based on age, race, dz severity, comorbidities, & febuxostat use. https://buff.ly/YMSV1wj
12. Netherlands pragmatic open-label RCT from 8 rheum centres tested T2T vs Sx Rx in 308 Gout pts starting ULT (87% male; 66 yrs). Remission (no flares & pain < 2) betw 18-24 mos was more in T2T pts (39% vs 24%; p=0.02), but more AE w/ Sx driven Rx (53 vs 42%) https://buff.ly/kSIT9T0
13. Chinese target trial emulation of 2092 adults with stage G3–G4 CKD & asymptomatic hyperuricemia starting ULT. At 3 yrs, renal progression (ESKD or ≥40% eGFR decline) was 33.3% in T2T vs 35.8% in non-T2T (risk ratio 0.93; 0.83–1.08). https://t.co/lAT0noE1uA
14. Subanalysis of SURMOUNT-1 Obesity trial l (2539 pts w/ BMI ≥ 30; tirzepatide vs PBO) showed 21% wt loss by wk 72 w/ TIRZ. Serum uric acid (SUA) decr by -0.69, -0.92, & -0.95 mg/dL on TIRZ (5, 10, & 15 mg qd). Wt loss explained 73% of SUA reduction. https://t.co/V0stEDC4lF
15. Gout GEMS/FACTS
    • 12.1 million Americans have gout; but only 1.3% are seen by rheumatologists.
    • < 40% of gout patients are on ULT; <40% of ULT-treated gout patients achieve T2T (SUA < 6.0 mg/dl).
    • Gout prevalence rises with obesity (1% → 7%)
    • 15-20% of Americans (38-44 million adults) have hyperuricemia. Less than 25% will ever develop gout.
    • Black tart (Montmorency) cherries (or extract) have been shown to consistently reduce gout attacks.
    • Gout affects the spine in 14-35% of patients (proven by CT or DECT). Axial gout is usually misdiagnosed as discitis.