RNL 26 Report: Past, Present and Future of Gout Save
Audrey Gibson, PA-C, reports from RheumNow Live 2026 in Dallas, Texas, about the lecture, "Past, Present and Future of Gout" delivered by Dr. Robert Terkeltaub.
Transcription
Hi everyone. I'm Audrey Gibson, a physician assistant from Gainesville, Georgia. I'm live in Dallas at RheumNow Live meeting. I wanted to speak a little bit about a presentation that was given today.
Dr. Robert Terkeltaub gave us a clear-eyed look at where gout management has been and where it's still falling short. In the ideal evidence-based world, gout is straightforward: treat to target, get the serum uric acid below six, and sustain that urate lowering long enough and patients have fewer flares, shrinking crystal burden, and improved joint outcomes. Clinical trials prove that this works, especially when therapy is protocolized and followed closely.
But that's not the real world that most of us practice in. In everyday care, only about 20 to 30% of patients actually reach target uric acid levels in primary care, where most of our gout patients are managed. Adherence is poor, dose escalation stalls, and many patients never get beyond allopurinol 300 milligrams. The result is ongoing flares, progressive crystal burden, joint damage, and importantly, increased cardiovascular risk.
One of the most important reminders from this talk is that gout flares are not benign. Recent flares are strongly associated with myocardial infarction and stroke, and poorly controlled hyperuricemia worsens cardiovascular outcomes and mortality.
Dr. Terkeltaub states that allopurinol remains first line and starting low and going slow clearly reduces hypersensitivity risk. Baseline serum uric acid also matters. Levels above 8 or 9 milligrams per deciliter predict a much worse long-term course, more flares and more hospitalizations as well as more crystal deposition.
Looking ahead, the future is promising. SGLT2 inhibitors offer moderate urate lowering with cardiovascular benefit. Improved pegloticase strategies using immunomodulation have dramatically increased response rates in refractory gout, and selective URAT1 inhibitors may soon give us potent oral options with minimal titration.
The bottom line is this: gout is highly treatable, but only if we treat it like the chronic systemic disease that it is. Earlier intervention, tighter urate control, and smarter use of emerging therapies can fundamentally change outcomes for our patients. Thanks for tuning in and stay tuned for more updates from RheumNow Live.
Dr. Robert Terkeltaub gave us a clear-eyed look at where gout management has been and where it's still falling short. In the ideal evidence-based world, gout is straightforward: treat to target, get the serum uric acid below six, and sustain that urate lowering long enough and patients have fewer flares, shrinking crystal burden, and improved joint outcomes. Clinical trials prove that this works, especially when therapy is protocolized and followed closely.
But that's not the real world that most of us practice in. In everyday care, only about 20 to 30% of patients actually reach target uric acid levels in primary care, where most of our gout patients are managed. Adherence is poor, dose escalation stalls, and many patients never get beyond allopurinol 300 milligrams. The result is ongoing flares, progressive crystal burden, joint damage, and importantly, increased cardiovascular risk.
One of the most important reminders from this talk is that gout flares are not benign. Recent flares are strongly associated with myocardial infarction and stroke, and poorly controlled hyperuricemia worsens cardiovascular outcomes and mortality.
Dr. Terkeltaub states that allopurinol remains first line and starting low and going slow clearly reduces hypersensitivity risk. Baseline serum uric acid also matters. Levels above 8 or 9 milligrams per deciliter predict a much worse long-term course, more flares and more hospitalizations as well as more crystal deposition.
Looking ahead, the future is promising. SGLT2 inhibitors offer moderate urate lowering with cardiovascular benefit. Improved pegloticase strategies using immunomodulation have dramatically increased response rates in refractory gout, and selective URAT1 inhibitors may soon give us potent oral options with minimal titration.
The bottom line is this: gout is highly treatable, but only if we treat it like the chronic systemic disease that it is. Earlier intervention, tighter urate control, and smarter use of emerging therapies can fundamentally change outcomes for our patients. Thanks for tuning in and stay tuned for more updates from RheumNow Live.
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