Researchers and clinicians gathered in Chicago for the 2012 ACR State-of-the-Art Clinical Symposium, which was held April 28–29, to attend an overview of current topics of rheumatology. Attendees spent the day discussing gout, lupus (particularly during pregnancy), and rheumatoid arthritis. Nonrheumatologists provided outside perspectives on rheumatic disease: A dermatologist spoke about psoriasis, a hand surgeon spoke about rheumatic involvement in the hand, and a primary care physician spoke about musculoskeletal manifestations of HIV infection. [Editor’s Note: This session was recorded and is available via ACR SessionSelect] As session chair John J. Cush, MD, director of clinical rheumatology at Baylor Research Institute in Dallas, Texas, explained, “It is good when rheumatologists can hear from experts in another field.”
Dr. Cush noted that all of these topics are very clinically relevant and the presenters focused their talks on advances in disease management.
Hyperuricemia and Gout
The keynote address was given by Michael H. Pillinger, MD, a rheumatologist at the Manhattan VA Medical Center in New York. Dr. Pillinger elegantly described what Dr. Cush called, “the genesis of the inflammatory aspects of gout.”
Gout is a significant and growing problem. There are currently four million patients with gout in the United States. An epidemiological study of patients in Rochester, Minn., indicated a doubling in the incidence of gout from the 1970s to the 1990s. Dr. Pillinger explained that these patients are not only in pain, but they are also missing work. The median number of days lost due to gout or gout flares is about a week out of every year. Dr. Pillinger went on to describe gout as not just an acute problem, but rather one that may have significant health implications. Specifically, patients who have gout have worse survival rates over a five-year follow-up than do patients without gout.
The earliest documentation of gout occurred in 2640 BC by the Egyptians. Over the centuries, gout was further described, and, in 1961, McCarthy and Hollander introduced the polarizing microscope for the visualization of urate crystals. This was then followed by a dead zone in gout research and the treatment of gout did not appreciably advance for the next 40 years. Dr. Pillinger’s talk, however, described the renaissance in interest in gout that began in the year 2000 and has lead to new research and new therapies.
Paradigm Shift
Up until three years ago, the renal excretion model was used to explain how an increase in high blood–uric acid levels is not effectively addressed by the kidney, leading to a buildup of uric acid in the body. This model was based on rat studies, but Dr. Pillinger explained that we now know that it is not true for humans.