- The DASH (Dietary Approaches to Stop Hypertension) diet;
- Losartan, an anti-hypertensive drug;
- Atorvastatin, a cholesterol-lowering drug;
- Calcium channel blockers; and
- SGLT-2 (sodium-glucose cotransporter 2) inhibitors, increasingly.
Managing patients with SGLT-2 inhibitors, which are approved for use along with diet and exercise to lower blood sugar in adults with type 2 diabetes, holds exciting potential for people with gout and its comorbidities, Dr. Dalbeth said. Effective gout management can enable patients to take control of other areas of their health while reducing exposure to NSAIDs and corticosteroids.
“The future will tell us what role the SGLT-2 inhibitors will play in gout treatments for patients with those comorbidities,” said Naomi Schlesinger, MD, the session’s second speaker and professor and chief of the Division of Rheumatology at the University of Utah School of Medicine, Salt Lake City.
Most patients with gout have multiple comorbidities, and this fact is even more common in women than in men, regardless of age. For optimal treatment outcomes, one needs to control inflammation—both during acute flares and in chronic gout—along with reducing the uric acid pool and addressing polypharmacy in patients, Dr. Schlesinger said.5
The Kidneys
What does the physician do for patients with gout and kidney disease when NSAIDs are contraindicated because they can exacerbate or cause acute renal injury or failure? Recommendations for the use of colchicine at this point are largely empirical, not based on randomized controlled trials, Dr. Schlesinger said. Physicians need to be aware that in patients with severe CKD, the half-life of colchicine is prolonged, and the risk of toxicity is greater than in those without CKD.
For patients on dialysis, the total recommended dose of colchicine is 0.3 mg twice weekly, with close monitoring. Another option: If the patient can’t tolerate colchicine, a short course of glucocorticoids can be prescribed.
Gout is also more common and severe in patients who have had a kidney transplant, and kidney stones are common in these patients. For patients experiencing their first gout flare with kidney stones, initiate urate-lowering therapy and address predisposing factors, such as smoking and obesity, Dr. Schlesinger said.
Racial Disparities
Jasvinder Singh, MD, MPH, of the University of Alabama, Birmingham, reviewed the literature on racial disparities and health inequities for gout incidence, treatment and outcomes. Black men have a higher rate of gout than white men, and Black women have a higher rate of gout than white women, according to ARIC (the Atherosclerosis Risk in Communities Study), a U.S. population-based cohort study of middle-aged adults enrolled between 1987 and 1989 with ongoing annual follow up through 2012.6