Gout Research at a Glance: ‘My picks for the top research in gout presented at ACR Convergence 2021’

Dr. Stamp

ACR CONVERGENCE 2021—More than 40 research abstracts on gout were accepted for presentation at ACR Convergence 2021. While we continue to see evidence of the poor management of gout, we also see new evidence on urate-lowering therapy in both the treatment and prevention of gout. Many of these abstracts challenge us to improve our clinical practice for our patients with gout.

Abstract 0682: Gout management and outcomes during the COVID-19 pandemic in late 2020–2021: A cross-sectional internet survey¹

Research by Singh J, Edwards NL

COVID-19 has presented numerous challenges for both healthcare professionals and people with rheumatic diseases. Although much of the initial concern focused on our immunosuppressed patients and how they might fare, we are now seeing evidence that those with other rheumatic diseases, such as gout, are being negatively impacted by the pandemic.

This abstract highlights the role of anxiety and depression in people with gout during the COVID-19 pandemic and the subsequent effect on adherence, difficulty accessing healthcare and getting adequate treatment for gout flares.

This is a timely reminder that people with gout should have an action plan and a ready supply of medication with which to manage their flares.

Abstract 1899: Mortality in patients with sub-optimally treated gout in the Veterans Health Administration: A national retrospective cohort study²

Research by Helget L, et al.

Rheumatologists have long recognized the importance of the treat-to-target urate strategy in people with gout in addressing patient-important outcomes, such as flares and the size and number of tophi.

This large retrospective study reported that all-cause mortality was increased by ~22% in those people with suboptimally treated gout, defined as less than two fills of >90 days’ duration of urate-lowering therapy (ULT) and a mean serum urate concentration of ≥6 mg/dL (0.36 mmol/L), compared with those with optimally treated gout, even after adjustment for comorbidities.

This is another reminder for us to treat our patients with gout with ULT in order to achieve target urate. However, we need further research on the most effective strategies for use of  ULTs to achieve target urate and how these can be effectively implemented in primary care, where most gout is managed.

Abstract 1900: Urate lowering therapy in the treatment of gout. A multicenter, randomized, double-blind comparison of allopurinol and febuxostat using a treat-to-target strategy³

Research by O’Dell J, et al.

The majority of the phase 3 trials examining the efficacy and safety of febuxostat used fixed-dose allopurinol, typically 100 or 300 mg daily. However, allopurinol doses >300 mg daily are frequently required to achieve target serum urate, even in those with chronic kidney disease (CKD).