This study provides further evidence that incident gout is uncommon over a two-year period, even in those with hyperuricemia, and that there is no benefit to the use of ULT to prevent incident gout.
Abstract 0674: A behavioral intervention to improve gout outcomes in African Americans with gout: A 12-month multicenter, randomized controlled trial6
Research by Singh J, et al.
Gout is one of the most common forms of arthritis and disproportionately affects Indigenous peoples and minority populations. Although gout is eminently treatable, it is, in general, poorly managed, resulting in poor outcomes. Indigenous and minority populations are under-represented in clinical trials, particularly industry-sponsored trials, required for regulatory approval.
Although this study showed no benefit from the culturally appropriate gout storytelling intervention, it is heartening to see research specifically focused on this area. As the authors conclude, we need more research to develop effective, culturally appropriate interventions to improve outcomes for Indigenous peoples and minority populations with gout.
Abstract 1897: A randomized double-blind controlled trial of intensive serum urate lowering with oral urate-lowering therapy for erosive gout7
Research by Dalbeth N, et al. (Author’s note: I am an author on this abstract.)
Intensive ULT with pegloticase has improved bone erosion in people with gout. However, pegloticase typically reduces serum urate concentrations to much lower levels than oral urate-lowering therapies do, and it is currently a last-line therapy for most patients.
In this two-year randomized, controlled trial, oral ULTs were utilized in a standard protocol and participants were randomized to a target urate of 3.4–4.9 mg/dL (0.20–0.29 mmol/L) or 1.7–3.2 mg/dL (0.10–0.19 mmol/L). Using oral ULT, the lower serum urate target was more difficult to achieve, the medication burden was substantial, and there was no improvement in bone erosion scores.
The current 2020 ACR guideline recommends a target serum urate concentration of <0.36 mmol/L (6 mg/dL) for all people with gout. And in comparison to the 2012 guidelines, no recommendation about a lower target was made for those with more advanced disease, such as tophi or bone erosions.
Conclusion
The research presented at ACR Convergence 2021 shows that clinicians still have work to do to help our patients manage their gout and that urate-lowering therapy can help in the treatment and prevention of gout.
Lisa Stamp, MBChB, PhD, is a rheumatologist, professor of medicine and the associate dean of research at the University of Otago, Christchurch, New Zealand. She has extensively researched the pathophysiology and management of gout.