Studies are currently underway to determine whether a particular substance can be identified in milk that can serve as a treatment for gout. Preliminary data suggest that there may be a factor in skim milk powder that decreases the frequency of gout flares.
Comorbidites of Gout
There is also an evolving appreciation of the comorbidities associated with gout and hyperuricemia. These multiple comorbidities are not seen in patients with other rheumatic diseases, Dr. Pillinger said. Patients with gout mostly have metabolic syndrome or, as Dr. Pillinger stated succinctly, “These are often sick people.”
The recently published Framingham Offspring Study enrolled 5,124 individuals and found that patients who had gout had a 50% to 150% increase in the risk of heart failure. The risk was not obvious in the first 10 to 15 years after diagnosis, but became evident 30 years out. This observation leads to the question: Is it hyperuricemia or gout that conveys risk of coronary artery disease? Unfortunately, this question has not yet been answered.
In Asia, a retrospective analysis of a patient database examined hyperuricema versus gout as risk factors for coronary and all-cause mortality. The investigators grouped patients into normal uricemia, hyperuricemia, and gout, and found an increasing risk of cardiovascular mortality as uric acid levels increased. This increase in cardiovascular risk decreased in the hyperuricemia group when adjustments were made for other risk factors for cardiovascular disease. The risk remained, however, in the gout group after adjustment for other cardiovascular risk factors.
Atherosclerosis can be viewed as an inflammatory disease, which leads to the question: Would the antiinflammatory drug colchicine be useful in preventing cardiovascular disease? This question was addressed in a study performed using the New York Veterans Administration gout cohort. The investigators examined cardiac endpoints in patients treated with colchicine versus those not given colchicine. The authors found that patients treated with colchicine had fewer than half the number of myocardial infarctions that the control group had.
Another study, performed in Taiwan, examined the effect of urate-lowering therapy (ULT) in cardiovascular mortality. Using a database review, the investigators found that ULT lowered the risk of mortality from cardiovascular disease and stroke in patients with gout.
Investigators are also studying whether gout contributes to kidney disease and whether lowering uric acid levels is associated with a reduction in kidney disease. Research suggests that lowering serum urate may preserve renal function in gout patients.
Dr. Pillinger concluded by stating that we desperately need to ascertain whether gout patients should be treated purely to prevent gout attacks or if there are additional benefits associated with the therapy. The recent increase in interest in gout has both underscored the need for new therapies and has advanced the development of new therapies.
Lupus and Pregnancy
Multiple cohort studies have shown that women with lupus have an increase in pregnancy loss when compared with the general population. The rate of pregnancy loss appears to be about 20% in women with lupus—a rate that is about twice that of the general population. Women with lupus also have about twice the rate of preterm births (30%) when compared with the general public.
