ACR Convergence 2022 Philadelphia—revealed a wealth of gout research from basic science to clinical exciting to see a wealth of research on gout being undertaken worldwide.
Key Highlights
The opioid crisis and gout: Neogi et al. reported on the opioid epidemic in the U.S. and Canada where nearly 600,000 people have died from an opioid overdose over the past 20 years. This is one of the most pressing public health issues facing the US and Canada. Although Neogi et al showed that opioid prescribing was double that of the general population during the first year after a diagnosis of gout.
For people with gout, the recommended treatments for gout flares are colchicine, non-steroidal anti-inflammations, or corticosteroids. Opioids are NOT recommended for gout flare treatment. Flare treatments are best started as soon as the flare commences so people with gout should have a readily available supply of their recommended medication.
Reference:
Neogi T, Englund M, Turkiewicz A, Kiadaliri A. Frequency and patterns of opioid use in the management of gout: A population-based study [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
Learn more about gout treatment options: https://gouteducation.org/medical-professionals/treating-gout/gout-treatment-and-pain-relief/
Improving outcomes when using intravenous pegloticase in gout: The MIRROR trial; Botson et al.
Urate-lowering medications are recommended for the long-term management of gout. When oral tablets fail to provide sufficient benefit the newer medication pegloticase which is given by intravenous infusion may be used. The use of pegloticase can be limited by the development of anti-drug antibodies which contribute to loss of efficacy, signaled by a rise in blood urate levels and infusion reactions. In other forms of arthritis, a medication called methotrexate has been used to prevent the formation of anti-drug antibodies thereby preventing the loss of efficacy.
The 12-month data from the MIRROR study showed that fewer people who received methotrexate in combination with pegloticase experienced a loss of efficacy. This resulted in sustained urate lowering and resolution of tophi in 53.8% of the methotrexate group, compared with 31.0% in the placebo group.
Reference:
Botson J, Saag K, Peterson J, et al. 12-month findings of the randomized, reference: double-blind, placebo-controlled, multicenter, efficacy and safety study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase (MIRROR RCT) [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
What Drives Racial Disparities in Gout in the USAal.6
Several abstracts addressed racial disparities in gout showing. poor outcomes in non-white participants and higher rates of U.S. emergency department visits and hospitalizations in certain ethnic groups, especially Black Americans, with gout. There is a long history of stigmatization and blaming the patient in gout. Efforts need to be made to educate healthcare professionals that the patient is not to blame and to destigmatize this disease. Healthcare providers need to address the multiple barriers to health are access for under-served populations to address these racial disparities.
References:
McCormick N, Lu L, Yokose C, et al. What Drives racial disparities in gout in the USA?—Population-based, sex-specific, causal mediation analysis [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
Yokose C, McCormick N, Lu N, et al. Contemporary racial/ethnic disparities in emergency department visits and hospitalizations for gout in the United States—2019 nationwide analysis [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
New technologies for diagnosing gout. For many people, the diagnosis of gout requires joint aspiration whereby fluid is removed from the joint so the monosodium urate crystals which trigger the gout flare can be seen under a microscope. Newer imaging techniques are being developed which can aid in the visualization of the crystals without the need for joint aspiration. Becce et al. reported on point-of-care multi-energy/spectral photon-counting CT (PCCT) that is capable of detecting very small amount of both monosodium urate crystals that cause gout and calcium pyrophosphate crystals which cause pseudogout. Although this was not undertaken in humans it provides the required evidence to progress towards human trials.
Reference:
Becce F, Viry A, Racine D, et al. Point-of-care multi-energy photon-counting ct for earlier non-invasive diagnosis of gout and calcium pyrophosphate deposition disease [abstract]. Arthritis Rheumatol. 2022;74(suppl 9).
Learn more about diagnosing gout: https://gouteducation.org/medical-professionals/diagnosing-gout/
