Cardiovascular Risk and Gout Treatment: Febuxostat v. Allopurinol

MedicalResearch.com Interview with:
“Gout in my foot” by vagawi  is licensed under CC BY 2.0Seoyoung C. Kim, MD, ScD, MSCE
Associate Professor of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Division of Rheumatology, Immunology and Allergy
Brigham and Women’s Hospital, Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Since patients with gout are at an increased risk of cardiovascular events, we wanted to examine comparative cardiovascular safety of the two most commonly used urate-lowering drugs – febuxostat and allopurinol.

Using claims data from US Medicare, we conducted a cohort study of 24,936 febuxostat initiators PS-matched to 74,808 allopurinol initiators.

We found the risk of the primary cardiovascular endpoint (MI or stroke) was similar between the two groups. Analyses on secondary endpoints as well as all-cause mortality showed similar findings except that febuxostat was associated with a modestly reduced risk of heart failure exacerbation among patients with preexisting heart failure. In our sensitivity analysis, the risk of all-cause mortality associated with long-term use of febuxostat v. allopurinol appears to be increased but statistically not significant.

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How Much DASH Diet is Required To Reduce Uric Acid?

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Stephen P. Juraschek, MD, PhD

Instructor of Medicine
Beth Israel Deaconess Medical Center/Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent evidence suggests that the DASH diet is associated with lower uric acid levels and lower risk of gout. Furthermore, a secondary analysis of the DASH trial showed that complete replacement of a typical American diet with the DASH diet lowered uric acid levels. However, it is unknown if partial replacement of a typical American diet with DASH foods might lower uric acid.

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Gout Linked To Raised Risk of Erectile Dysfunction

MedicalResearch.com Interview with:

Dr Edward Roddy Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist Arthritis Research UK Primary Care Centre Research Institute for Primary Care & Health Sciences Keele University Staffordshire UK

Dr. Edward Roddy

Dr Edward Roddy
Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist
Arthritis Research UK Primary Care Centre
Research Institute for Primary Care & Health Sciences
Keele University
Staffordshire UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Both gout and erectile dysfunction (ED) are prevalent in the general population, and share some common risk factors such as obesity, alcohol consumption and comorbidity (vascular disease, renal disease etc). We undertook a retrospective cohort study in UK Clinical Practice Research Database, a large longitudinal UK database of UK computerised primary care records, to quantify the risk of incident ED in men with gout. We found that men with gout had 30% greater risk of developing erectile dysfunction than men without gout, after adjusting for confounding variables such as lifestyle factors and comorbidity, although the absolute increased risk was small (0.6%). We did a further analyses including men who already had ED when they were diagnosed with gout, finding that they were also at increased risk of being diagnosed with ED in the year before they developed gout, suggesting that hyperuricaemia, which people can have for decades before developing gout, may be a key reason to explain the increased risk of erectile dysfunction in people with gout.

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How Does Gout Affect Risk of Colon Cancer?

MedicalResearch.com Interview with:

Michael Pillinger, MD Professor of Medicine and Biochemistry and Molecular Pharmacology NYU School of Medicine

Dr. Michael Pillinger

Michael Pillinger, MD
Professor of Medicine and Biochemistry and Molecular Pharmacology
NYU School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We are interested in the co-morbidities of gout and the fact that gout is accompanied by multiple cardiovascular, renal and other events. The implications of gout for cancer are less clear, but the basic biology suggests that either:

1) the acute and chronic inflammation of gout could contribute to a pro-cancer environment;
2) the anti-oxidant effects of urate could have anti-cancer properties;
3) the ability of uric acid to serve as a “danger signal” released from dying cells (potentially including cancer cells” could promote anti-cancer immunity.

The clinical literature is murky at best.

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Urate Lowering Therapy in Moderate to Severe Chronic Kidney Disease

MedicalResearch.com Interview with:

Gerald D. Levy MD Internal Medicine/Rheumatology Southern California Kaiser Permanente Downey, CA

Dr. Gerald Levy

Gerald D. Levy MD
Internal Medicine/Rheumatology
Southern California Kaiser Permanente
Downey, CA 

MedicalResearch.com: What are the main findings of your study?

Patients with hyperuricemia and chronic kidney disease (CKD)  improve when serum Uric Acid (sUA) is brought below 6mg/dl with urate lowering therapy.

We found a 6% improvement in this group compared to patients not at goal.

More importantly the stage of CKD appears to be important with CKD II showing approximately 3% who improve with nearly 10% of patients improving in the CKD III group.
We did not see benefit in those patients who are stage 4 CKD.

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No Increased Risk of Chronic Kidney Disease with Allopurinol Use

MedicalResearch.com Interview with:
Dr. Ana Beatriz Vargas dos Santos
Médica do Serviço de Reumatologia
Universidade do Estado do Rio de Janeiro

MedicalResearch.com: What is the background for this study?

Response: Gout is the most common inflammatory arthritis worldwide and, despite available treatment, the management of gout remains suboptimal. One of the reasons for this suboptimal management of gout is the hesitant use of urate-lowering therapy, including a common reduction in dose or discontinuation of allopurinol in patients with gout who have kidney dysfunction based on the assumption that allopurinol may be worsening kidney function. However, there is no evidence that allopurinol is toxic for the kidneys, and this dose reduction or discontinuation results in more difficult-to-treat gout.

Chronic kidney disease (CKD) stage 3 or above occurs in approximately 20% of people with gout, and there is emerging evidence that urate-lowering therapy may improve kidney function in patients with both gout and CKD. Although CKD is common, most people with gout start out with normal kidney function. Yet, there are limited data regarding the effects of allopurinol on kidney function in such individuals. We, therefore, undertook this study to assess whether people with newly diagnosed gout who are starting allopurinol are at increased risk for developing CKD stage 3 or worse.

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DASH Diet For Hypertension May Also Lower Uric Acid in Gout Patients

MedicalResearch.com Interview with:

Stephen P. Juraschek, MD, PhD Fellow, Division of General Internal Medicine Johns Hopkins Hospital

Dr. Stephen Juraschek

Stephen P. Juraschek, MD, PhD
Fellow, Division of General Internal Medicine
Johns Hopkins Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Diet has long been viewed as an important way to lower uric acid levels to prevent gout attacks; however, there is little evidence about whether a particular dietary pattern might be effective for lowering uric acid. For the first time we show that the DASH diet, an effective diet for lowering blood pressure, it lowers uric acid levels substantially in people with abnormally high uric acid levels.

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Steroids An Option to NSAIDS for Treatment of Acute Gout

MedicalResearch.com Interview with:

Professor Timothy H Rainer MD MBBCh Director, Accident & Emergency Medicine Academic Unit The Chinese University of Hong Kong

Prof. Timothy Rainer

Professor Timothy H Rainer  MD MBBCh
Director, Accident & Emergency Medicine Academic Unit
The Chinese University of Hong Kong 

Medical Research: What is the background for this study? What are the main findings?

Prof. Rainer: Gout is a type of arthritis characterised by periodic attacks of acute joint swelling and severe pain, and  often treated with colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs).  Two recent randomized, controlled trials showed that oral prednisolone, a corticosteroid, was as effective as NSAIDs in the treatment of acute gout, but these studies involved small numbers of patients.  The researchers investigatedwhether oral prednisolone was as effective and safe as indomethacin (a NSAID) in a larger sample of patients who had acute gout symptoms and who were seen in the emergency department (ED) setting. Patients in both the prednisolone and indomethacin groups had clinically meaningful decreases in their pain levels during the 2 hours they were observed in the ED as well as during the 14-day follow-up period. Both groups had a similar decrease in pain levels. No major adverse events were reported in either group although there were more minor adverse events in the indomethacin group.

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Acute Gout Episodes Peaks in November

MedicalResearch.com Interview with:
Paras Karmacharya, MD
Internal Medicine Reading Health System
West Reading, PA 19611
Co-Authors: Ranjan Pathak MD, Madan Raj Aryal MD,
Smith Giri MD, Anthony A Donato MD MHPE

Medical Research: What is the background for this study?

Response: Studies describing seasonal variations in acute gouty arthritis note a seasonal trend, but disagree on timing, with most showing a peak in spring months while others showing peaks later in the year. However, serum uric acid (SUA) levels seem to peak in the summer months. This disparity has led to the hypothesis that the flares might be related to factors other than elevated serum uric acid levels. Various theories on the effects of weather and immune system changes on the chronobiology of the equilibrium and precipitation of monosodium urate crystals have been proposed. We aimed to shed light on this question by examining the seasonal variation in the incidence of acute gouty arthritis in the US using a large inpatient database.

Medical Research: What are the main findings?

Response: We used the Nationwide Inpatient Sample (NIS) database, a large national database that represents 20% of all hospital admissions, to identify adult patients with a primary diagnosis of acute gouty arthritis from 2009-2011 during their hospitalization. A total of 28,172 hospitalizations with primary diagnosis of acute gouty arthritis were reported from 2009-11. The peak incidence of acute gout was seen in the month of November (peak/low ratio 1.34, 95% CI 1.29-1.38, p<0.05) (Figure 1). The highest number of hospitalizations was observed in autumn months, while the lowest incidence was observed in spring (28.12% vs. 23.13%, p<0.001).

Medical Research: What should clinicians and patients take away from your report?

Response: Unlike previous studies, our analysis found the peak incidence of acute gout in the fall with its peak in the month of November. Various environmental (temperature, humidity, diet, physical activity) and biochemical factors (low cortisol levels, high absolute neutrophil counts and plasminogen activator inhibitor-1) have been implicated for the seasonal variation, but the data on this is conflicting. Whether our findings are reflective of purine and alcohol intake over the US holidays in November and December is a hypothesis that requires further testing.

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Majority of Gout Patients Do Not Achieve Target Uric Acid Level

Marsha A. Raebel, PharmD Senior Investigator Kaiser Permanente Colorado's Institute for Health Research

Dr. Raebel

MedicalResearch.com Interview with:
Marsha A. Raebel, PharmD
Senior Investigator
Kaiser Permanente Colorado’s Institute for Health Research

Medical Research: What is the background for this study? What are the main findings?

Dr. Raebel: Gout is an inflammatory arthritis that affects at least 7.5 million American adults. A hallmark of gout is high serum uric acid that can result in urate crystals being deposited in joints, causing pain and joint damage. The American College of Rheumatology (ACR) guidelines recommend lowering serum uric acid to target values in patients with gout to prevent urate crystal deposition in joints and to promote crystal dissolution. For most patients, serum uric acid levels should be reduced to < 6mg/dL and maintained below that level. Measuring serum uric acid is a necessary step when titrating urate-lowering medications using a treat to target approach, but little is known about either serum uric acid measurement practices or attainment of target serum uric acid levels outside of clinical trials. We set out to characterize uric acid measurement and target serum uric acid attainment in patients with gout in the usual ambulatory care settings of the Kaiser Permanente integrated health system in the United States.

We identified 72,803 patients newly-diagnosed with gout in three Kaiser Permanente regions; 61% had at least one serum uric acid measurement within the baseline year prior to their gout diagnosis. Over each 12 month interval after the gout diagnosis, fewer patients had a serum uric acid measured. For example, serum uric acid measurement decreased to 40% of the patients the first year after the gout diagnosis, and to 26% of patients the second year after the gout diagnosis. While median serum uric acid levels across all patients decreased from 8.0 to 6.6 mg/dL over the entire 12 years of follow-up, almost 60% of patients never achieved a serum uric acid level less than 6 mg/dL. Achievement of this target serum uric acid level was more frequent in those who had a lower serum uric acid at baseline. Less than 12% of patients achieved all follow-up serum uric acid levels in the target range.

Medical Research: What should clinicians and patients take away from your report?

Dr. Raebel: Clinicians should be aware that, although most patients had at least one serum uric acid measured at some time, regular serum uric acid assessment was infrequent. Infrequent serum uric acid assessment impedes optimal use and monitoring of urate-lowering therapy. More than half of patients did not achieve any serum uric acid value within the target range of less than 6mg/dL. Given that the majority of patients with new-onset gout never reach the target serum uric acid level, more frequent serum uric acid measurement is urged.

Specifically, patients should adhere to having serum uric acid monitored as recommended by their physician and should request that their physician periodically order laboratory serum uric acid testing for them at frequencies based on treatment guidelines. To assist in reaching serum uric acid target levels, patients should take their urate-lowering medication as prescribed by their doctor. Furthermore, they should not stop their urate-lowering therapy without having been so advised by their doctor.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Raebel: We recommend developing interventions that support physicians and patients with gout in monitoring serum uric acid and treating to target serum uric acid levels. For example, best practice alerts could be developed and implemented in electronic health records that prompt physicians to order serum uric acid laboratory testing when more than a year has passed between measurements for any patient with gout or more frequently for patients who are not in the target range.

Citation:

Abstract presented at the 2015 ACR meeting November 2015

Treating to Target in Gout: The Epidemiology of Serum Urate Measurement Among Patients with Incident Gout in Usual Care Settings in the United States

Marsha A. Raebel, PharmD (2015). Majority of Gout Patients Do Not Achieve Target Uric Acid Level 

Elevated Uric Acid Correlates With High Risk of Acute Kidney Injury

Wisit Cheungpasitporn, MD Nephrology Fellow Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MMedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD
Nephrology Fellow
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN
Program director: Suzanne Norby, MD
Co-authors: Charat Thongprayoon, MD, Andrew M. Harrison, BS and Stephen B. Erickson, MD
Project mentors: Stephen B. Erickson, MD Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

 

Medical Research: What is the background for this study?

Dr. Cheungpasitporn: Uric acid has been linked to acute kidney injury (AKI) through crystal-dependent pathways and crystal-independent mechanisms, including reduced renal blood flow and glomerular filtration rate. Serum uric acid measurement has recently been examined as a marker for early AKI detection, especially in the setting of postoperative AKI following cardiovascular surgery. The effect of admission serum uric acid levels on the risk of in-hospital AKI in the general hospitalized patients, however, was unclear. Thus, we conducted a study to assess the risk of AKI in all hospitalized patients across different serum uric acid levels. The findings of our study data were recently published in Clinical Kidney Journal.

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Gout: Using CT Scan to Diagnose Difficult Cases

Tim Bongartz, M.D. Associate Professor of Medicine Department of Rheumatology Mayo Clinic, MinnesotaMedicalResearch.com Interview with:
Tim Bongartz, M.D.
Associate Professor of Medicine
Department of Rheumatology
Mayo Clinic, Minnesota


MedicalResearch.com: What are the main study findings?

Dr. Bongartz:  Dual-energy computed tomography (DECT) is an imaging methods that has been in use for many years to classify the material of renal stones. Our study demonstrates that this technology can be useful in identifying monosodium urate deposits in and around joint, allowing to diagnose patients with gout with overall high sensitivity and specificity. Importantly, a stratified analysis of patient subgroups revealed that DECT is less accurate in diagnosing patients with a first flare of gout, emphasizing the importance of careful patient selection when using this new technology. In a “diagnostic-yield” substudy, we explored the question how much DECT could contribute to correctly diagnose patients where clinicians did have a high level of suspicion for gout, but synovial fluid aspiration results came back negative. In about a third of these patients with negative routine testing, we could confirm a diagnosis of gout through use of DECT.
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Pegloticase aids gout patients not helped by standard treatments

Injections of pegloticase, a modified porcine enzyme, can produce significant and sustained clinical improvements in 2 out of 5 patients with chronic gout that is resistant to conventional therapies, researchers report in the August 17, 2011, issue of JAMA.

In two controlled clinical trials, pegloticase rapidly lowered high levels of uric acid, the biochemical abnormality in gout, and kept it in the normal range for six months or more in 42 percent of patients receiving the drug every two weeks. Forty percent of patients had complete resolution of at least one of the painful swollen joint nodules, known as tophi, a hallmark of severe gout.

Injections of pegloticase, a modified porcine enzyme, can produce significant and sustained clinical improvements in 2 out of 5 patients with chronic gout that is resistant to conventional therapies, researchers report in the August 17, 2011, issue of JAMA.

In two controlled clinical trials, pegloticase rapidly lowered high levels of uric acid, the biochemical abnormality in gout, and kept it in the normal range for six months or more in 42 percent of patients receiving the drug every two weeks. Forty percent of patients had complete resolution of at least one of the painful swollen joint nodules, known as tophi, a hallmark of severe gout.

“This represents the first effective therapy for a group of patients who previously had no options at all,” said the study’s senior author, Michael A. Becker, MD, professor of medicine at the University of Chicago. “This is for patients with severe gout, including major disabilities and high levels of pain. Many of these people had dramatic responses within months, some with complete resolution of tophi, as well as reduced levels of pain and disability. The rapidity of these outcomes is unheard of.”

“People are dramatically helped by the drug,” said rheumatologist John S. Sundy, MD, PhD, director of the Duke Clinical Research Unit and lead author of the study. The drug’s response among patients who have failed common therapies is typically an “all-or-nothing result,” he added, “providing marked relief for those who benefit.”

Becker cautioned that “it’s not curative, but it resets the clock, moving the hands back on a patient’s struggle with a progressive disease.”

Once associated with European royal families, gout is increasingly a middle-class American disease, with connections to obesity, hypertension, diabetes, heart disease and alcohol abuse. An estimated 6 million people, about 2 percent of the U.S. adult population, have gout, a number that has increased by about 50 percent since 1990.

The disease is caused by a gradual accumulation of uric acid. When levels exceed the saturation point, uric acid forms tiny urate crystals, like thousands of little needles, that deposit in the lining of joints and other tissues. The crystals can cause inflammation, swelling and intense pain. A favorite target is at the base of the big toe, a common site for acute arthritic attacks and tophi.

There are medications for chronic gout that block the synthesis of uric acid or help the kidneys remove it. For about 3 percent of people with gout, however, these drugs either are ineffective or cause intolerable side effects. This leaves about 120,000 to 180,000 patients in the United States with chronic disabling disease and, until recently, no effective therapy.

Pegloticase—approved by the FDA in September 2010 for the treatment of severe, refractory gout—was designed to meet that need, filling a gap left by nature. Most species, except for humans and a few other primates, produce the enzyme urate oxidase (also know as uricase). This enzyme converts uric acid to allantoin, which is far more soluble in fluids and can be easily excreted. “It essentially digests uric acid,” Becker said.

Scientists at Duke, led by Michael Hershfield, MD, developed the compound and spent decades to fine tune the drug and usher it to market. They modified the version of the enzyme from pigs and wrapped it in polyethylene glycol to protect it from being degraded or attacked by the patient’s immune system. The coating extends the half-life of the enzyme from eight hours to 10 to 12 days, so patients need an injection just once every two weeks, making this drug suitable for long-term treatment.

When pegloticase is injected into patients with severe gout, their uric acid levels return to normal within 24 hours. This can lead to gradual dissolution of uric-acid crystals and eventual resolution of gout symptoms.

The two parallel clinical trials focused on 212 patients from 56 rheumatology practices in the United States, Canada and Mexico. They enrolled patients with severe gout and high uric-acid levels who were not helped by or couldn’t tolerate standard treatments. Patients were divided into three groups. One group was injected with 8 milligrams of pegloticase every two weeks, one group received pegloticase every month and one group got a placebo—injections of saline but no actual drug. All participants were enrolled for six months of treatment.

Although uric-acid levels fell to normal ranges within 24 hours in all patients who received the drug, for some patients the drug soon lost its beneficial effect. In 42 percent of patients who got the drug every two weeks, however, uric-acid levels stayed within normal ranges for at least 80 percent of the six-month period. In 35 percent of those who got injections once a month, uric-acid levels remained low for 80 percent of the trial period. Patients who received a placebo had no change in levels.

Forty percent of biweekly injection patients and 21 percent of those getting monthly injections had complete resolution of one or more tophi within six months, compared with 7 percent of patients receiving placebo. Patients who received the drug also reported improved physical function and quality of life.

Nine out of 10 patients, however, had at least one adverse event. The most common were gout flares—brief, treatable attacks of pain and inflammation. These declined after the first three months of treatment.

The second most common side effect, and the primary reason for patients to withdraw from the study, was an infusion-related reaction; 26 percent of treated patients, most of whom had already stopped responding to the drug, developed an immune response to injection of the foreign protein. Although patients were given medications to reduce the risk and severity of an immune response, about 5 percent of biweekly and 8 percent of monthly patients had a serious reaction. These all resolved completely.

Nearly all of the patients in the study had multiple cardiovascular risk factors and seven patients died during the trial period. The authors recommend “measures to stabilize cardiovascular problems prior to and during treatment.”

Most patients eventually developed antibodies against the drug, which suggests that it may be difficult to repeat treatment months or years later. Additional research is aimed at learning the optimum duration of treatment and bolstering the drug’s response in more patients.

Despite the risks, “this is an advance – a significant advance,” Becker said.

Sundy added: “This is a group of people for whom there has not been another option for a long time.”

The cost of pegloticase, sold as Krystexxa by Savient Pharmaceuticals, is about $60,000 for a year of treatment. Most patients complete treatment within six to eight months.

It may also be very useful for transplant patients, Becker said. About 10 percent of transplant recipients get gout and many can’t take the standard medications because they interfere with the drugs that prevent rejection.

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Savient Pharmaceuticals funded this study. The authors, in addition to Becker and Sundy, were Herbert Baraf of the Center for Rheumatology and Bone Disease in Wheaton, Mass.; Robert Yood of the Fallon Clinic in Worcester, Mass.; Lawrence Edwards of the University of Florida, Gainesville; Sergio Gutierrez-Urena of the Hospital Civil of Guadalajara, Mexico; Edward Treadwell of East Carolina University, Greeneville N.C.; Janitzia Vasquez-Mellado of Hospital General de Mexico, Mexico City; William White of the University of Connecticut, Farmington; Peter Lipsky of Charlottesville, Va.; and Zeb Horowitz, William Huang, Allan Maroli, Royce Waltrip and Steven Hamburger of Savient Pharmaceuticals, East Brunswick, N.J. The academic authors determined the content of the final manuscript.

US Gout prevalence increases over last 2 decades

A new study shows the prevalence of gout in the U.S. has risen over the last twenty years and now affects 8.3 million (4%) Americans. Prevalence of increased uric acid levels (hyperuricemia) also rose, affecting 43.3 million (21%) adults in the U.S. Greater frequency of obesity and hypertension may be associated with the jump in prevalence rates according to the findings now available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

Gout, an inflammatory arthritis triggered by crystallization of uric acid within the joints, causes severe pain and swelling. Medical evidence suggests that gout is strongly associated with metabolic syndrome—a group of health conditions characterized by central obesity, insulin resistance, high blood pressure and blood lipid issues—and may lead to heart attack, diabetes and premature death. Prior research found that gout incidence in the U.S. more than doubled from the 1960s to 1990s.

“Our study aim was to determine if the prevalence of gout and hyperuricemia among U.S. adults has continued to climb in the new millennium,” said Dr. Hyon Choi, Professor of Medicine in the Section of Rheumatology and the Clinical Epidemiology Unit at Boston University School of Medicine in Massachusetts and senior investigator of the present study.

Researchers analyzed data from the latest U.S. National Health and Nutrition Examination Survey (NHANES) which was conducted in 2007 and 2008, comparing the data with those from previous NHANES surveys (1988-1994). There were 5,707 participants who completed the most recent NHANES survey which included questions regarding history of gout diagnosed by a healthcare professional. Researchers defined hyperuricemia as serum urate level greater than 7.0 mg/dL in men and 5.7 mg/dL in women.

Results from the nationally-representative sample of adult Americans suggest gout and hyperuricemia remain prevalent in the U.S. and compared to earlier NHANES data was 1% and 3% higher, respectively. After adjusting for obesity or hypertension, the differences in prevalence rates were substantially lessened. Further analysis revealed that gout prevalence was higher in men (6%) compared to women (2%); hyperuricemia occurred in 21.2% of men and 21.6% of women.

Dr. Choi concluded, “We found that the prevalences of gout and hyperuricemia continue to be substantial in the U.S. adult population. Improvements in managing modifiable risk factors, such as obesity and hypertension, could help prevent further escalation of gout and hyperuricemia among Americans.”

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This study is published in Arthritis & Rheumatism.

Full citation: “Prevalence of Gout and Hyperuricemia in the US General Population.” Yanyan Zhu, Bhavik J Pandya, Hyon K Choi.” Arthritis & Rheumatism; Published Online: July 28, 2011 (DOI: 10.1002/art.30520). http://doi.wiley.com/10.1002/art.30520.