November 10-15

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ACR Convergence 2023

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Gout concerns extend to several different types of comorbidities


3 minutes

Naomi Schlesinger, MD
Naomi Schlesinger, MD

A Monday afternoon Clinical Practice session will examine several comorbidities that can complicate management and affect long-term prognoses for patients.

Goutside the Box: Extra-Articular Gout Manifestations will take place from 2:30 – 4:00 pm in Hall B1, Building B in the Georgia World Congress Center. 

“Gout, the most prevalent inflammatory arthritis worldwide, is commonly associated with multiple comorbidities,” said Naomi Schlesinger, MD, Professor of Medicine, Chief, Division of Rheumatology, and Director, Rutgers Robert Wood Johnson Gout Center. “The diagnosis and treatment of comorbidities should be an integral part of gout diagnosis and treatment.”

Dr. Schlesinger will moderate the session along with Alexander So, MD, FRCP, Professor at the University of Lausanne, Switzerland. Session presenters will address the latest information about the role of hyperuricemia in gout as it relates to the renal disease, cardiovascular (CV) disease, and neurological issues.

Richard Johnson, MD, Professor, Medicine-Renal Med Diseases/Hypertension, University of Colorado School of Medicine, noted that hyperuricemia is highly associated with hypertension and chronic kidney disease (CKD). His presentation will discuss the epidemiology of renal disease in patients with gout and review the renal effects of hyperuricemia and gout along with the effects of treating hyperuricemia on renal disease.

Experimental and pilot clinical studies strongly support a role for lowering uric acid levels in CKD, Dr. Johnson said.

“Large clinical trials are ongoing and will be important in clarifying the role of lowering uric acid in CKD as well as the level of hyperuricemia for intervention,” he said.

While inflammatory arthritis is gout’s fundamental feature, gout is a metabolic condition associated with insulin resistance and high levels of cardiovascular-metabolic-renal comorbidities and premature death, said Hyon Choi, MD, PhD, Director, Clinical Epidemiology, Massachusetts General Hospital. During his presentation, Dr. Choi will review the CV effects of hyperunicemia and gout during his presentation.

“Despite the independent associations between serum urate levels, gout, and CV endpoints reported in many epidemiologic studies, Mendelian randomization studies for causality for these associations have been largely null and the limited number of human trial results have been conflicting, with a number of large-scale trials currently underway,” he said.

In the meantime, Dr. Choi said, common lifestyle approaches such as weight control, regular exercise and CV-focused eating plans such as the Mediterranean and DASH diets can modestly help lower both CV risk and serum urate levels.

The session’s final presenter, Jasvinder Singh, MD, MPH, Professor of Medicine and Epidemiology, University of Alabama-Birmingham, will cover the more controversial topic of how much effect gout and hyperuricemia can have on neurological diseases. 

Dr. Singh said that the results concerning neurological effects are mixed, with limited data to this point, but lower serum urate may be associated with more severe nuerological diseases, except in dementia. He noted that lower serum urate levels were observed in several neurological diseases, but not in all studies conducted.

“The effects of treatment of hyperuricemia on neurological disease outcomes need further study,” Dr. Singh said.