Gout-Related Conditions and Patient Disparities
Researchers focus on treating conditions that occur with gout, and ways to reduce health disparities.
By Jill Tyrer | Dec. 21, 2023
People who have gout are likely to also have other conditions that accompany it. Treating those comorbidities is just as important as treating the gout itself, and in some cases they go hand-in-hand. Nicola Dalbeth, rheumatologist and professor at the University of Aukland, New Zealand, addressed this topic at the recent 2023 American College of Rheumatology annual meeting.
The standard approach to treating gout is to treat the painful flares and inflammation it causes as well as high levels of uric acid in the blood that is often a hallmark of gout. Uric acid builds up and forms needlelike crystals that lodge in joint tissues, causing acute pain.
Typically, a severe flare is accompanied by other conditions, Dr. Dalbeth says. In men, it’s common to see hypertension, heart disease, kidney disease and diabetes. Women with gout often have even higher rates of comorbidities, especially chronic kidney disease, cardiovascular events and hypertension. And these additional conditions can have serious consequences, including premature death.
“We became very aware of comorbidities in the Covid-19 era,” she says. Studies have shown that people with gout have a higher risk of poor outcomes with Covid, largely related to coexisting cardiometabolic conditions.
Studies have found that high uric acid levels often occur along with cardiovascular disease, but they have not found that they cause it. Instead, she proposes, maybe the gout flare or inflammation itself is contributing to the increased risk of cardiovascular events. One study indicated that the risk of acute myocardial infarction and stroke is higher in the 120 days after a flare.
Doctors need to be testing for cardiovascular disease and chronic kidney disease risk in people with gout, and actively managing those conditions as well as the gout, she says. Flares can be reduced or controlled with medications such as low-dose colchicine or canakinumab.
In addition, the comorbidities need to be addressed with medications like losartan, atorvastatin and calcium channel blockers. Semaglutide inhibitors, especially in people with diabetes, may also control comorbidities, as will a healthy, plant-based diet, like the DASH diet, she says.
One study showed that uric acid lowering medication allopurinol was not effective in reducing cardiovascular events in people who don’t have gout. But that doesn’t mean there isn’t still a role for these kinds of medications, she added. “Effective gout therapy prevents flares over time and reduces exposure to nonsteroidal anti-inflammatory medications and steroids,” both of which can cause lingering damage with prolonged use. “Effective urate-lowering therapy needs to be part of the program.”
Additionally, when gout is under control, then it’s easier to manage other health issues. Patients will be able to do more on their own to care for their health, like exercise,” Dr. Dalbeth says. “If you’ve got recurrent gout flares, exercise and other aspects of a healthy lifestyle are very difficult.”
Rheumatologist Jasvinder Singh, MBBS, MPH, professor of medicine and epidemiology in immunology and rheumatology at the University of Alabama Birmingham, focused on health inequities in gout.
The incidence of gout is far higher in Black men than white men and in Black women than white women, as is the risk of coexisting conditions. Research shows that In the U.S., Blacks, Asians and Hispanics with gout are much more likely to seek care in emergency departments and to be hospitalized than white people with gout.
In addition, the consequences of having gout are much higher for Black people than whites. In a three-city survey, Dr. Singh found that Black gout patients had significantly worse health-related quality of life than Caucasian patients. They had more functional limitations than whites and poorer mental and emotional health. “On almost every scale, African Americans with gout in three communities in the U.S. were doing much worse compared to Caucasians.”
In a study of nearly 10,000 adults with gout, minorities were half as likely to take urate-lowering medication as prescribed compared with whites. Plus, they were less likely to be prescribed urate-lowering medications.
These medications work equally well in Black patients as white patients, but only if they are prescribed and taken appropriately, he adds.
Dr. Singh and his team surveyed gout patients in the Birmingham, Alabama, area about the impacts of gout on their life and found that they were much harder for Blacks than for whites. Black people ranked the following among their top seven concerns related to gout: dietary restrictions due to gout, severe/extreme pain, gout bringing the day to a halt, the effect of gout on emotional health/irritability, and the need to use canes or crutches during a flare.
In comparison, white patients were more likely to report the impact of gout on their work.
He described a trial he led, funded by the Veteran’s Administration, using storytelling as a method to improve adherence. Storytelling is a way of reducing barriers to adherence and has been found to help lower blood pressure. Ultimately, it didn’t work, but additional research may get different results.
Other steps are needed to reduce these disparities and improve outcomes for Black, Asian and Hispanic gout patients, beginning with better insights into the mechanisms of the disparities, he says. Moreover, researchers need to engage these patients into more research trials targeting the causes of the disparities as well as the outcomes.
People who have gout are likely to also have other conditions that accompany it. Treating those comorbidities is just as important as treating the gout itself, and in some cases they go hand-in-hand. Nicola Dalbeth, rheumatologist and professor at the University of Aukland, New Zealand, addressed this topic at the recent 2023 American College of Rheumatology annual meeting.
The standard approach to treating gout is to treat the painful flares and inflammation it causes as well as high levels of uric acid in the blood that is often a hallmark of gout. Uric acid builds up and forms needlelike crystals that lodge in joint tissues, causing acute pain.
Typically, a severe flare is accompanied by other conditions, Dr. Dalbeth says. In men, it’s common to see hypertension, heart disease, kidney disease and diabetes. Women with gout often have even higher rates of comorbidities, especially chronic kidney disease, cardiovascular events and hypertension. And these additional conditions can have serious consequences, including premature death.
“We became very aware of comorbidities in the Covid-19 era,” she says. Studies have shown that people with gout have a higher risk of poor outcomes with Covid, largely related to coexisting cardiometabolic conditions.
Studies have found that high uric acid levels often occur along with cardiovascular disease, but they have not found that they cause it. Instead, she proposes, maybe the gout flare or inflammation itself is contributing to the increased risk of cardiovascular events. One study indicated that the risk of acute myocardial infarction and stroke is higher in the 120 days after a flare.
Doctors need to be testing for cardiovascular disease and chronic kidney disease risk in people with gout, and actively managing those conditions as well as the gout, she says. Flares can be reduced or controlled with medications such as low-dose colchicine or canakinumab.
In addition, the comorbidities need to be addressed with medications like losartan, atorvastatin and calcium channel blockers. Semaglutide inhibitors, especially in people with diabetes, may also control comorbidities, as will a healthy, plant-based diet, like the DASH diet, she says.
One study showed that uric acid lowering medication allopurinol was not effective in reducing cardiovascular events in people who don’t have gout. But that doesn’t mean there isn’t still a role for these kinds of medications, she added. “Effective gout therapy prevents flares over time and reduces exposure to nonsteroidal anti-inflammatory medications and steroids,” both of which can cause lingering damage with prolonged use. “Effective urate-lowering therapy needs to be part of the program.”
Additionally, when gout is under control, then it’s easier to manage other health issues. Patients will be able to do more on their own to care for their health, like exercise,” Dr. Dalbeth says. “If you’ve got recurrent gout flares, exercise and other aspects of a healthy lifestyle are very difficult.”
Health Disparities in Gout Patients
Rheumatologist Jasvinder Singh, MBBS, MPH, professor of medicine and epidemiology in immunology and rheumatology at the University of Alabama Birmingham, focused on health inequities in gout.
The incidence of gout is far higher in Black men than white men and in Black women than white women, as is the risk of coexisting conditions. Research shows that In the U.S., Blacks, Asians and Hispanics with gout are much more likely to seek care in emergency departments and to be hospitalized than white people with gout.
In addition, the consequences of having gout are much higher for Black people than whites. In a three-city survey, Dr. Singh found that Black gout patients had significantly worse health-related quality of life than Caucasian patients. They had more functional limitations than whites and poorer mental and emotional health. “On almost every scale, African Americans with gout in three communities in the U.S. were doing much worse compared to Caucasians.”
In a study of nearly 10,000 adults with gout, minorities were half as likely to take urate-lowering medication as prescribed compared with whites. Plus, they were less likely to be prescribed urate-lowering medications.
These medications work equally well in Black patients as white patients, but only if they are prescribed and taken appropriately, he adds.
Dr. Singh and his team surveyed gout patients in the Birmingham, Alabama, area about the impacts of gout on their life and found that they were much harder for Blacks than for whites. Black people ranked the following among their top seven concerns related to gout: dietary restrictions due to gout, severe/extreme pain, gout bringing the day to a halt, the effect of gout on emotional health/irritability, and the need to use canes or crutches during a flare.
In comparison, white patients were more likely to report the impact of gout on their work.
He described a trial he led, funded by the Veteran’s Administration, using storytelling as a method to improve adherence. Storytelling is a way of reducing barriers to adherence and has been found to help lower blood pressure. Ultimately, it didn’t work, but additional research may get different results.
Other steps are needed to reduce these disparities and improve outcomes for Black, Asian and Hispanic gout patients, beginning with better insights into the mechanisms of the disparities, he says. Moreover, researchers need to engage these patients into more research trials targeting the causes of the disparities as well as the outcomes.
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