Conventional oral urate-lowering therapies frequently to fail to achieve target serum uric acid (sUA) levels in patients with chronic kidney disease and uncontrolled refractory gout. This can lead to increased urate burden and complications, including worsening kidney disease, cardiovascular events, and metabolic syndrome. Tune in to find out how to incorporate targeted therapies when managing uncontrolled refractory gout and improve your patients’ quality of life.
Gout Beyond the Joints: What’s the Hidden Danger?
Gout Beyond the Joints: What’s the Hidden Danger?
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This is CME on ReachMD. I’m Dr. Richard Johnson, and today we’re going to talk about Gout: Beyond the Joints. What’s the hidden danger?
So gout is common. It affects 9 million people in the United States. It is caused by a high uric acid in the blood that then can increase the risk for it to precipitate and form crystals in the joints. It is driven in part by diet. It’s driven in part by genetics. But a very, very important cause is kidney function, and that’s because the kidney has a major role in excreting uric acid.
Now, not only does areduction in kidney function raise uric acid, but diseases that are associated with a reduction in kidney function, such as diabetes and hypertension, are also associated with a high uric acid. So it’s like a two-way street in which diseases that are associated with a high uric acid lead to kidney disease, and kidney disease, in fact, also leads to a high uric acid. So this is why the kidneys are so important in gout. And, in fact, in people who have normal kidney function, only about 1 in 50 people have gout, but in people who have reduced kidney function, almost a quarter of the people have gout. And likewise, the high uric acid is seen in about 15% of the adult population who have normal kidney function, but in the vast majority of patients who have reduced kidney function.
So kidney disease is part and parcel of having gout, and more than 50% have kidney disease who have gout.
So what is the hidden danger? Well, we talk about gout as being simply an arthritis, you know, a very painful disease involving the joints, like the big toe and the ankle and the wrist. But in fact, gout is a systemic disease. The crystals are not just depositing in the joints; they’re in the other the tissues as well. Now we know that there are crystals that are forming, of course, in the skin and in the kidneys and in other sites.
And so the crystals are associated with inflammation, and systemic inflammation is associated with a lot of problems. And so when you get a gout attack, you’re getting fever and inflammation, but even when the gout subsides, that inflammation persists. And so it’s so important that we try to control gout to control the inflammation, as the inflammation has been associated with a lot of complications, like heart disease, and diabetes, and kidney disease, and so it’s all part of one big complex, one big syndrome. And we should view gout as not just an arthritis but as a systemic disease that warrants treatment to help not just the joint pain but other aspects of the systemic symptoms.
So with that is my little bite-sized talk for you, and that’s our time. Thanks for listening.
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In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Richard Johnson, MD
Professor of Medicine
University of Colorado
Anschutz Medical Campus
Research: National Institute of Health
Ownership Interest: Colorado Research Partners, XORTX Therapeutics
Receives Royalties: Elsevier, BenBella Books
Consulting Fees: Dinora, Horizon Pharma
Abdul A. Abdellatif, MD, FASN
Division of Nephrology
Baylor College of Medicine and CLS Health
No relevant relationships reported
John K. Botson, MD, RPh
Director of Rheumatology
Orthopedic Physicians Alaska
Research: Horizon Therapeutics
Patent Holder: Horizon Therapeutics
Consulting Fee: AbbVie, Amgen, Eli Lilly, Horizon Therapeutics, Novartis
Brittany Weber, MD, PhD
Director, Cardio-Rheumatology Clinic
Associate Physician, Prevention Cardiology & Cardiovascular Imaging
Brigham and Women’s Hospital
Research: AHA, NIH
Consulting Fees:, Agepha, Horizon Therapeutics, Kiniksa, Novo Nordisk
- Cindy Davidson has nothing to disclose.
- Hany Ibrahim, MD, has nothing to disclose.
- Samantha Keehn has nothing to disclose.
- John Maeglin has nothing to disclose.
- Brian McDonough has nothing to disclose.
- Tim Person has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Discuss the pathophysiology and prevalence of high uric acid levels and uncontrolled gout in patients with renal disease and the contribution of chronic gout to chronic kidney disease (CKD) progression, associated comorbidities, and increased mortality
- Apply knowledge of available diagnostic tools to identify patients with elevated serum uric acid (sUA) levels early in the progression of CKD to initiate proper urate-lowering therapy (ULT) and reduce urate burden
- Summarize the limitations of standard ULT options in patients with CKD
- Incorporate emerging urate-lowering therapies, including pegloticase-methotrexate combined therapy and clinical trial evidence, into clinical practice in the treatment of appropriate patients with uncontrolled gout
- Discuss gout as an independent risk factor for CVD and its association with CVD morbidity and mortality, necessitating early screening and treatment to attain target sUA levels
This activity is designed to meet the educational needs of nephrologists, rheumatologists, cardiologists, primary care physicians, and others who encounter, diagnose, and treat gout.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is supported by an independent educational grant from Horizon Therapeutics, USA, Inc.
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