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.
Should We Look for Gout in the Cardiology Clinic?
Should We Look for Gout in the Cardiology Clinic?
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This is CME on ReachMD. I’m Dr. Richard Johnson, and here with me today is Dr. Brittany Weber, a preventive cardiologist at the Brigham and Women’s Hospital.
Brittany, how can gout predispose to heart disease, and how can we better help our patients?
Well, thank you so much, Dr. Johnson, for such an important question. And so first, you know, I think we need to recognize the importance of gout as an independent risk factor for cardiovascular disease. We know that from epidemiologic studies, both retrospective as well as prospective studies moving forward, that patients with gout have an increased risk of cardiovascular disease. In fact, studies have shown that gout itself is an independent risk factor for subsequent all-cause mortality in patients that are admitted with cardiovascular disease. Thus, as a cardiologist, active screening for gout could allow us to detect patients at this higher risk and help us tailor patient management to decrease this cardiovascular burden. Ways for us to decrease this cardiovascular burden would be to not only treat active gout, but also treat those identified risk factors. Thus, for me, I believe early screening is dramatically important because we have effective therapies to treat gout, and thus we can mitigate this excess risk by the early recognition and detection. And this awareness needs to come from the broad community, which is why I’m so excited about these efforts. We need primary care, cardiology, and the subspecialties that sees these patients to be aware of this excess risk and be implementing screening methods. Patient awareness in all this is also key.
Lastly, and to your question, it’s also very important that we understand the biomarkers that associate with this excess risk. In my clinic, in cardio-rheumatology, every single patient, in addition to their lipid panel, they get a high-sensitivity CRP [C-reactive protein]. We have ample data of the clear increased risk associated with the systemic inflammation and cardiovascular risk, and importantly, we now have effective pharmacotherapies. When we talk about the gout patient population, we need to understand the importance of measuring serum uric acid and particularly treating it in these patients and also be thinking about how we could be implementing these biomarkers in a larger population in the future.
For sure, gout is a systemic inflammatory disease. I agree with you completely. The crystals in the joints cause local inflammation, but it’s also associated with systemic inflammation and elevated CRP, or high-sensitivity C-reactive protein.
Inflammation is a really critical driver of heart disease. It’s fairly easy to understand how gout can drive heart disease, and there’s data that crystals, urate crystals, may not just be in the joints, but they can even be in blood vessels and particularly in atherosclerotic plaque.
And do you guys do DECT scans, or dual-energy CT scans, to look for urate crystals?
It’s a wonderful question and, no, we do not. I do a lot of coronary CT research myself in patients with inflammatory diseases, and we need to better develop these technologies so we can get that science out there so we can then start implementing. We have these technologies, each independently available, but understanding all the technicalities of actually how we can get them into screening, clinical practice, I do see as kind of the next wave front.
Thank you so much, Dr. Johnson, and thank you to the audience for taking a listen to a very important topic.
Well, thank you, Brittany. This has been a brief but great discussion, and thanks to everyone for tuning in.
You have been listening to CME on ReachMD. This activity is provided by Prova Education and is part of our MinuteCE curriculum.
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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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