Saturday, July 29
Refractory gout has long been overlooked in the family of arthritic diseases. It was seen as an inert condition where the key was managing a patient’s serum uric acid level. Research has revealed it to be a more complex inflammatory condition, and a biologic has greatly improved its treatment options.
Those advances and a call for a stronger partnership between podiatrists and rheumatologists in treating patients with gout will be emphasized during “Refractory Gout: An Overview of Pathogenesis and Treatment.”
“We are beginning to realize that gout actually invokes many inflammatory pathways, for example, upregulation of proinflammatory cytokines and involvement of the NLRP3 inflammasome, which further mediates the immune response to monosodium urate crystal deposition. Now, we are beginning to view gout in much the same way we view other inflammatory arthritides, such as rheumatoid arthritis. In doing so, the treatment for gout has evolved,” said presenter Gordon K. Lam, MD.
A key part of that evolution was the development of pegloticase, a biologic treatment approved by the FDA for the treatment of refractory chronic gout. No longer is treatment limited to using xanthine oxidase inhibitors, such as allopurinol and febuxostat, or uricosurics, such as probenecid or lesinurad.
“Now, we are able to functionally cure patients of gout. The ‘functional’ is the key qualifier because we can’t truly cure gout yet, but by treating them aggressively, we can treat patients to zero flares,” said Dr. Lam, medical director at Northern Region Research Center at Carolinas HealthCare System in Concord, NC.
Dr. Lam will review clinical trials studying gout, technologies to assess gout, and the efficacy and safety of medications. He also will explore how rheumatologists can collaborate with podiatrists to optimize the treatment of patients with gout.
“We in rheumatology have realized that podiatrists can be a powerful partner in our care of gout patients,” he said. “We need to foster this collaboration because I view podiatrists as the first-line responders in our management of gout. We can utilize podiatrists in an optimal fashion for better overall holistic care of the patient.”
The treatment of refractory gout has lagged behind rheumatoid arthritis, but these recent advances have put it in a position to move it forward, Dr. Lam said.
“The rubric of gout has completely changed within the past few years with our evolved understanding of its pathogenesis, our greater appreciation of its manifestations, and our increased treatment options,” he said. “Now, we have a biologic to treat refractory gout in much the same way we utilize biologics to treat other inflammatory arthritides, such as rheumatoid arthritis. We are hoping this represents a sea change in our ability to treat gout patients.”