Gout: 3 New Things

Jul 23, 2018

The gout-dementia connection, daily medication reminders, and the impact of interleukin-1β inhibition on gout attacks.

References1. Singh JA, Cleveland JD. Gout and dementia in the elderly: a Medicare claims study. Ann Rheum Dis. 2018;77:140. Abstract OP0182.2. Bunphong K, Narongroeknawin P. Mobile phone text messages for improving allopurinol adherence: a randomised controlled trial of text message reminders. Ann Rheum Dis. 2018;77:155. Abstract OP0212.3. Solomon D, Glynn RJ, MacFadyen JG, et al. Serum urate, gout, and cardiovascular disease in a randomised controlled trial of canakinumab: a CANTOS secondary analysis. Ann Rheum Dis. 2018;77:56-57. Abstract OP0014.

Highlights of three new studies presented at the 2018 European Congress of Rheumatology include: (1) gout may raise the risk of dementia in elderly patients; (2) daily text message reminders may improve adherence; and (3) the monoclonal antibody canakinumab significantly reduces gout attacks.^1-3 Scroll through the slides for the latest findings and their clinical implications.

(Eraser: ©Lightspring/Shutterstock.com; cell phone: ©DediGrigoroiu/Shutterstock.com; xray: ©Thailoei92/Shutterstock.com.)

Among a cohort of 1.23 million Medicare beneficiaries, 65,324 people had incident dementia. The crude incidence rates in people without gout were 7.36 per 1000 person-years and with gout were 13.58 per 1000 person-years.¹

In multivariable-adjusted analyses, gout was independently associated with a significantly higher hazard ratio (HR) of incident dementia (HR, 1.17). Older age was associated with up to a 6.3-fold higher risk of dementia. The risk was also higher for women, blacks, and those with higher medical comorbidity.

Clinical Implications: “Our study found a considerable increased risk of dementia associated with gout in the elderly. Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk,” said lead author Jasvinder Singh, MD, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham.

A study of 82 patients with gout randomized 42 patients to receive daily short message reminders to take allopurinol and 40 patients to receive a weekly short message containing information on non-pharmacologic treatment for gout (control group).²

After 12 weeks, 88.1% of the intervention group were considered adherent versus none of the control group. Serum urate levels were significantly decreased in both groups; however, the reduction in the intervention group was significantly greater than in the control group (-1.47 ± 0.86 vs -0.28 ± 0.39 mg/dL). Serum creatinine levels were also significantly decreased in the intervention group but were unchanged in the control group.

Clinical Implications: “Our results clearly show that mobile phone text reminders could be an important tool to enhance allopurinol adherence and help in controlling serum urate levels in gout patients,” said senior author Pongthorn Narongroeknawin, MD, Head of Rheumatic Disease Unit, Phramongkutklao Hospital, Thailand.

A randomized, double-blind, placebo-controlled trial of interleukin-1Î² inhibition included 10,061 patients (median age, 61 years) with stable atherosclerosis (previous myocardial infarction) and C-reactive protein (CRP) level ≥ 2 mg/L.³

The patients were randomized to placebo or one of three doses of canakinumab (50 mg, 150 mg, or 300 mg), administered subcutaneously once every 3 months. Serum urate and CRP levels were measured at baseline and every 3 months for the first year and then annually.

Canakinumab significantly reduced the rate of gout by more than half compared with placebo, regardless of the baseline serum urate level.

Clinical Implications: “Our results demonstrate a striking effect of canakinumab on reducing the risk of gout attacks in atherosclerosis patients. Moreover, these data illustrate serum urate as a risk marker for both gout and cardiovascular events, though canakinumab has no effect on serum urate levels due to its mechanism of action,” said lead author Daniel Solomon, MD, Professor of Medicine at Harvard Medical School in Boston.