Gout, the most common form of inflammatory arthritis, can wreak havoc on the body. The good news? It’s easily managed with the right help. Whether you’ve been recently diagnosed, care for someone suffering, or are a medical professional treating the disease, the Kicking Gout in the Acid podcast can help you learn more.
In this episode of Kicking Gout in the Acid, Dr. Larry Edwards is joined by Gout Education Society International Advisory Council member Dr. Puja Khanna, rheumatologist at the University of Michigan. The two discuss the variety of health conditions, also known as comorbidities, commonly seen alongside gout and how they can impact those with the disease.
Key Takeaways:
Gout is often associated with other metabolic diseases like obesity, kidney disease, heart disease, diabetes, and hyperlipidemia – it’s not simply pain in the toe.
Gout comorbidities impact the treatment of gout; for example, NSAIDs are not a good option for anti-inflammatory treatment of flares in those with kidney disease or diabetes, prompting the use of different options.
Those with gout should be on the lookout for symptoms of comorbidities and talk with their doctor to find the best treatment plan for themselves.
Education is a crucial part of gout management; when combined with self-advocacy, those with gout can reduce the disease’s burden on the body and avoid the negative complications of comorbidities.
Start your journey with gout today via the Gout Education Society website and sign up for the monthly newsletter.
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Looking for nearby gout specialists? Find rheumatologists, nephrologists and more via the Gout Specialists Network.
Educational Materials:
Gout Patient Brochure
Medical Professional Guide
Kicking Gout in the Acid is sponsored by Sobi.
Podcast Transcript
Ian PonitzHello, and welcome to Kicking Gout In The Acid, a podcast from the Gout Education Society. My name is Ian Ponitz, and I'm your host for this series. Kicking Gout In The Acid features conversations between Dr. Larry Edwards, chairman and CEO of the Gout Education Society, and experts on the disease.
Each episode will dive into important topics that you, the listener, should know about gout. The goal? To feel empowered to get gout under control.
In this episode, Dr. Edwards will be joined by Dr. Puja Khanna from the University of Michigan. The two will discuss the role of comorbidities, or related health conditions, alongside gout, how they impact the treatment of gout, and what those with gout can do to mitigate their risk. Dr. Edwards, take it from here.
Dr. Larry EdwardsThanks, Ian. I'm joined today by Dr. Puja Khanna from the University of Michigan. She is an expert in gout, gout treatment, and is also a member of our advisory council on the Gout Education Society. Puja, maybe you'd like to fill in people a little bit more about your affinity for gout?
Dr. Puja KhannaThank you so much, Dr. Edwards. For all purposes, I am a rheumatologist, but my area of expertise has been gout for close to 15, 16 years. I am a trained epidemiologist as well, so my focus has been patient-oriented outcomes. And gout seemed to be a space in rheumatology that had some work going on, but not as much as rheumatoid arthritis, versus more of the orphan diseases, which were scleroderma and lupus. And that's where I focused in on gout, which was a very common disease known to man for more than 400 years, but we still had very limited treatments, and that's what prompted me to enter the arena of clinical trials.
I've had the fortune of participating as principal investigator in a bunch of trials, including in acute gout and urate-lowering therapies for chronic gout. But where my passion lies is honestly with my patients, and I think there's a lot of stigma attached to gout, where we need more and more focus and patient advocacy. So, that's where we are right now in my career trajectory.
For the University of Michigan, my role is to serve as the associate chair of clinical affairs, while I also dabble a little bit in my research area, which is gout.
Dr. Larry EdwardsGood. Terrific. We'll be working right along those lines of individual care for gout patients because we're gonna be talking today about the comorbid conditions, the metabolic diseases that are pretty common that occur alongside gout, and talk a little bit about what that interconnection is, and what we think the cause of that relationship is, maybe.
Do you have some thoughts on that?
Dr. Puja KhannaAbsolutely. As we all know, gout is common, but what we have seen is that attention to gout comes forward only when the patient has an acute flare-up in their joints. I think that's where the travesty lies, because gout happens because of high levels of uric acid, which we define as hyperuricemia.
Hyperuricemia is not just in the joints, as we know. It's actually a systemic disease. Uric acid can deposit itself across the body, and that is precisely the reason why we see that association of gout with obesity, or gout with kidney disease, gout with heart disease, and gout with diabetes. So, I think that's where the focus should move, honestly, in my opinion, that we start to think only of the joint and we only treat gout when joints get involved.
But we need to take a step back and think about all of the comorbidities that start earlier than gout, and perhaps we want to bring the focus in on the urate piece and start treating a priori, meaning preemptively, so that we can address the urate burden before it becomes a systemic disease. And there is very little, at that point, that we can reverse, because other organ systems have been involved, and you have developed more comorbidities, and as a result, treatments are difficult.
Dr. Larry EdwardsYeah. You mentioned a number of the metabolic diseases that gout's associated with, including obesity, heart disease, and diabetes. I guess hypertension's probably the most common of those. And taken altogether, along with kidney disease and elevated lipids, I guess all of those taken together is what the medical profession calls metabolic syndrome, which used to be Syndrome X. I always loved that because it has this mysterious ring to it. But metabolic syndrome is very closely associated with, as you say, hyperuricemia and gout.
Are there mechanisms that we can think of that would be true of? You'd said the inflammation outside of the joints, so that there's more systemic inflammation, maybe. You think that's a cause?
Dr. Puja KhannaThat is absolutely the cause, because if you want an analogy, it's similar to elevated blood sugars or high lipid levels. When you have high levels of uric acid circulating in the body, that creates what we call a chronic level of inflammation in the body.
Now, depending on where the uric acid will go and deposit itself, and as we grow older, there is the factor of what we call senescence. As we grow older, every organ system responds differently to the inflammation that is already in the organ system, and then you add another load. So, we've noticed in our epidemiologic studies that as we grow older, we have more acute flare-ups. And as a result, the frequency will grow, and you will require things such as steroids for management, or one medication is better in managing the disease, versus the other is more effective, and it becomes harder and harder to treat.
I think there is definitely that element where there is a direct correlation. However, we struggle to show this causal relationship in large observational studies. That is where we want to show proof. And with the various studies that are going on right now, we are slowly and steadily making headway.
Dr. Larry EdwardsYeah. So I think that the message is that control of gout is both related to control of these other metabolic diseases, and control of the other metabolic diseases is somehow very closely aligned to how easy it would be to get gout under control.
I think for all those people with heart disease and diabetes and hypertension, ignoring their gout is really anti-productive because they're gonna have a much harder time controlling those conditions.
Now, let's talk for a little bit about how having these various metabolic conditions, like kidney disease and heart disease and diabetes, affects the kind of medications that we use to treat both the inflammation of gout and the cause of gout, the hyperuricemia. Can you comment on those?
Dr. Puja KhannaAbsolutely. One of the challenges that we have is that with the urate burden, the uric acid in our body is cleared through our kidneys primarily. So, 75% of it is cleared through the kidneys, whereas 25% is going to be cleared through the gut.
And what happens is that if you have kidney disease, maybe because you have hypertension or you have diabetes, or you have heart disease, your kidneys are not functioning well, and the clearance of urate also goes down. That is one of the key things that lowers your ability to process, for the body to process that acute flare-up as well. And that is important to remember because folks who have kidney disease end up veering away from medications such as non-steroidal anti-inflammatories or even medications like Colchicine because we have realized that they can actually cause more adverse effects, for instance, not only on the kidneys, but also on the gut.
So you rely on a class of medications, which is called corticosteroids. Now, the beauty of corticosteroids is that they are very effective, but they're only effective when you start them promptly as soon as an acute flare starts. There is a large body of data to show similar efficacy with Colchicine and non-steroidals.
But the challenge with corticosteroids is what? That they also have their own side effects. For instance, in a patient who is diabetic,...
