ACR Convergence 2024 - Conference Recap on Gout

The American College of Rheumatology’s annual meeting, ACR Convergence 2024, was held from November 14 to 19 at the Walter E. Washington Convention Center in Washington, D.C. This prestigious event brought together leading experts in the field to exchange the latest advancements in rheumatology.

At ACR Convergence 2024, several significant abstracts were presented focusing on gout. These abstracts delved into topics such as the effects of weight loss drugs on gout, the risk of dementia, and the role of nutrition, among others. The following presentations, which are highlighted below, shed light on important developments in the management of gout and demonstrate the ongoing efforts to enhance patient outcomes.

The Association Between Gout and Gallstone Disease: US General Population Analysis

Gout is commonly linked with kidney stones, but its connection to gallstone disease remains unclear. Despite sharing risk factors such as obesity and diabetes, there is a notable difference in gender predilection, with gallstone disease affecting more females and gout affecting more males. Recent medications like semaglutide and tirzepatide, used to treat common risk factors for gout, have been associated with an increased risk of gallstone disease.
Given these findings, researchers aimed to investigate and quantify the relationship between gout and gallstone diseases using data from a nationally representative sample of US adults. Both gout and gallstone disease are prevalent conditions in the US, with their prevalence on the rise. It is estimated that 3.3 million US adults suffer from both gout and gallstone disease, and individuals with gout have a 1.6-fold higher likelihood of also having gallstone disease. Further research is needed to fully comprehend the association between gout and gallstone disease.
Summary

The Impact of Hospital Region on Mortality and Other Outcomes in Patients with Gout: A Two-Year Nationwide Analysis

Gout is a chronic inflammatory arthritis condition caused by the deposition of monosodium urate crystals, which can lead to an increased risk of complications such as serious infections and premature mortality. Studies have shown that there are variations in the onset and progression of gout, with environmental-genetic interactions playing a significant role. However, the specific extent of regional variations in patients with gout and their associated outcomes in the United States remains unclear.
Recent research has indicated a notable increase in sepsis and length of hospital stay in certain regions of the US. One possible explanation for this disparity could be the differences in social determinants of health, which may impact access to a healthy diet, medication adherence, and alcohol consumption. It is also worth noting that the regions with the highest proportion of Asian gout patients experienced a higher prevalence and complications of gout. Therefore, it is essential to further investigate the race/ethnic variances, including genetic factors, among patients with gout.
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Weight Loss Induced by Anti-obesity Medications and Gout Among Overweight and Obesity Individuals: A Population-based Cohort Study

Weight loss is often recommended for managing gout; however, the impact of weight loss on incident gout and recurrent gout flares in overweight and obese individuals is not well understood. Our study sought to investigate the relationship between the rate of weight loss induced by anti-obesity medications and the risk of developing gout or experiencing gout flares again in overweight or obese individuals.
Our findings revealed that a higher rate of weight loss induced by orlistat within one year was associated with a decreased risk of developing gout and experiencing recurrent gout flares in overweight or obese individuals. This suggests that the rate of weight loss induced by certain medications may play a role in reducing the likelihood of gout occurrence and flare-ups in this population.
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Performance of Two Gout Remission Definitions in a Two-Year Randomized Controlled Trial of Nurse-led Care

In a clinical trial of nurse-led gout care, the performance of the 2016 preliminary gout remission definition was compared to a simplified gout remission definition.
Both the 2016 preliminary gout remission definition and the simplified gout remission definition effectively distinguished between the nurse-led care group and the usual care group. The simplified definition identified a greater number of individuals in both groups as being in gout remission and demonstrated strong construct validity when assessed with a gout-specific health-related quality of life instrument. The simplified definition emerges as a practical and reliable option for defining gout remission in clinical trials involving gout.
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Are Participants in Gout Clinical Trials Representative of People with Gout in the General Population?

Ensuring that study participants accurately reflect the diversity of the general population is crucial for ensuring that the results of clinical trials can be applied effectively in real-world clinical settings. The primary objective of this study was to assess whether phase 3 clinical trials for gout medications approved by the US Food and Drug Administration (FDA) adequately represented the US population of individuals with gout.
Analysis of phase 3 clinical trials for gout medications approved by the FDA since 2009 revealed a lack of representation of key demographic groups and individuals with cardiometabolic comorbidities commonly associated with gout. To enhance the generalizability of findings and improve the relevance of clinical trial results to the broader population of individuals with gout, future trials should prioritize the inclusion of women, older adults, individuals from diverse ethnic backgrounds, and those with common comorbid health conditions associated with gout.
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Efficacy and Safety of Genakumab versus Compound Betamethasone in Gout: The GUARD-1 Study

The GUARD (Genakumab in high Uric Acid-induced Arthritis/goutfor Resolution and Delay study) program was established to assess the effectiveness and safety of Genakumab, a novel fully humanized, monoclonal anti-IL-1β antibody developed by GenSci Co., in patients with gout through the IL-1β pathway. This study focuses on comparing the efficacy of Genakumab versus Compound betamethasone in treating Chinese adult patients experiencing gout flare.
In summary, for adults who cannot take NSAIDs and/or colchicine due to contraindications or intolerance, Genakumab has shown non-inferiority to Compound betamethasone in relieving pain from gouty arthritis attacks. Additionally, Genakumab has demonstrated superiority over Compound betamethasone in delaying new flare-ups within 12 weeks, with this effect being maintained until the end of the 24-week period.
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Cost-effectiveness of Low Dose Colchicine Prophylaxis When Starting Allopurinol Using the “Start-Low Go-Slow” Approach for Gout

The study aimed to assess the cost-effectiveness of low-dose colchicine prophylaxis in reducing gout flares when initiating allopurinol using the “start-low go-slow” approach.
After six months of treatment with colchicine prophylaxis, the cost-effectiveness results were inconclusive. However, the higher costs and quality-adjusted life year (QALY) losses, primarily due to gout flares in the six months following the discontinuation of colchicine, as indicated in the clinical outcomes report, suggest that this regimen may not be cost-effective over a one-year follow-up period. Future research could explore strategies to reduce rebound gout flares after stopping prophylaxis or consider an extended period of prophylaxis when initiating urate-lowering therapy (ULT).
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Effect of a Whole Food Plant-Based Diet in Patients with Gout: A Pilot Randomized Controlled Trial

A poor diet is a significant risk factor for hyperuricemia and gout, as well as being linked to obesity and metabolic syndrome (MetS), both of which are known risk factors for gout and cardiovascular disease (CVD). The prevalence of CVD is notably higher in individuals with gout.
Research has shown that adopting a Mediterranean-style whole food plant-based diet (WFPD) can effectively treat diseases related to MetS and obesity. Therefore, our study aimed to explore the impact of a dietary intervention based on a WFPD on serum uric acid (SUA) levels, gout disease activity, and cardiovascular risk in gout patients.
The results of our study revealed that following a Mediterranean-style WFPD led to a significant decrease in SUA levels in gout patients with abdominal obesity. Furthermore, adhering to this diet resulted in reduced gout severity and pain, notable weight loss, decreased waist circumference, and improved LDL cholesterol levels, ultimately lowering the risk of CVD.
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Risk of Dementia in Patients with Gout: Potential Impact of Survival Bias

Previous studies have suggested a potential link between gout and a lower risk of dementia, indicating a possible neuroprotective role of hyperuricemia. However, when assessing the risk of dementia in relation to certain exposures, such as gout, it is crucial to consider the potential for bias, particularly survival bias and competing risks (Chang et al.).
In this study, the researchers aimed to evaluate the risk of dementia in patients with gout compared to controls, taking into account age as a potential factor influencing survival bias. The researchers hypothesized that any protective effect of gout would be more pronounced in older individuals.
The findings revealed that the association between gout and dementia varied significantly across different age groups, with a stronger protective effect observed in older individuals. While this could suggest a modification of the causal effects of gout by age, it also raises concerns about the presence of survival bias. Individuals with gout who pass away prematurely may have been at a higher risk of developing dementia if they had lived longer.
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Thank you for joining us for this recap of the ACR Convergence 2024. We recommend visiting this link to explore all the posters presented at the event. We look forward to seeing you at ACR25!

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ACR Convergence 2024 – Conference Recap on Gout