Early Gout Is Bad For The Heart: Recent Research Context

Expert Critique

FROM THE ASCO Reading Room

Vaneet Kaur Sandhu Assistant Professor of Internal Medicine, Rheumatology Loma Linda University

Early gout is defined to include those individuals with polyarticular flares, a family history of gout, need for longer urate-lowering treatment, higher serum uric acid levels, and metabolic syndrome. While much research is ongoing in gout, it seems to include primarily an older population. There are inadequate data in younger individuals with gout despite a greater than two-fold increase in gout prevalence since the 1960s and first attacks of gout occurring in higher numbers before age 40.

Li and colleagues have demonstrated that almost half of individuals under 30 years of age with gout had hyperlipidemia or hypertension and nearly 30% had both. In light of known associations of gout with cardiovascular disease, this paper emphasizes the importance of educating patients and providers both of the importance of early diagnosis and management (including treatment adherence) of early gout to avoid long-term adverse cardiovascular outcomes as well as recurrent gout attacks.

My own experience with gout management is brimming with nonadherence; this study certainly gives clinicians the evidence their patients need to understand what these medications are truly helping with.

Full Critique

Though many associate gout as being a disease that comes with age, recent data suggest that first attacks are happening in patients in their younger years.

Data suggest that gout is the most common type of inflammatory arthritis, and that the number of patients afflicted with this disorder is growing. A study estimated that 3.9% of adults in the United States have gout. Its prevalence among adults in the U.S. more than doubled between the 1960s and the 1990s.

First gout attacks are happening at a younger age than previously thought: 0.4% in the U.S. aged 20-29 and 1.3% in those 30-39 are affected. Similar data for the U.S. population within the past decade are unavailable. Distribution varies in different populations. A study from Taiwan, for example, revealed that 25% of patients with gout experienced their first episode before they turned 30.

Younger patients are what inspired Yan Li, MD and colleagues to conduct their study "Clinical Characteristics of Early-Onset Gout in Outpatient Setting," which was recently published in ACR Open Rheumatology.

"Although not frequently encountered, a few young patients I had seen in the past several years (in medical school) had very poorly controlled gout, leading to episodic disabling gout attacks and early joint deformities," Li told MedPage Today in an e-mail.

And while researchers have not been able to agree on what defines early-onset gout, it has been that the condition has features that include polyarticular flares, a family history of gout, longer urate-lowering treatment, higher serum uric acid levels, and metabolic syndrome. Studies have also shown that those who get gout early are also at higher risk for severe gout or cardiovascular disease.

Li and colleagues noted that although there has been extensive research into the clinical characteristics of gout -- its comorbidities, medications, treatment adherence, and outcome -- mainly in elderly patients, more study of early-onset gout is needed, particularly in the U.S. The authors wrote that "Given the potential aggressiveness of gout progression and the clinical consequences that would warrant early recognition and intervention, we conducted this retrospective study to investigate the clinical characteristics and treatment of young patients with gout."

"As hyperuricemia has been suggested as part of metabolic syndrome and gout as an independent risk factor for cardiovascular disease, the shift towards early-onset gout and poorly controlled disease in young patients calls for attention and intervention," Li said.

Li noted they were surprised to find that nearly half of gout patients under 30 had been diagnosed with hyperlipidemia or hypertension.

"About 30% had both. The concomitant cardiovascular risk factors in the early-onset gout population are much higher than the general U.S. population," Li said.

She added that she hopes the results of their research will inspire more accessibility for gout-related educational and medication monitoring programs and an improvement in clinical outcomes.

"We would like to raise attention that young patients with early onset gout frequently had cardiovascular risk factors, may be an undertreated population with poor adherence to long-term urate lower therapy, and suffer from recurrent gout attacks. Educational programs both for physicians and patients could help improve the understanding and adherence of treatment for gout," Li said.