Early Treatment and Gout Comorbidities

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In the MD Insights program “The ‘Disease of Kings:’ Addressing Misperceptions and Treating Gout Effectively Now and in the Future,” Theodore R. Fields, MD, professor of clinical medicine at Weill-Cornell Medical College, and director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses gout diagnosis, misperceptions about the disease, and the consequences of undertreatment of this condition. He also reviews current gout treatment options and discusses potential future treatments.

In this segment, Theodore R. Fields, MD, talks about the benefits of early treatment in patients with gout and also discusses the impact comorbid conditions can have on the course of the disease and treatment outcomes.

Patients with gout who receive early treatment can avoid complications and slow the progression of the disease. Fields said that, because gout is a progressive disease that gets worse over time, if a patient has two attacks in one year and does not receive treatment, “the next year it’s likely to be three attacks and the next year it’s likely to be four. So it’s really in the patient’s advantage to treat them early.”

He said there is some retrospective data that suggest early treatment of uric acid may be good for the kidneys and heart. “There’s really no reason to delay treatment. Some patients just don’t like medicine, but in general we try to convince them once they meet the criteria to go ahead and get treated,” said Fields.

Gout can be difficult to treat in part because it has many associated comorbidities, including obesity, hypertension, renal disease, coronary disease, diabetes, and kidney dysfunction. According to Fields, only 10 percent of gout patients have no comorbidities.

“Ninety percent of patients have at least one comorbidity, and many of them have three or four comorbidities. This is a problem because it may influence our choice of long-term agent to use in treatment,” said Fields.

For example, the decision to use allopurinol or febuxostat depends on kidney function, the choice to use an NSAID is related to kidney function, and the use of oral corticosteroid can be affected by whether the patient also has diabetes.

“This has a major impact and it comes up in 90 percent of patients with gout. Something is going to come up that’s going to impact how you think about long-term management,” said Fields.