Pegloticase Effective in Treating the Most Severe Forms of Gout

For patients with the kind of gout that doesn’t respond to conventional urate-lowering therapies, treatment with pegloticase, a uricase that’s new to the market, can work wonders, said Naomi Schlesinger, MD, professor of medicine and chief of rheumatology at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School. She spoke during an Association of Rheumatology Health Professionals disease update session on gout at the American College of Rheumatology/Association of Rheumatology Health Professionals 2012 meeting in Washington, DC.

“We’ve never had a drug that worked so quickly to decrease and resolve tophi,” she said. Forty percent of patients saw complete resolution of one or more tophi within 25 weeks. “Our oral medications don’t work as quickly,” she added.

The drug was administered via an acute two week IV infusion. Pegloticase also improved patient-recorded outcomes relating to function and pain assessment.

Prophylaxis to prevent acute attacks

In a wide-ranging presentation that touched on everything from diagnosis to treatments, Schlesinger noted that treatments can spark attacks that make patients resist drug therapies. The problem is when we lower the uric acid pool, she said, patients get attacks. “They think that our treatment is actually harming them when in fact we’re helping them,” she said. So we have to combat this when starting serum urate-lowering therapies.

“Cherries I want to suggest may have anti-inflammatory properties,” she said, adding that prophylaxis with cherry juice concentration should be considered as prophylaxis against attacks of gout in patients starting urate-lowering therapy.

Building upon decades-old cherry studies, Schlesinger’s 2010 study published in the Annals of the Rheumatic Diseases found that 92% of patients who drank cherry juice daily for 4 months or more saw a 50% or greater reduction in acute attacks. More than 1 in 3 (36%) not on urate-lowering therapy (serum urate: 7.8mg/dl) were attack-free at four months.

A recent survey in the Arthritis & Rheumatism found that eating up to 1.5 cups of cherries within 48 hours of an attack led to a 35% reduction in acute attacks. In the lab, Schlesinger and her team showed that cherry juice inhibited the secretion of Interleukin-1β and TNF-α by up to 50%.

Using response to ice to diagnose gout

In her discussion of gout diagnosis, Schlesinger noted that an ice pack can aid doctors in diagnosing gout. Patients with acute gout or pseudogout found topical ice helped relieve their joint pain compared to patients with rheumatoid arthritis.

In contrast, if you put an ice pack on a patient with rheumatoid arthritis or psoriatic arthritis, you’ll actually increase their pain.

However, if you’re debating whether the patient has septic arthritis or acute gout, this is not the test to do, she said, because patients with septic arthritis will also find relief once you put an ice pack on their inflamed joints.

Schlesinger also offered a glimpse into the future of gout diagnosis by showing images from a dual energy CT (DECT) scan. With special software, uric acid shows up in green and calcium shows up in purple or blue. As an example, she showed scans of a 75-year-old patient peppered with multiple tophaceous deposits on her feet.