Given the rising rates of obesity and hypertension, Dr. Choi and other rheumatologists stressed the importance of taking a holistic approach to treating patients with gout and hyperuricemia, starting with preventive measures.
Dr. Edwards said that "Physicians should all be more aggressive in how we coach patients on weight reduction and other lifestyle modifications including exercise. We should be routinely monitoring serum urates in at-risk patients so that we can review the nonpharmacologic approaches to urate lowering and management of their comorbid diseases."
Dr. Choi and his associates recommend avoidance of heavy drinking, "while moderate drinking, sweet fruits, and seafood intake (particularly oily fish) should be tailored to the individual, considering their anticipated health benefits against cardiovascular disease." They added that coffee and vitamin C supplementation may be long-term preventive measures that can lower urate levels and reduce the risk of gout and associated comorbidities.
There remain unmet challenges.
Dr. Burns noted that "It’s easy to treat people for what they come to you for. The problem is getting people to change their lifestyle," especially for those who have arthritis for whom exercising is not easy.
Meanwhile, the increase in the number of gout patients, majority of whom are cared for by primary care physicians, raises some concerns among rheumatologists.
Dr. Maria Saurez-Almazor noted that the challenge for primary care is the management of more complex patients, particularly with the advent of new therapies with which they may not be familiar," said, head of rheumatology at the University of Texas M.D. Anderson Cancer Center. The solution? "Education, education, education," she said. "For physicians to treat hyperuricemia to target, often this goal is not pursued aggressively. For patients, understanding the role of lifestyle modifications, and the importance of adherence to therapy (non-adherence is very high in this population) is crucial."
Dr. Hyon K. Choi
The study has some limitations, Dr. Choi and his colleagues reported.
"Unlike estimates of serum urate levels that are based on objective measures, gout prevalence estimates in the NHANES studies are based on self-reports and are thus likely inflated, similar to other condition estimates based on the NHANES. On the other hand, we cannot rule out the possibility that the survey might have missed gout cases that have not been diagnosed by health care professionals," the authors wrote.
Dr. Choi predicted that the prevalence of gout has been rising since the NHANES data was collected. The next step, he said, "is to work on preventive strategies that now have been shown to be effective by multiple studies. So manipulation of these factors should be more aggressively implemented rather than ignored. Improvement in managing these factors can help slow down the escalation."
Dr. Choi has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda. The study was supported by Takeda Pharmaceuticals International Inc. Other physicians quoted had no relevant disclosures.