Better Education on Gout

Dr. Edwards offered other education tools available through the Gout Education Society, a nonprofit established in 2004 to improve the quality of care and minimize the burden of gout.

Remission

Next, Angelo L. Gaffo, MD, section chief of rheumatology at the Birmingham Veteran’s Affairs Medical Center and associate professor in the Division of Rheumatology at the University of Alabama, Birmingham, also highlighted the Nottingham model, referring to it as an augmented protocol of gout care. He said the model has become a standard of care supported by the ACR guidelines, and he encouraged rheumatologists to implement the model, if feasible.

Dr. Gaffo focused his discussion on the need for a better construct of remission in gout. In 2024, a simplified version of criteria for gout remission was shown to be associated with more patients achieving remission than the original criteria proposed in 2016.⁴ The simplified criteria for gout remission included achieving a serum urate target of <6 mg/dL checked twice in the prior 12 months, tophus (none) and flares (none in prior 12 months). The simplified version has been endorsed by the Outcome Measures in Rheumatology (OMERACT), and Dr. Gaffo said to expect this version to appear in future gout studies.

To further achieve gout remission, Dr. Gaffo said it’s important to resolve the issue of treating-to-target (i.e., a serum urate goal of <6 mg/dL in most patients) as endorsed by all the rheumatology societies or the alternative treat-to-avoid symptoms as proposed by the ACP (i.e., treat to avoid recurrent flares; no monitoring of urate levels). He pointed to data supporting treat-to-target and said upcoming clinical trials comparing the two approaches, such as the TRUST trial, will provide more information.⁵

Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.

References

1. Briesacher RA, et al. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008 Apr;28(4):437–443.
2. Kim A, Kim Y, Kim GT, et al. Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study. Clin Rheumatol. 2020 Dec;39(12):3769–3776.
3. Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: Proof-of-concept observational study. Ann Rheum Dis. 2013 Jun;72(6):826–830.
4. Tabi-Amponsah AD, Doherty M, Sarmanova A, et al. Post-hoc analysis of two gout remission definitions in a two-year randomized controlled trial of nurse-led versus usual gout care. Semin Arthritis Rheum. 2024 Sep 18:69:152555.
5. Choi H. Treat-to-target serum urate versus treat-to-avoid symptoms in gout (TRUST) [NCT04875702]. ClinicalTrials.gov. 2024 Oct 1.