Gout Rounds: 5 New Developments

1. Both High and Low Uric Acid Boost Cardiovascular Risk.

A recent study evaluated relationships between serum uric acid level and newly emergent acute myocardial infarction, congestive heart failure, coronary artery disease, composite cardiovascular (CV) events, hypertension, hyperlipidemia, and renal disease in patients with gout. Both hyperuricemia and hypouricemia were linked with increased risk of CV events.

2. MI Risk is High in Gout and Other Arthritis.

A systematic search was performed to evaluate the risk of incident myocardial infarction (MI) across 5 major types of arthritis. MI risk was significantly increased in gout, rheumatoid arthritis, psoriatic arthritis, and osteoarthritis and tended toward increased risk in ankylosing spondylitis. Traditional risk factors were more prevalent in all types of arthritis.

3. Uric Acid Level Runs Low With DASH Diet.

The Dietary Approaches to Stop Hypertension (DASH) Diet, designed to lower high blood pressure, also may lower uric acid (UA) levels. The effect was greater among patients with hyperuricemia. In addition, higher sodium intake decreased serum UA levels.

4. Ketogenic Diet Douses Gout Flares.

The low-carb, high-fat ketogenic diet prevents inflammation and joint pathology during gout flares. The ketone β-hydroxybutyrate, a known alternate metabolic fuel, is an anti-inflammatory molecule that may serve as a treatment for gout.

5. Putting Primary Care on the Gout Care Map.

A new “roadmap” for improving gout care in all clinical practices calls on primary care to play a bigger role: “Major improvements in gout outcomes at a population level will require much deeper engagement of primary care and affiliated health professionals, and will require careful validation, particularly in populations with differing cultural and socioeconomic backgrounds.”