Welcome Back Rheumatology Fans,

You have Gout to be joking that I am discussing Gout again! Seriously, fascinating.

Article Link: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2844321

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Or below is a summary:

People with gout are at significantly higher risk of cardiovascular disease, and this risk should be central to how we assess and manage them in clinical practice. In this episode, the focus shifts beyond gout as an episodic inflammatory arthritis and instead frames it as a condition with important long-term systemic consequences—particularly for cardiovascular health.

Evidence consistently shows that individuals diagnosed with gout have an elevated five-year risk of major cardiovascular events such as myocardial infarction and stroke. This increased risk is driven by two main factors. First, gout is a chronic inflammatory condition, and systemic inflammation is a well-established contributor to cardiovascular disease. Second, many of the risk factors associated with gout—such as obesity, hypertension, metabolic syndrome, smoking, and alcohol consumption—overlap with those seen in people at high cardiovascular risk. The combination of these mechanisms means that gout should prompt clinicians to think well beyond joint symptoms alone.

A large, robust study involving over 100,000 patients explored whether achieving effective urate control could influence cardiovascular outcomes. Participants with gout were treated with urate-lowering therapy, commonly allopurinol, and outcomes were compared between those who achieved a serum urate level below 6 mg/dL and those who did not. This “treat-to-target” approach resulted in a meaningful reduction in cardiovascular disease risk over five years when compared with usual care.

Importantly, the benefits were not limited to cardiovascular outcomes. Patients who achieved the target serum urate level also experienced fewer gout flares, reinforcing that this biochemical target is clinically meaningful and reflective of effective disease control. In addition, subgroup analysis showed that patients who already had a higher baseline cardiovascular risk—such as those with hypertension or a family history of cardiovascular disease—derived the greatest relative benefit. In other words, the people who stand to lose the most from cardiovascular events may also gain the most from optimal gout management.

For clinicians working in rheumatology and musculoskeletal care, the implications are clear. A diagnosis of gout should act as a trigger for broader cardiovascular risk assessment. This includes monitoring serum urate levels and aiming for a target below 6 mg/dL, but also addressing modifiable lifestyle factors. Reducing alcohol intake, managing body weight (particularly abdominal adiposity), smoking cessation, and supporting physical activity are all key components of comprehensive care. Pharmacological urate-lowering therapy and lifestyle interventions should be viewed as complementary rather than competing strategies.

Physiotherapists and other allied health professionals have an important role to play in recognising cardiovascular risk factors, reinforcing health behaviour change, and ensuring that concerns are escalated appropriately to medical colleagues when needed. Even when cardiovascular management falls outside our direct scope, identifying and flagging risk can make a meaningful difference.

Ultimately, treating gout effectively is not just about preventing flares—it is about improving long-term health outcomes. By adopting a treat-to-target approach and integrating cardiovascular risk reduction into routine care, we can significantly improve both joint health and overall wellbeing for people living with gout.

Further Resources

https://rheumatologyphysio.substack.com/p/investigating-gout

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