Q&A with Abdul Abdellatif, MD: New Era for Gout Patients
NOVEMBER 14, 2019
Abdul Abdellatif, MD
During the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., Abdul Abdellatif, MD, academic physician, Baylor College of Medicine, explained in an interview with MD Magazine® why this patient population does not always get the treatment they need.
MD Magazine: Do you believe patients with gout are underserved in nephrology research for new treatments?
Abdellatif: Gout is actually very prevalent in the population. We have approximately 8-9 million adults in the United States that have the diagnosis of gout. Maybe that's an under estimate of the true prevalence of the disease state.
Most of the time our patients unfortunately are undertreated. And for many reasons, either they don't disclose to their physicians their disease state because they can over treat or treat themselves with over the counter anti-inflammatory agents and think that the disease is controlled.
Unfortunately, the disease is precipitated by uric acid crystals. Taking over the counter anti-inflammatory agent does not do anything to eliminate the culprit for the disease states.
Therefore, when you treat an acute gout attack, you are only limiting the acute inflammatory process, but not controlling the disease.
Therefore, it's important for our physicians to actually actively ask our patients if they have had experienced any of those symptoms of gout, especially when they specifically present them with any complaints of any arthritis.
Because some of the patients may be misdiagnosed with osteoarthritis, rheumatoid arthritis, and their actual underlying disease could be that they have gouty arthritis.
MD Magazine: Are more treatment options needed to properly serve this patient population?
Abdellatif: Actually, we have multiple levels of treatment options for our patients. Unfortunately, some of those are underused for our patients.
For example, we have a couple of urate lowering agents to lower the uric acid level in the circulation. But when you look at the actual patient population receiving these medications, most of them don't achieve recommended guidelines range for a uric acid level of less than 5-6.
However, we have other medications such as Krystexxa, which is a medication that can be used in these patients who have failed the other urate lowering agents to control their disease by lowering their uric acid levels to significantly low levels.
MD Magazine: If there are more treatment options available, do you believe that patient guidelines would be revised and changed?
Abdellatif: I believe the guidelines have recommended to us to treat the patient in different ways. First of all, by educating the patient by restricting their dietary intake, but also by employing medication to control their uric acid level.
However, emphasizing some of the new agents, which I really call it the new era of treating gout especially in patients with chronic kidney disease that have significantly higher risk for developing gout and maintaining a higher hyperuricemia when they have gout that they may benefit from an additional more aggressive therapy such as Krystexxa.
MD Magazine: On kidney transplants for gout patients.
Abdellatif: One of my fields of nephrology is actually I take care of post-transplant patients at a large institution, Baylor College of Medicine with the Houston Methodist Transplant Center.
And what we see actually is the prevalence of gap in our transplant patients is significantly higher, almost 10 times the general population. When we analyze the data, looking at more than 6000 patients post-transplant, we noted that about 25% of patients have a diagnosis of gout and 15% of them may have it before they started.
They received their kidney transplant, but at least about 10% of them will develop gout after the transplant. And that's most of the time related to some of the medications that we give them to protect their kidney like calcineurin inhibitors, Ciclosporin, and PROGRAF or tacrolimus.
MD Magazine: Is there anything else you want to say?
Abdellatif: We noted in a retrospective analysis of transplant patients in the United States in a study sponsored by Horizon Therapeutics, that the patients who develop gout after transplants actually had a higher risk to progress to end-stage renal disease or to return back to dialysis in the first 1-5-years compared to those patients who had either preexisting gout or have no gout.
Not only that, but we also looked at the complications related to kidney transplant and these patients were noted to have a higher risk for complications including rejection and these patients who had developed gout versus the ones who has not developed gout.