The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

Area of Science:

• Rheumatology
• Cardiology
• Nephrology

Background:

• Gout is the most prevalent inflammatory arthritis, with increasing global incidence and prevalence.
• Gout significantly impacts cardiovascular health and quality of life, often underestimated.
• Ischemic heart disease (IHD) and chronic kidney disease (CKD) are common comorbidities in gout patients.

Purpose of the Study:

• To highlight unmet needs in gout management.
• To identify gaps in current research regarding gout treatment and its comorbidities.
• To emphasize the need for international collaboration to improve gout care.

Main Methods:

• Review of current literature on gout prevalence, comorbidities, and management challenges.
• Analysis of existing treatment guidelines and identification of research deficits.
• Discussion of the causal relationship between gout, hyperuricemia, and associated diseases.

Main Results:

• Physician underutilization of urate-lowering therapy (ULT) and poor patient adherence are significant management issues.
• Lack of robust randomized controlled trials for safe gout treatment doses, especially in patients with IHD and advanced CKD.
• Absence of established optimal serum uric acid (SUA) targets and validated clinical outcome measures for treat-to-target approaches.

Conclusions:

• Suboptimal gout management necessitates addressing low ULT initiation and adherence.
• Further research is crucial for establishing safe and effective gout treatments, particularly for high-risk patient groups.
• International collaborative efforts are essential to improve the comprehensive care of gout patients.