There were far
too many posters, talks, abstracts, etc. at the EULAR 2013 Meeting in Madrid
than to comment on everything. So I select my personal highlights and updates.
B. Manger [SP0006]
talked on “Visualising crystals: DECT and more”. “Dual energy computed
tomography (DECT) is an imaging method, which uses X-ray beams of two different
energies to differentiate solid sodium urate deposits from connective tissues
and from calcium containing structures by their absorption properties.” “…,DECT
may not only be a very helpful imaging method for tophus assessment and
follow-up in clinical trials and during urate lowering therapy in patients with
the established diagnosis of chronic gout. It may also be valuable as differential
diagnostic tool in patients with “unclassified” acute or relapsing arthritides,
when aspiration of synovial fluid is not possible or not successful.“
I haven’t used DECT
yet and also don’t know, where to look for someone, who is experienced in this
method, here in the vicinity.
S.-J. Kee and
colleagues studied [OP0002]: “Pathomechanism of bone
destruction in chronic gouty arthritis”. “MSU [monosodium urate
monohydrate] crystals induced the expressions of IL-1, IL-6, TNF-alpha and
RANKL in PBMCs [peripheral blood mononuclear cells], but inhibited OPG [osteoprotegerin]
expression.” Conclusions: “ …, our data show that
MSU crystals have the potential to induce pro-resorptive cytokines, and T cells
are involved in osteoclastogenesis in chronic gout.” Good basic research, which
might lead to understand, why erosive lesions look different in gout and RA for
instance.
T. Cooper and
colleagues presented a study [FRI0568-PC]: “Gout: are we getting it right in primary care? An audit of serum uric acid
level measurement and monitoring.” Methods: “This study audited one
general practice in the UK.” Results: “A total of 125
patients had received allopurinol in the 3 year period. 76 patients (60.8%) had
not had their SUA level measured, leaving only 49 (39.2%) who had their SUA
levels checked. …”. Conclusions: “Clearly the
majority of patients receiving allopurinol in this general practice were not
having their SUA levels measured, being treated to target or monitored
annually. If these simple tests and management strategies were performed in
primary care then a large number of hospital admissions for attacks of gout
could be avoided, with the accompanying save in expenditure. …”
So, it’s
important to have revisits by the patient, who have been presented to rheumatologists
in order to help our colleagues in primary care, once we’ve seen these gout
patients as I presume they suffer from more severe or complicated forms of
gout.
D. Chandrasekaran and colleagues presented [SAT0363]: “Evaluation of the use of colchicine in the management of chronic gout.” The
authors looked at 515 patients taking colchicines. Conclusions: “… a significant percentage of gout patients are
inappropriately on long-term colchicine with only 26% having serum uric acid
levels at or below the target level of 6 mg/dl.”
I may add that some GPs don’t read the letters, maybe because the
patients don’t show up or maybe because they think that the gout problem has
been solved, once the arthritis has been treated. With us rheumatologists there
rests an educational responsibility – we have to both educate our referring
colleagues as well as our gout patients, whom we normally see only
sporadically.
D. Khanna and
colleagues looked at [SAT0384]: “Patients that continue to
flare despite reaching EULAR/ ACR recommended serum urate target.” Conclusions:
“Less than 50% of patients treated with a XOI inhibitor alone reached sUA
target. Of the patients achieving a sUA level of < 6 mg/dL, over a third
reported 2 or more flares in a 12-month period.”
Can you see gout
patients, who do not flare? I can’t as our outpatient department is only allowed
to see patients suffering from severe auto inflammatory diseases. How can we help
then? Wait till the poor patients flares again? I don’t have an easy answer.
Gout is a topic
that lots of colleagues outside the rheumatologic world feel fit in, but there
are still gaps to be filled. I read out of the above studies, that we as
rheumatologists have an educational responsibility owards colleagues in primary
care and patients as well.
More on gout:
ACR2012 Abstracts on Gout without drug
studies http://rheumatologe.blogspot.de/2012/12/acr2012-abstracts-on-gout-without-drug.html
Gout and other crystal diseases at the
EULAR 2012 http://rheumatologe.blogspot.de/2012/07/gout-and-other-crystal-diseases-at.html
Some Ideas on Gout http://rheumatologe.blogspot.de/2012/05/some-ideas-on-gout.html
An expedition into the world of gout http://rheumatologe.blogspot.de/2012/04/expedition-into-world-of-gout_27.html
Gout / subcutaneous
depots of uric acid http://twitpic.com/4q61mh
No comments:
Post a Comment