SNOWMASS, COLO. – The epidemiology of gout has changed considerably in the past several decades, rendering treatment more challenging.
For example, today fully 21.4% of all U.S. adults are hyperuricemic as defined by a serum uric acid in excess of 6.8 mg/dL.
Dr. Robert L. Wortmann
"When I was a fellow it was 5%. There’s a lot more uric acid in the world today," Dr. Robert L. Wortmann observed at the symposium.
Major contributing factors include metabolic syndrome, the obesity epidemic, increased consumption of high-fructose drinks and processed foods, and alcohol. Liquor has a twofold stronger urate-boosting effect than does wine, and beer’s impact is fourfold greater than wine, according to Dr. Wortmann, professor of medicine at Dartmouth Medical School in Hanover, N.H.
"When I was in training uric acids above 9 mg/dL weren’t common; now, when I see a newly diagnosed gout patient with a uric acid level below 9, it’s exceptional. Gout patients today have uric acids of 10, 11, and 12 mg/dL as opposed to 7.5, 8, and 9 in decades past," he said.
Since 1964 the standard dose of allopurinol has been 300 mg/day. Back then, that was sufficient to reach the serum uric acid target of less than 6.0 mg/dL in about 90% of gout patients. Today, 300 mg/day gets only about 40% of patients to target, as has been shown in numerous studies.
Dr. Wortmann reported serving as a consultant to Ardea Biosciences, Novartis, Savient, Takeda, and URL Pharmaceuticals.