June 4, 2023

Professor Michael Doherty from the University of Nottingham, Nottingham, UK, speaks to Prof Jaap van Laar, Editor of Rheumatology about their study published in the Journal.

A number of papers have shown that people with gout have juice survival and that’s being reported to be due to a number of causes cardiovascular disease chronic kidney disease but also certain cancers and a key question has been debated a lot this is you treat people effectively learn the uric acid does it have enough thanks on not just getting rid of their gallant

Like they were the crystals but does it improve their comorbidities and put on a survivable and there’s been a number of papers on this where they’ve been conflicting someone found a positive result for that fear no treatment whereas others have not found that so we wanted to investigate that in the clinical practice research data think mm-hmm which is quite a

Large general practice database in the uk and what we published includes mortality in that database and this was the next step to see the treatment effected that so did it in it didn’t not in this putting this study and when you look at large databases there’s true of any study really there’s potential confounders and vices that you need to be aware of yeah the two

Important ones when you’re looking for a treatment effect on my disease in such a database is firstly confounded by the indication mmm and people with gout tend to get out of here on the dominie if they’ve got bad gout they’ve got multiple comorbidities so they tend to be ill i and people who don’t get along and i won’t see if you don’t take that into account it can

Make the potential treatment effect or worse the opposite is the more time advice and people who get onto an acrylic often get it after many years of having gaps and to get into a treatment group you already have two survived from the time about presentation and for the purposes of a study you remotely whereas that immortality doesn’t apply to people during the long

Treatment group so that means adjustment as well and in a study we did it just became abilities using the chopsticks which has 17 important abilities examined and also we used one of those several methods of trying to take off the attack last issue and probably because we did do that we ended up with no specific truth defects evident right which which probably not

Doesn’t mean it allopurinol is not effective but bit rather than that it’s not given that the right doses is that that’s how eating correct absolutely right we know the from the database that from the vast majority more than nine out of ten people get just 300 milligrams or less about retinol and in this day and age that’s insufficient for the vast majority of people

In terms of hitting the right target i pleasure to get rid of gout crystals but also to potentially have an effect and the cardiovascular system so probably because all the problems with large database is the reflector a real-life practice which is often subaltern unfortunately you probably do need a randomized controlled trial where you do treat the target and

Give the right treatment and and this is also one of the other messages from your paper that maybe there is a role for a rheumatologist in helping gps to achieve the targets for uric acid certainly treating two targets is an accepted principle diseases count the most common inflammatory disease where life is the only one working we get rid of the package engagement

It’s actually very easy to treat the vast majority of successfully they just take some time to get you take the person the patient so i get motivated and adhere to the treatment yeah and if you do discuss things with we will get properly and we’ve published on this gives you the full information about a hundred percent and won’t be right now in therapy and adherence is very good you

Transcribed from video
The effect of allopurinol on all-cause mortality in adults with incident gout. By Oxford Academic (Oxford University Press)