Dietary Management Improves Disease-Specific, Metabolic Outcomes in Gout

Nonpharmacologic gout management, including dietary counseling, may improve both disease-specific and metabolic outcomes, according to study data presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

Study authors retrospectively reviewed data collected between 2009 and 2016 from patients with gout at the Long Beach Veterans Affairs Hospital (n=130). Patients were stratified into 2 cohorts; a majority (n=100) received diet counseling, while the remaining did not. Study authors reviewed data for 24 months after either initial gout diagnosis or intervention, evaluating flare frequency and related emergency department visits, creatinine clearance, serum uric acid levels, and metabolic syndrome risk factor changes — including blood pressure, body mass index, cholesterol, and hemoglobin A1c (HbA1c) levels — at 6-month intervals.

Despite an overall trend toward fewer gout attacks over time, patients who received vs did not receive diet counseling experienced a more significant decrease in the number of gout attacks by month 12 (P =.002) and month 18 (P =.001). After diet counseling, more patients reached target serum uric acid levels (P =.002) at 6 months, and their levels were maintained at 24 months (P <.001). These patients also experienced improved creatinine clearance and high-density lipoprotein (HDL; P =.06 and P =.08, respectively).

Study authors noted that among patients with improved low-density lipoprotein (LDL) and HDL values, serum uric acid levels were more likely to have improved by 6 months (R²=0.4; slope, 0.03 and R²=0.4; slope, 0.16, respectively). Patients with improved HbA1c and LDL levels experienced fewer visits to the emergency department within the first 6 months (R²=0.4; slope, 0.14 and R²=0.4; slope, 0.05, respectively). At 18 months, improved HbA1c was associated with decreased serum uric acid (R²=0.5; slope, 0.2).

“[Patients with gout] who receive diet counseling had better control of [serum uric acid levels] and a lower rate of future attacks and [emergency department] visits,” the study authors concluded. “Given the serious complications and increased cardiovascular risks that can be associated with metabolic syndrome, optimization of gout through a nonpharmacologic intervention such as diet counseling can enhance clinical outcomes and optimize healthcare resources.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Chang J, Tsui J, Wong M. Effectiveness of dietary counseling on gout management and risk factors for metabolic syndrome in gout patients. Presented at: American College of Rheumatology 2020 Annual Meeting; November 5-9, 2020. Abstract 1607.