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OBESITY GETS IN THE WAY OF GOUT TREATMENT, HERE’S WHY
Obesity significantly reduced the effectiveness of febuxostat-based urate-lowering therapy among men with gout, with those with obesity showing lower target achievement rates and more flares than their normal-weight counterparts.
INTRO
Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, most commonly affecting the big toe. It occurs when urate crystals accumulate in joints due to high levels of uric acid in the blood (hyperuricemia).
These painful episodes can last days to weeks and are often followed by long periods without symptoms before recurring. Gout can eventually lead to joint damage, tophi (urate crystal deposits under the skin), and kidney stones if left untreated.
There is a significant association between obesity and gout. Research indicates that individuals with obesity have a substantially higher risk of developing gout compared to those with normal weight, with some studies suggesting a 2-3 times increased risk. This relationship exists because excess adipose tissue contributes to increased uric acid production while simultaneously reducing its elimination.
Weight gain is associated with higher uric acid levels, and the prevalence of gout rises proportionally with body mass index (BMI). Additionally, obesity often coexists with metabolic syndrome, insulin resistance, and hypertension—all conditions that further increase gout risk and complicate its management.
METHODOLOGY
This prospective cohort study assessed febuxostat efficacy in male gout patients categorized by BMI: Normal weight (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 28), and obese (BMI ≥ 28).
The study included 527 men (aged 18-70 years) who initially received 20 mg febuxostat daily for 4 weeks, with dosage increased to 40 mg daily if serum urate (SU) levels remained > 6 mg/dL during monthly follow-up visits.
The primary endpoint was the percentage of patients achieving SU levels < 6 mg/dL after 12 weeks of treatment.
Secondary endpoints included the percentage of patients achieving SU levels < 5 mg/dL and the proportion requiring 40 mg febuxostat daily at the 12-week mark.
TAKEAWAY
At week 12, the obese group showed a significantly lower rate of achieving SU levels < 6 mg/dL (38.9%) compared to both the overweight (54.2%) and normal-weight (63.8%) groups (P < .05).
Similarly, achievement of SU levels < 5 mg/dL at week 12 was markedly lower in the obese group (10.6%) versus the normal-weight group (25.7%) (P < .05).
Both obese and overweight groups experienced a higher cumulative incidence of gout flares compared to the normal-weight group (P < .05).
Factors affecting treatment target achievement included older age (increasing likelihood) and both high BMI and family history of gout (decreasing likelihood).
IN PRACTICE
“Personalized medication is necessary for obese male patients to prevent gout flares and achieve SU targets in the management of gout,” the authors wrote.
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