Conducting high-quality clinical research to expand the depth of studies into the causes of and treatments for gout is a goal for physicians at a new research and treatment center for gout and hyperuricemia at UAB.
UAB recently received a five-year, $5.3 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Disease at the National Institutes of Health to establish a Center of Research Translation (CoRT) to study gout, which affects about two percent of Americans. “Most of those sufferers are men, but it can affect women as well,” says Kenneth Saag, MD, co-director of the center and a professor of medicine in UAB’s Division of Clinical Immunology and Rheumatology.
Saag says the UAB CoRT will provide the opportunity to take discoveries surrounding gout treatment and prevention from the laboratory to patients, helping them return to everyday activities. “We are investigating several new drugs for the treatment of gout, and with the addition of the CoRT, we will be able to significantly expand our scope,” he says.
The CoRT team views the new center as the centerpiece of a growing portfolio of clinics and clinical research for gout. “We will have more investigators to look at the pathobiology and racial disparity of gout,” Sagg says. “We will collaborate with experts all over the country and look forward to expanding our research activities at UAB. We also plan to establish a new gout clinic in the Kirklin Clinic to be led by UAB CoRT Associate Director Jasvinder Singh, MD.”
The center has three projects that will focus on different aspects of gout and hyperuricemia, one being a study of whether lowering serum urate levels will be effective in managing hypertension. The team also will work with a group from Kaiser Permanente to create a virtual clinic to evaluate the effectiveness of using non-physician health care workers to manage gout patient care. “In medicine today, physicians are so busy. We want to look at the possibility of developing a system of care that will use pharmacologists, nurses and physician assistants to manage gout patients, who require regular follow up. Our intention is to manage patients centrally using these physician extenders so we can improve the quality of care that gout patients receive,” Saag says.
In a third project, the CoRT team will investigate the benefits and side effects of drugs for the treatment of gout. The researchers will use data from the Veteran’s Administration and will not use patients in the study.
“Beyond the research planned in the center, we currently are testing new uricosuric drugs and are conducting other clinical trials of these medicines in gout,” Saag says. “For example, we are testing pegloticase for safety and effectiveness.”
Gout generally affects older patients and often is associated with obesity, hypertension, hyperlipidemia and diabetes. It is characterized by sudden, recurrent attacks that often occur without warning. Symptoms include severe pain in one or more joints – most commonly in the big toe – and red or purplish, tight, shiny skin over the joint. While the causes of gout are well known and treatments are available, large gaps exist in the quality of patient care. “Another burden of gout treatment is that the number of patients is increasing because people are living longer,” Saag says. “For example, advances in our understanding and ability to treat heart disease, kidney disease and other serious conditions are extending people’s lives so gout becomes a greater concern.”
Saag adds that generally there are important and relatively simple things medical practices should be doing for gout patients. Since gout medicines may need to be adjusted frequently, measuring serum urate regularly is crucial to gout care. “There are a lot of proactive things like this that we need to be doing for gout patients,” he says. “We previously helped to develop quality indicators in this area. We looked across the board at our treatment and care management options and realized there was still a lot of room for improvements.”
The new UAB CoRT will provide the resources to study many facets of the debilitating condition and will provide physicians with new information and treatments to help patients who suffer from gout. “We want to establish a true center for gout at UAB. We believe that through this center UAB can become a hub for improving gout care and better understanding its causes,” Saag says. “Ultimately, we hope to increase general knowledge among physicians so we can address this public health problem all across the country.”