Dr Ted Mikuls Explains Gout Study's Regional Data, Findings on Urate Control

Ted Mikuls, MD, MSPH, Stokes-Shackleford Professor of Rheumatology, vice chair for research, internal medicine, at the University of Nebraska, discusses findings on urate-lowering therapy and the lack of regional data on gout-related lower-extremity amputation.

Ted Mikuls, MD, MSPH, Stokes-Shackleford Professor of Rheumatology, vice chair for research, internal medicine at the University of Nebraska, led a study that compared rates of lower extremity amputations (LEAs) in US veterans with and without gout, using data from the Veterans Health Administration. Here, he explains how urate-lowering therapy may help prevent LEAs and discusses other areas in which he hopes to see additional research.


Were you able to determine if there were any differences by region or between urban and rural areas? Why or why not?

I think those are important questions for additional research. We didn't break the study down by region. I wouldn't anticipate that that would have a meaningful effect on the results. In other words, I don't think that's probably going to confound the results, although I think there may be differences by region that exist and that would be interesting to explore. Certainly, the urban-rural disparities that have been described in a lot of other conditions—including conditions like cardiovascular disease—I think would be important to look at in gout, as well.

There have been some studies suggesting that those disparities do exist in gout. Unfortunately, for this particular study, we really weren't in a position to really accurately define to the degree we'd want to, for lack of a better term, the degree of rurality for these rural patients. There's ways to do that, but that was really beyond the scope for this study.

Are there other findings from your study you would like to see further researched?

The suggestion in our findings that urate control may actually lower the risk of lower-extremity amputation, I think that's really intriguing data. We defined optimal urate-lowering therapy based on goals that have been established by professional organizations as thresholds that we should lower uric acids below when we're treating gout.

When we look at those thresholds and whether these patients have evidence of reaching that goal, it does suggest that that has a protective effect against having a lower-extremity amputation, and that's intriguing data. Now, it doesn't prove that we can go out and prevent all of these from happening in these patients, but it's certainly suggestive, and again, just as a call to arms, to really take pause and ask those questions about gout as you're evaluating a patient for lower-extremity amputation.