Gout and Genetics: What Your Background Might Mean
Welcome to season two of Kicking Gout in the Acid. This season will dive into additional topics of importance to not only those with gout, but for those treating the disease as well. Whether you’ve been recently diagnosed, care for someone suffering, or are a medical professional treating the disease, the Kicking Gout in the Acid podcast can help you learn more.
This episode of Kicking Gout in the Acid features a conversation between Dr. Larry Edwards and Dr. Robert Keenan, Rheumatologist, Chief Medical Officer at Arthrosi Therapeutics, and member of the International Advisory Council for the Gout Education Society. The two explore the broad reach of gout across different demographics, discuss how gout presents differently, and considerations healthcare professionals should be aware of during treatment.
Key Takeaways:
Gout doesn’t discriminate by age, gender, background, or diet. Doctors should be aware that the signs of gout aren’t always as straightforward. Misdiagnosis is common, so it’s important to take a step back and recognize the subtle symptoms.
Genetics play a meaningful, but complex, role. Family history is a significant risk factor, however, research points to polygenic and epigenetic factors than one single genetic mutation.
Demographics matter, but not in the way most people think. While men typically develop gout in their 40s-50s, the prevalence is nearly equal in women post-menopause.
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Educational Materials:
Gout Patient Brochure
Medical Professional Guide
Crystal Clear Checklist
Kicking Gout in the Acid is sponsored by Sobi.
Podcast Transcript
Ian PonitzHello, and welcome to Kicking Gout In The Acid, a podcast from the Gout Education Society. My name is Ian Ponitz, and I'm your host for this series. Kicking Gout In The Acid features conversations between Dr. Larry Edwards, chairman and CEO of the Gout Education Society, and experts on the disease.
Each episode will dive into important topics that you, the listener, should know about gout. The goal? To feel empowered to get gout under control.
In this episode, Dr. Edwards is joined by Dr. Robert Keenan, Chief Medical Officer at Arthrosi Therapeutics, and member of the Gout Education Society's International Advisory Council. Today, Dr. Keenan and Dr. Edwards will discuss how gout affects different populations, the role of genetics and gender on gout, and how medical professionals can better serve diverse communities.
Dr. Edwards, take it from here.
Dr. Larry EdwardsThanks, Ian. I'm happy to be joined today by Dr. Robert Keenan, internationally recognized expert in the field of gout. He's also the Chief Medical Officer of Arthrosi Therapeutics, and I'm delighted to have us join in our conversation.
Can you start off, Rob, by telling a little bit about what your interest in gout has been over the years and what kind of studies and research you've done?
Dr. Robert KeenanYeah. Thanks for having me. I appreciate the opportunity to talk about my favorite medical topic or my favorite topic, probably in general, much to my wife's dismay, of gout.
Yeah, so I got interested in gout back in medical school, quite honestly, and then my interest further developed in residency, then subsequently in fellowship. I had the opportunity at NYU to start a gout registry with the VA there, and that kind of really kicked off my clinical research interest.
From there, I just continued it on as I transitioned to Duke University, and I started a gout clinic and kept up with the clinical research there as a principal investigator for a number of drug studies, as well as principal investigator for some epidemiological studies that were externally funded. So that's kind of how I kept the love of gout and the love of treatment of gout and taking care of this patient population over the last twenty-plus years now.
Dr. Larry EdwardsYeah, it's an incredibly interesting disease with a crazy history to it. It certainly is a fun thing to study, and the nice thing is that it's essentially a curable disease if patients listen to the recommendations. We have good medications. We're getting better medications coming down the pipeline, so I think that there's a lot of hope for the future.
Let's go ahead, Rob, and start off the discussion today, talking really about the demographics of gout, who gets gout. It's said that there's about 9 to 12 million adults in the United States that have gout, coming to about 4% of the population of adults.
What else can you tell us about the demographics of this disease?
Dr. Robert KeenanYeah. So I like to tell patients that gout doesn't discriminate.
I mean, there's a lot of misnomer about. Oh, it's the over-indulgent rich person who eats too much, you know, meat and drinks too much alcohol, that gets you gout.
But really, I mean, just pretty much gout can affect any ethnicity, any race across the spectrum. Of course, men are more likely to get gout earlier on, so you think about the typical gout patient as a man in his fifties, you know, late forties, early fifties when they first initially present with their first flare.
But eventually, women do catch up with men post-menopausal. So once they reach menopause, the incidence and prevalence of gout in women starts to catch up with that of men. So by the time they're seventy-five, eighty, it's pretty much almost equal to that of men. Again, it can affect anybody.
Now, typically, as far as who gets gout the most, so to speak, there was a recent study that was put out by Yokosi a couple of years ago. I guess it was twenty twenty-three years ago that showed that over the last couple of decades, the Asian population in the US, actually, their prevalence doubled from about 3.3% to about 6.6%. That was a higher increase and a higher rate of increase in prevalence compared to every other ethnic group, including whites and blacks and Hispanics. So I thought that was interesting.
If you look at the black population in general, their prevalence of gout is also higher than that of whites. And you can think, “Well, maybe this is something genetic,” and it's probably not genetics, especially when people develop gout in their fifties and sixties.
You know, you’ve got to think about a genetic component when they're developing gout in their late teens or twenties, for example. But it's not so much genes as it is just potentially lifestyle, other comorbid illnesses like chronic kidney disease or metabolic syndrome.
If you look at that Yokosi study of the Asian population being doubled, you know, it wasn't double. It was actually lower than whites about thirty years ago. So, as with blacks, it could be just a lack of access to care. It could be not being started on urate-lowering therapy when they should. So that kind of pretty much dictates, and if they develop gout and have not started on anything to bring their uric acid down, then they're more likely to have gout longer, more flares, and more severe gout down the road.
Dr. Larry EdwardsThere's been a lot of work on the genetics of it, and we can talk about that in a short while.
I think other components you've mentioned are the gender, of course, with men predominant early on in the forties, fifties, and sixties, and women becoming much more susceptible to gout as they get into their seventies and eighties. The frequency of gout in that older population, seventy-five, eighty, is actually very high, 20%, 25% percent of the population of adults.
Can you talk a little bit about age?
You mentioned earlier on, Rob, that the image that most people have of gout is some portly old white guy sitting around drinking some alcoholic beverage or eating a large meal. We know that that's not the primary source of problems. Can you talk about the type of people that you see that would really say that that's not the problem, as far as women, as far as athletes getting it, people that don't drink, people that don't eat meat? All of those are in the spectrum.
Dr. Robert KeenanYeah, exactly. So that's where potentially some of those genes kind of come into play in that patient population, especially whether it's women, and just post-menopausal, and especially if they have a strong family history, their father had gout, their grandfather had gout, their brothers have gout, there's a good chance they'll develop gout.
A lot of times, in women, they'll present different than men. They won't necessarily present with a big, hot, painful red big toe. They'll present with it in their hands, for example, and it might not even flare like a typical gout flare. It might be a little more subtle. And I think that's important for women to recognize because, you know, I've had patients, women patients who came to me for joint pain in their hands, and, you know, they obviously had some osteoarthritis in their hands, and they came to me saying their pain's just getting worse, and they're having episodes where it's just worse some days than others.
Sure enough, I say, "Well, this looks like it could be potentially gout." And, you know, one patient I can think of off the top of my head said, "I don't have gout. My husband has gout, but I don't have gout. There's no way I have gout. He eats too much," et cetera, et cetera.
I said, "Well, I think you may have gout. Let's take some X-rays and see what we see, and then check uric acid and see what we see." And sure enough, she had gout on top of her osteoarthritis in her hands.
So that patient population certainly is not gonna be necessarily typical in many ways, not only, you know, necessarily what they're eating or not eating,...
