b'Gout Largely Treatable but Remains a Considerable Burden in Older Veterans Once called the disease of kings, gout no longer has an association with wealth and indulgence. In reality, its prevalence is higher in menand older patients, and it affects military veterans treated at theVA more than patients in the community. It also is on the rise,something that especially concerns researchers.By Mary Anne DunkinOMAHA,NEOneoftheearliestrecordedandprevalence5.8% in the VA compared to almost 4% most intensely painful diseases, gout was historical- in another national U.S. studysuggesting that, by ly called the disease of kings. For centuries it wascrude numbers alone, gout is an even bigger problem thought to affect only the wealthy and aristocratic.in our veterans than the general population.Althoughgoutspainfulreputation(somesayAlthough Helget said she and her colleagues have merely the pressure of a bedsheet or a breeze on anno updated figures from the original study, based on inflamedjointcanbeexcruciating)haspersisted,other estimates in the United States and other parts of its association with wealth and indulgence has beenthe world, she thinks its very likely that this preva-challenged and refuted. lence has continued to increase over time.Clinical experience and research, including studies in veterans, have painted a different pictureone thatA Curable Disease affects all socioeconomic classes, with certain groupsGout occurs when excess uric acid deposits as nee-being more vulnerable to uncontrolled gout and itsdle-sharp crystals in the joints. Uncontrolled, gout serious complications.can become chronic, punctuated by periodic attacks on joints.Concerning Findings in VeteransIn theory, gout can be cured when treatment with Concerningly,theprevalenceofgouthasrisenappropriateurate-loweringtherapies(allopurinol in recent years, and it appears to affect veteransand febuxostat) achieves a goal uric acid of 6mg/disproportionately. dL or lower. Ina2020studyexaminingtheprevalenceandOthertreatmentoptionsincludeprobenecid, burden of gout in the veteran population, research- which increases the renal excretion of uric acid, ers led by rheumatologist Lindsay N. Helget, MD,andfortreatment-resistantgout,IVpegloticase, of the Omaha, NE, VA Medical Center found that,whichrapidlybreaksdownuricacidintomore in 2014, the prevalence of gout in the VHA wassoluble compounds that the body can more easily 5.8% compared to 4.2% in 2005. Gout prevalenceeliminate, Helget said. was highest among men, older patients and non- But, due to underutilization of appropriate treat-Hispanic black patients. During 2014, 4.0% of allment and other factors, many people never achieve inpatient or outpatient encounters and 1.3% of hos- that goal.pitalizations were gout-related. 1 While uncontrolled gout is an issue across all patient Goutisaproblemeverywhere,notjustforthepopulations,researchershavefoundthatattaining veteran population, Helget told the Compendium oftreatment goals with serum urate is more challenging Federal Medicine. However, when comparing thein nonwhite populationsfor yet unknown reasonsfindings of our paper to the findings in other stud- suggesting we need to pay specific attention to this ies,theredoesappeartobeasubstantiallyhigherpopulation when treating gout, said Helget. These 30'