b'u FromPage 31populationsincludeBlack/AfricanAmericans,gout patients in the VA whose gout is sub-optimally Asian,NativeHawaiian/PacificIslanderandtreated, meaning they did not recurrently fill their gout American Indians. treatment medications or reach control of their serum AstudypresentedattheAmericanCollegeofurate, had a 22% increased risk of mortality compared Rheumatologysannualscientificmeetingbyto VA patients with gout who were considered to be researchersattheVAPortland,OR,Healthcarewellcontrolled[meaningthey]refilledtheirgout System found that gout also tended to be poorly con- medications and met their uric acid goals, she said. 5trolled in patients living in rural areas. In the study of 2,421 veterans who were identified as having goutAppropriate Management is Crucial and received care at VA in 2019 with VA NorthwestThe overall take home message of our findings is Network (VISN 20), only one-third of those identi- that gout afflicts a large number of patients in the fied as living in rural areas had controlled gout usingVeteransHealthAdministrationandthereforewe serumuratelevels.Theauthorsstatedthatinter- need to be taking steps to ensure these patients are ventions that share rheumatology best practices andidentifiedandtreatedappropriately,Helgetsaid. expertise for managing gout with VA primary careGout is a chronic condition requiring chronic man-teams, such as the VA Rheumatology Extension foragement.Ideally,toensureitsoptimallong-term CommunityHealthcareOutcomesECHOprogrammanagement, gout should be viewed no differently and expansion of telehealth within VA rheumatology,than any other chronic conditions for which you have should be developed and tested to enhance quality ofregular follow up appointments for management. care for rural veterans. 2 We have incredibly effective treatments, which can help the vast majority of patients manage their gout. More Than Painful Joints A long-term approach needs to be the standard of care Painful gout attacks are often treated with opioids,in gout management to ensure that medications are Helgets prevalence study showed. In 2014, 16.4%working, dosing is appropriate, and patients are com-ofprevalentgoutpatientswerereceivingaweakpliant with prescribed therapies, she said. opioid, nearly doubling the prescription rate of weak1Helget, L. N., England, B. R., Roul, P., Sayles, H., Petro, A. D., opioids in 2005, a finding Helget found particularlyMichaud, K., & Mikuls, T. R. (2021). Incidence, Prevalence, and surprisingand concerning . 1 Burden of Gout in the Veterans Health Administration. Arthritis care Although her group have not examined figures beyond& research, 73(9), 13631371. https://doi.org/10.1002/acr.243392014, she said, we have done additional analyses of2Barton, J., Larsen, C., Matsumoto, R., & ONeill, A. (2021). Rural this data within the same time frame which showed thatveterans with goutRheum for improvement. ACR Meeting Abstracts. https://acrabstracts.org/abstract/rural-veterans-with-gout-nearly 60% of gout patients receive an opioid at somerheum-for-improvement/point in their disease course and that gout patients were3Barton, J., Larsen, C., Matsumoto, R., & ONeill, A. (2021). Rural 36% more likely than those without gout to receive opi- veterans with goutRheum for improvement. ACR Meeting oids leading to chronic opioid use.3 Abstracts. https://acrabstracts.org/abstract/rural-veterans-with-gout-Frequent gout attacks that occur when serum uricrheum-for-improvement/acid levels are not controlled can cause irreparable4Mikuls, T. R., Soto, Q., Petro, A., Helget, L., Roul, P., Sayles, H., damagetothejoints.OthercomplicationsincludeCope, B., Neogi, T., LaMoreaux, B., ODell, J. R., & England, B. R. (2022). Comparison of Rates of Lower Extremity Amputation intophi, accumulations of monosodium urate in the softPatients With and Without Gout in the US Department of Veteranstissues, synovial tissues or bones near the joints; kid- Affairs Health System. JAMA Network Open, 5(1), e2142347. https://ney stones; kidney disease and even kidney failure.doi.org/10.1001/jamanetworkopen.2021.42347One study in veterans found suboptimal serum urate5Arthritis & Rheumatism. (2021b). Mortality in patients with sub-control was also associated with a higher rate of loweroptimally treated gout in the Veterans Health Administration: A extremity amputations in patients with gout.4 national retrospective cohort study. ACR Meeting Abstracts. https://acrabstracts.org/abstract/mortality-in-patients-with-sub-optimally-Even more concerning is that uncontrolled gout istreated-gout-in-the-veterans-health-administration-a-national-retro-associated with increased mortality. We do not spe- spective-cohort-study/cifically have those numbers, but we have found that 32'