Around 8.2 million people in the US have gout – a type of arthritis that results in the formation of small crystals inside and surrounding joints. It is usually diagnosed in men over 30 and women after menopause, causing sudden, severe attacks of pain, swelling, tenderness, and redness in one or more joints. Often, one of the most affected zones is the big toe. Discomfort can last for days or weeks and as the condition progresses, it may be impossible to move the joint normally. How does gout differ from other types of arthritis, and what are some of the newest treatments available?

Gout is a Metabolic Type of Arthritis

There are over 100 types of arthritis and related diseases, two of the most common of which are inflammatory arthritis (including rheumatoid arthritis or ankylosing spondylitis) and metabolic arthritis, or gout. Rheumatoid arthritis is an autoimmune disease, which means that the body’s own immune cells attack the joints. Gout, on the other hand, is caused by a buildup of uric acid in the blood. One of the easiest ways to tell the difference between the two is that people with gout frequently experience an extremely intense flash of pain that feels like their joint is being burned by a flame. Rheumatoid arthritis, on the other hand, feels more like a pain that creeps up on you.

Pegloticase Injection Co-administered with Methotrexate for Gout

One of the most innovative treatments for gout, approved by the FDA in July 2022, is a pegloticase (Krystexxa) injection combined with methotrexate. The approval was based on the results from the MIRROR randomized controlled trial, which showed significant improvements when patients were treated with pegloticase and methotrexate, compared to when pegloticase was used alone. In fact, the co-administered injection showed a 30% improved response. Specifically, some 71% of patients who received both treatments achieved serum urate levels at below 6 mg/dL for at least 80% of the time during month six, compared to only 39% of persons in the pegloticase-only group. The results also showed a significant resolution of one or more tophi (stone-like deposits of monosodium urate) at month 12 of the study.

Atom Bioscience Trials

Atom Bioscience, a clinical-stage biotech company specializing in metabolic and inflammatory disease, recently announced (in June 2022) that it was working on updating its clinical development of ABP-671—a new oral drug for chronic gout. The company’s Phase 2a randomized, double-blind, placebo-controlled clinical trial of ANP-671 (a second-generation oral URTA1 inhibitor) successfully reduced uric acid levels to less than 6 mg/dL. Moreover, there were no safety concerns. Based on these findings, the company is proceeding to Phase 3 studies and hopes to launch the drug soon after if the results are as expected.

Lifestyle Factors for Gout Prevention

In addition to novel treatments for gout, patients are also recommended to follow a healthy lifestyle, lose weight if necessary, moderate their alcohol consumption, and follow a Mediterranean diet. Although the causes of gout are largely genetic, adopting a healthy lifestyle can help reduce the risk of developing gout. Doing so could also be a lifesaver when it comes to heart health. In August 2022, a new study was published, showing that gout flare-ups may increase the risk of heart attack and stroke.

When it comes to gout, both new and traditional means of preventing flare-ups should be embraced. This is especially true in light of the fact that gout attacks can also increase the likelihood of a heart attack and stroke. Meanwhile, pegloticase (Krystexxa) injections combined with methotrexate have now been approved, and they have shown excellent results. Atom Science also hopes to bring its second-generation oral URTA1 inhibitor, ANP-671, to the battleground to help annihilate the debilitating effects of gout.

By Nina Berkshire