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11-09-2017 | Rheumatology | News | Article

Weight loss supported for obese patients with gout

medwireNews: Evidence from a systematic review suggests that weight loss is likely to be beneficial for overweight and obese patients with gout.

Robin Christensen (Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark) and colleagues analyzed data from 10 studies reporting the effects of weight loss in this patient group, including one randomized controlled trial. The studies covered interventions for weight loss, including diet, physical activity, and bariatric surgery, in addition to unintentional weight loss that occurred as a result of consuming a high-protein diet or treatment with metformin or diuretics.

Participants lost between 3 kg and 34 kg over a follow-up period ranging from 4 weeks to 7 years, and weight loss was associated with a change in serum uric acid (sUA) levels of –168 to +30 µmol/L. The proportion of patients achieving a target sUA concentration below 360 µmol/L ranged from zero to 60% among those with raised levels at baseline.

Six of eight studies reporting gout attacks demonstrated that weight loss was associated with a reduction in the number of attacks, with one study showing a dose-dependent relationship.

Although the evidence suggested an overall beneficial effect of weight loss, the team notes that participants experienced a temporary increase in sUA levels and gout attacks immediately after undergoing bariatric surgery in two studies, suggesting that “unfavourable effects may occur” in the short-term. However, they emphasize that adverse events were generally “poorly reported” in the included studies.

Christensen and colleagues also caution that the evidence in favor of weight loss for achieving target sUA levels was of only moderate quality and that supporting weight loss for reducing sUA levels and gout attacks was low quality.

“Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies,” they write in the Annals of the Rheumatic Diseases.

And the researchers call for randomized studies to “provide more trustworthy estimates of gout-related benefits and harms” associated with weight loss, “including the effect on joint pain, tophi, physical function, [health-related quality of life], adverse events and patient global assessment.”

By Claire Barnard

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