Ted Mikuls, MD, MSPH, Stokes-Shackleford Professor of Rheumatology, Vice President of Research, Internal Medicine at the University of Nebraska, led a study that compared rates of lower extremity amputations (LEAs) in US veterans with and without gout, using data from the Veterans Health Administration. Here, he explains how urate-lowering therapy can help prevent LEAs and discusses other areas where he hopes to see more research.


Were you able to determine whether there were differences by region or between urban and rural regions? Why or why not?

I think these are important questions for further research. We have not broken down the study by region. I wouldn’t expect this to have a significant effect on the results. In other words, I don’t think it’s likely to skew the results, although I think there may be differences by region that exist that would be worth exploring. I think it would also be important to look at the urban and rural disparities that have been described in many other conditions, including conditions like cardiovascular disease, in the case of gout.

Some studies suggest that these disparities exist in gout. Unfortunately, for this particular study, we really weren’t able to define precisely what degree we would like, for lack of a better term, how rural these rural patients were. There are ways to do this, but that was really beyond the scope of this study.

Are there any other findings from your study that you would like to see explored further?

The suggestion in our findings that urate control can actually reduce the risk of lower extremity amputation, I think is really intriguing data. We have defined optimal urate-lowering therapy based on goals that have been established by professional organizations as thresholds below which we should lower uric acids when treating gout.

When we look at these thresholds and whether these patients have evidence of reaching this goal, it suggests that it has a protective effect against lower limb amputation, and that’s intriguing data. Now, that doesn’t prove that we can go out and prevent all of this from happening to these patients, but it’s certainly suggestive, and again, just like a call to arms, to really pause and ask these questions about gout while you’re evaluating a patient for lower extremity amputation.