Date: Saturday, November 7, 2020
Session Title: Metabolic & Crystal Arthropathies Poster
Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Despite scarce evidence regarding the effects of weight loss in gout1, international guidelines recommend dietary advice and weight loss as a core management strategy in people with gout and concomitant obesity. We explored whether there are potential clinical benefits associated with intensive weight loss in obese individuals with gout.
To compare in a proof-of-concept randomized trial the effect of an intensive, 16-weeks weight loss program (full meal replacement with hypocaloric products and weekly visits to a dietician), relative to a dietary advised control group (ordinary food and visits to a dietician only at baseline and at week 8), on primarily changes in body weight and secondarily serum urate, fatigue and pain in people with gout and concomitant obesity.
Methods: Participants were randomized using permuted blocks and stratification (i.e. sex (male vs. female), obesity (BMI< 40kg/m2 vs BMI≥40kg/m2), serum urate (< 6mg/dL vs ≥6mg/dL)). he primary outcome was change in body weight at 16 weeks, analyzed using repeated measures mixed models. According to the Statistical Analysis Plan, the key secondary outcomes were changes in serum urate, VAS gout pain, and VAS fatigue after 16 weeks. ClinicalTrials.gov (NCT03664167).
Results: Overall, 61 participants were enrolled and randomized, of whom 29 were assigned to intensive weight loss and 32 to dietary control. The participants had an average age of 60.3 (SD, 9.9) years, average BMI of 35.6 (SD, 5.0) kg/m2 and 59 (97%) were men. There was a statistically and clinically significant difference in the change in body weight from baseline to 16 weeks between the dietary and control groups (least squares means: -15.4 kg and -7.7 kg, respectively; difference: -7.7 kg (95%CI -10.9 to -4.7, p< 0.001). Mean changes in serum urate levels at the 16 weeks visit were -0.6 mg/dL and -0.3 mg/dL, respectively, with a difference between groups of -0.3 mg/dL (95%CI -0.9 to 0.3, p=0.744). The corresponding mean change in VAS fatigue was -17.4 mm compared to -8.6 mm, with a group difference of -8.8 mm (95%CI -25.5 to 7.9). Mean change in VAS pain corresponded to -2.5 mm compared to -12.5 mm, with a group difference of 9.9 mm (95% CI -11.1 to 31.0).
Conclusion: An intensive dietary intervention can effectively lower body weight in people with gout and concomitant obesity. Although absolute differences were present, we were not able to reject the null hypotheses for serum urate, fatigue, and pain in this proof-of-concept study with a small sample size
1 Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017. doi:10.1136/annrheumdis-2017-211472
Figure A: Effect of diet on weight B: Effect of diet on serum urate. Open dots = control group, Closed dots = intensive diet.
To cite this abstract in AMA style:Zobbe K, Christensen R, Nielsen S, Stamp L, Henriksen M, Overgaard A, Dreyer L, Knop F, Singh J, Doherty M, Richette P, Astrup A, Ellegaard K, Bartels E, Boesen M, Gudbergsen H, Bliddal H, Kristensen L. Weight Loss as Treatment for Gout in Patients with Concomitant Obesity: A Proof-of-Concept Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/weight-loss-as-treatment-for-gout-in-patients-with-concomitant-obesity-a-proof-of-concept-randomized-controlled-trial/. Accessed May 29, 2023.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/weight-loss-as-treatment-for-gout-in-patients-with-concomitant-obesity-a-proof-of-concept-randomized-controlled-trial/