Throughout the evolving COVID-19 pandemic, Massachusetts General Hospital has implemented many changes to patient care.
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Personalized and Multidisciplinary Care for Gout and Crystal Arthropathies
The Gout and Crystal Arthropathy Center strives to deliver the very best personalized, comprehensive, compassionate, and efficient care and support to our patients with gout, pseudogout, and other crystal arthropathies. Our team of experts is dedicated to excellence in patient care through early diagnosis, patient education, personalized treatment, and cutting-edge research in gout and other crystal arthropathies.
With accurate early diagnosis and appropriate acute and long-term treatment of gout and other crystal arthropathies, patients can expect to maintain good control of their arthritis so that they can lead productive lives free of joint pain. Our Center collaborates very closely with specialists in many different areas to provide the most comprehensive care possible to our patients, including screening and management of comorbidities that often co-exist with gout. As necessary, we will coordinate your care with providers in:
- Primary care
- Physical and occupational therapy
What to Expect
Diagnosing gout or other crystal arthropathy requires a careful review of a patient’s symptoms, physical findings, and relevant testing. During a patient’s first appointment at the Gout and Crystal Arthropathy Center, we will review his/her medical history, perform a physical examination, and decide what additional tests are necessary to make an accurate diagnosis. We will also conduct a careful review of the patient’s medical records; therefore, we ask all patients to bring their previous medical notes, as well as related test results, including available imaging evaluations. Once a diagnosis of gout or crystal arthropathy is established, we are able to assist in both the acute and chronic management of these conditions.
Our Care Approach
Once the diagnosis is confirmed, we deliver optimal gout care with a coordinated long-term strategic approach that involves several key components that go beyond initiation of anti-gout medications. This gout care strategy consists of patient education, individualized lifestyle advice, and appropriate use of anti-gout medications (typically, medications that lower serum urate levels) to achieve and sustain treatment targets of disease control and a potential cure (i.e., sustained serum urate control, absence of gout symptoms, improvement in quality of life). Over a one-year period, this approach can lead to more than 90% of patients achieving the primary treatment target of serum urate < 6mg/dL as recommended by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) guidelines.
Aside from routine clinic evaluations, we offer the following services at the Gout and Crystal Arthropathy Center:
- Musculoskeletal Ultrasound: Our experts in musculoskeletal ultrasound can provide real-time and dynamic evaluation of joints as well as perform ultrasound-guided procedures for targeted and often rapid pain relief.
- Electronic Visits: Our Center offers electronic visits which include some educational materials as well as a secure online questionnaire to determine whether any treatment changes need to be made in between clinic visits.
- Patient Gateway: Our Center encourages close communication between patients and providers by using Patient Gateway, our online portal.
In order to provide our patients with the most cutting-edge, evidence-based approaches to gout and crystal arthropathy care, our Center remains committed to clinical and translational research. Our physicians have already led a number of high-profile and impactful studies that have helped define the standard of care for patients with gout and other crystal arthropathies. Patients have the opportunity to participate in ongoing clinical research and trials to help further our collective knowledge about gout and other crystal arthropathies.
Funded by the National Institutes of Health (NIH P50, R01, R21, and R13) and Rheumatology Research Foundation, the Gout and Crystal Arthropathy Center has been conducting state-of-the-art outcomes research as well as clinical trials in gout and other crystal arthropathies. Recently, our Center has played a leadership role in the development of a unified gout care guideline for Rheumatologists and primary care providers through nationwide collaborative endeavors.
Clinical Trial for DASH Diet in Gout
Funded by the Rheumatology Research Foundation, we are the prime site for the Diet Gout Trial (DIGO) (https://clinicaltrials.gov/ct2/show/NCT03569020). This clinical trial is investigating the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on serum urate among patients with gout. Our investigators have previously shown that the DASH diet is associated with lower serum urate levels and risk of gout.
Epidemiologic Research of Gout
Our Center conducts NIH-funded epidemiologic studies on the prevalence and incidence of gout and hyperuricemia, as well as risk factors for the development of gout. In particular, we have assessed how different foods, beverages, supplements, and other environmental factors impact uric acid levels and the risk of gout. These studies are conducted based on prospective cohorts, such as the Nurses’ Health Study and Health Professionals Follow-Up Study (Choi et al. JAMA. 2010; Choi et al. NEJM. 2004; Rai et al. BMJ. 2017).
Genetics of Gout
Our Center has conducted NIH-funded genome-wide association studies (GWAS) and gene-environment interaction studies for gout (Kottgen et al. Nat Genet. 2013). Studying candidate genes that affect urate metabolism and excretion could have clinical implications for the treatment and prevention of gout. However, gout cannot be explained entirely by genetics alone, so our research also focuses on how genetics and lifestyle factors interact to lead to gout development and progression in our patients.
Boston Online Gout Study II
This is a large, multi-center study funded by a NIH P50 CORT (Centers of Research Translation) grant to investigate how genes interact with key environmental triggers of gout flares (i.e., gene-environmental interaction) through an Internet-based case-crossover study platform in collaboration with the Partners Biobank. The Boston Online Study I (funded by NIH P60) identified the triggering effects of purine-rich foods, alcohol, hospitalization, diuretic use, low-dose aspirin, overnight/early-morning time, and weather factors for gout flares (Zhang et al. Arthritis Rheum. 2014; Choi et al. Arthritis Rheum. 2015).
Dual-Energy CT in Gout Care
Dual-energy CT (DECT) is a special type of CT scan that allows for the non-invasive identification of urate crystals in joints and soft tissues based on their chemical composition. In collaboration with experts in imaging of crystal arthropathies, our Center is studying the clinical utility and pathogenesis of crystal deposits among patients with gout and pseudogout (Dalbeth et al. Ann Rheum Dis. 2018; Choi et al. Ann Rheum Dis. 2012). We are also investigating cardiovascular DECT imaging to determine the potential role of urate crystal deposition in coronary artery disease among patients with gout.
Allopurinol-Associated Severe Cutaneous Adverse Effects
Allopurinol, a medication that lowers serum urate levels, is commonly prescribed to patients with gout and is generally very safe and well-tolerated. However, allopurinol can be associated with a rare but serious complication called severe cutaneous adverse reactions, which can extensively involve skin, mucosa, and major organs. Investigators from our Center have been instrumental in identifying key risk factors for this severe adverse effect, such as age, sex, race, chronic kidney disease, and heart disease (Keller et al, Ann Rheum Dis. 2018).
The Gout Registry at Massachusetts General Hospital
The Gout Registry at Massachusetts General Hospital is a data and tissue repository established by the Gout and Crystal Arthropathy Center for patients with gout in partnership with the Partners Biobank. Particular areas of research interest include patient-reported outcomes in gout (e.g., employment, quality-of-life), ultrasound assessment of treatment response to gout care, and pharmacogenomics.
The Pseudogout Registry and Development of a Classification Criteria
The Pseudogout Registry at Massachusetts General Hospital is a data and tissue repository established by the Gout and Crystal Arthropathy Center for patients with pseudogout in partnership with the Partners Biobank. Among many aims, clinical information collected in this registry will be used in developing classification criteria for pseudogout, which are needed to streamline clinical research and care. Our Center is leading this project, funded by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR).
Uricase Infusion Trial
Uricase is an intravenous urate-lowering medication for the treatment of severe gout that is refractory to oral medications. We are a site for a clinical trial investigating different types and dosing regimens of pegylated uricase agents.
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Educating the Next Generation
As part of an internationally recognized teaching hospital, the Rheumatology Unit is committed to preparing the next generation of leading academic physicians, scientists and clinician-educators. Our fellowship program, affiliated with Harvard Medical School, entails intensive study of the clinical, diagnostic, therapeutic, pathogenic and research aspects of rheumatologic diseases.