Ethnicity / Race

About

GoutHelper appreciates that race and ethnicity are sensitive subjects and that in modern medicine we should strive to avoid race-based judgement and predictions, as well as develop accurate assessments of health that are not dependent on race or ethnicity. However, GoutHelper has to ask about race / ethnicity because of the risk imparted by HLA-B*5801.

HLA-B*5801

HLA-B*5801 is a gene that when present increases an individual's risk of serious side effects with the most commonly used long-term gout medication: allopurinol1. Having the HLA-B*5801 gene is much more common in individuals who are often Asian descent2. This was first described in Han Chinese, but has been subsequently observed in Korean and Thai populations. HLA-B*5801 is also more common in African Americans3.

Because of the risk associated with the HLA-B*5801 genotype and its increased prevalence in the aforementioned races / ethnicities, GoutHelper has to ask about race / ethnicity in order to provide safe guidance to practitioners when selecting long-term gout therapies. This practice is in line with the 2020 American College of Rheumatology guidelines for the management of gout, which recommends checking for the HLA-B*5801 gene in patients of Han Chinese, Korean, Thai, or African American descent4. Individuals with the gene should be started on a different medication if possible.

References

  1. Hung SI, Chung WH, Liou LB, Chu CC, Lin M, Huang HP, Lin YL, Lan JL, Yang LC, Hong HS, Chen MJ, Lai PC, Wu MS, Chu CY, Wang KH, Chen CH, Fann CS, Wu JY, Chen YT. HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci U S A. 2005 Mar 15;102(11):4134-9. doi: 10.1073/pnas.0409500102. Epub 2005 Mar 2. Erratum in: Proc Natl Acad Sci U S A. 2005 Apr 26;102(17):6237. PMID: 15743917; PMCID: PMC554812.
  2. Dean L, Kane M. Allopurinol Therapy and HLA-B*58:01 Genotype. 2013 Mar 26 [Updated 2020 Dec 9]. In: Pratt VM, Scott SA, Pirmohamed M, et al., editors. Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK127547/
  3. González-Galarza FF, Takeshita LY, Santos EJ, Kempson F, Maia MH, da Silva AL, Teles e Silva AL, Ghattaoraya GS, Alfirevic A, Jones AR, Middleton D. Allele frequency net 2015 update: new features for HLA epitopes, KIR and disease and HLA adverse drug reaction associations. Nucleic Acids Res. 2015 Jan;43(Database issue):D784-8. doi: 10.1093/nar/gku1166. Epub 2014 Nov 20. PMID: 25414323; PMCID: PMC4383964.
  4. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C, Levy G, Libbey C, Mount D, Pillinger MH, Rosenthal A, Singh JA, Sims JE, Smith BJ, Wenger NS, Bae SS, Danve A, Khanna PP, Kim SC, Lenert A, Poon S, Qasim A, Sehra ST, Sharma TSK, Toprover M, Turgunbaev M, Zeng L, Zhang MA, Turner AS, Neogi T. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760. doi: 10.1002/acr.24180. Epub 2020 May 11. Erratum in: Arthritis Care Res (Hoboken). 2020 Aug;72(8):1187. Erratum in: Arthritis Care Res (Hoboken). 2021 Mar;73(3):458. PMID: 32391934.
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