Insights into The Myths About Gout & the Barriers to Optimal Care
WASHINGTON, D.C.—Gout is poorly managed, and not just by a bit. Adherence to drug treatment for gout is the outlier among many of the top chronic medical conditions. Data show that gout has the lowest adherence rates at 36.8% compared with other chronic conditions, such as 72.3% for hypertension and 51.2% for osteoporosis.1
In a session at ACR Convergence, Of Kings and Men: Education and Remission in Gout, N. Lawrence Edwards, MD, professor of medicine, Division of Rheumatology and Clinical Immunology at the University of Florida, Gainesville, presented these low treatment adherence numbers, noting that clinicians have long known and not fully understood them.
Using a flow chart, he illustrated the magnitude of the problem. Of 21.1 million people in the U.S. with gout, only 7.6 million received a uric lowering therapy. Of those patients, 90% (6.7 million) were inadequately treated, with only about 10% (0.91 million) adequately treated.
Why are most patients with gout inadequately treated? Dr. Edwards pointed to two main problems: poor patient adherence to treatment and poor physician performance. Both problems, he suggested, reflect a need for better education around gout that includes addressing the myths and misconceptions about the disease and barriers to optimal gout management.
The Challenges
For patients, myths about gout include its perception, which can be embarrassing. Such perceptions include believing gout is self-inflicted (e.g., caused by an overindulgence in food and alcohol) or always linked to obesity. Or the myths may simply create a limited perception of the disease as a benign, intermittent condition with few—if any—consequences or occurring only if a person has joint pain. Also, that gout occurs only in men.
Along with misperceptions about the disease, several barriers impede optimal management, including a poor understanding of the disease mechanisms, a poor understanding of the treatment plan, poor health literacy, financial problems and fears of medications.
Rheumatologists also have biases that interfere with optimal gout management, some of which they share with their patients. These may include inherent biases against the disease, a poor understanding of the pathogenesis of gout and viewing the disease as benign. Additionally, rheumatologists may overemphasize dietary and lifestyle suggestions, restrict allopurinol doses to a very narrow therapeutic range and implement poor clinical follow-up and lab testing. They may also be a loyalist to treat-to-avoid symptoms recommendations proposed by the American College of Physicians (ACP) and unfamiliar with treat-to-target expert recommendations from EULAR and the ACR, among others.
