Patient Perceptions of Gout Management Goals

A Cross-Sectional Internet Survey

Jasvinder A. Singh, MBBS, MPH; N. Lawrence Edwards, MD

Disclosures

J Clin Rheumatol. 2020;26(4):129-133. 

In This Article

Abstract and Introduction

Abstract

Objective: To assess patient perceptions of gout management goals.

Methods: We conducted a cross-sectional Internet survey of people who visited the Gout and Uric Acid Education Society's website to assess patient/respondent perception of gout management goals. We used chi-square test for categorical or t-test for continuous variables.

Results: Among the 320 survey respondents with physician-diagnosed gout, mean age was 57 (SD, 13.4) years, 72% were male, 77% White; mean gout duration was 7.6 years (SD, 11), gout flares in the last year were 5.2 (SD, 6.1), and medical comorbidities were common, 2.7 (SD, 2.6). Two-thirds respondents each reported very severe or severe symptoms from gout and that gout ranked among the top two health conditions with a negative impact on quality of life. During a clinic visit, only one-third of respondents' physicians spent 50% of more of the time discussing gout treatment. Only 54% respondents were prescribed ULT by their healthcare provider. By patient preference, the best life-long gout treatment strategies were the lowering of the serum urate level and the control of gout symptoms (62%) followed by serum urate lowering (32%). Respondents considered the following as the most important things for making gout treatment satisfactory: (1) patient education; (2) effective physician–patient communication; (3) diet and lifestyle modification; (4) serum urate monitoring and target achievement; (5) pain management and flare prevention; and (6) medication management.

Conclusions: Patient identification of gout symptom control and serum urate level monitoring as the most important treatment goals is informative for clinicians and guideline developers.

Introduction

The publication of the recent American College of Physicians (ACP) gout guideline[1] has brought the discussion of gout treatment goal to the front and center. A new debate regarding whether urate monitoring vs. symptom management should be treatment goals in patients with gout receiving urate-lowering therapy (ULT) has emerged. ULT use is associated with a reduction of gout flares and improved function.[2–4] Therefore, serum urate-lowering to <6.0 mg/dl with ULT, i.e. treat to target (T2T) is recommended in most other gout treatment guidelines,[5,6] and considered the standard of care by most rheumatologists. The ACP gout guideline recommends that the treatment strategy for patients with gout receiving ULT should be guided by symptoms, i.e., "treat to avoid symptoms" (T2S) rather than T2T.[1] The ACP guideline cited the lack of randomized trial evidence for serum urate target as the rationale for not supporting T2T. It is interesting that ACP taskforce chose gout symptoms as a new ULT target, especially in the absence of observational study or trial and any qualitative or quantitative patient feedback.[1] Common gout symptoms include chronic joint pain, joint warmth, joint stiffness, reduction in joint function, difficulty in performing activities of daily living (ADLs), gout flares (acute, severe pain and functional limitation), and short- and long-term disability.

Our recent qualitative work with nominal groups in patients with gout revealed that prevention and better management of flare-ups, disease remission, diet/lifestyle changes, patient education, and medication management were the top patient-centered goals for gout management.[7] Our objective was to perform a cross-sectional survey in an independent sample to further examine the patient-priorities for the goals of gout therapy and to describe the current patterns of gout care by their health care providers related to urate monitoring vs. symptom management.

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