By Abhijeet S. Danve, MBBS, MD
Gout has quickly become a problem of global proportion. The disease, a debilitating form of inflammatory arthritis, has doubled in prevalence over recent decades. More than 41 million people in the world now live with gout.
That would be one thing if most people had their gout under control. But they don’t. Approximately 70% of patients continue to experience frequent flares. That’s seven in 10 people who regularly suffer severe joint pain that disrupts family time, distracts them from work and distances them from friends. Untreated gout can also cause irreversible joint damage. Despite the availability of low-cost, well-tolerated medications, just 27% of patients start taking one to lower their uric acid within a year of the onset of gout.
As a physician, I am committed to turning the tide on gout. I urge fellow health care providers to join me by considering four simple steps:
- Talk with your patients. Simple, right? Whether in primary care or a specialty area, providers can help by talking to patients who have gout comorbidities and explain to them about the interplay between their conditions. Common gout comorbidities include hypertension, chronic kidney disease, obesity and cardiovascular disease. Providers can help by working with patients to manage these conditions.
- Help destigmatize gout. Patients with gout suffer quietly due to stigma attached to the diagnosis, particularly with regards to diet and lifestyle factors. Despite having a severe disease, patients often trivialize and downplay the symptoms to avoid shame and embarrassment, leading to under diagnosis and under treatment of gout. Perhaps they’ve been teased by family or colleagues. They need us, as medical professionals, to provide compassionate care, help them feel comfortable and give them the tools to manage their illness. Gout cannot be solely managed even with the harshest dietary restrictions and most patients eventually require urate lowering therapy, so we should avoid patient blaming.
- Thoroughly explain treatments. Even when I’m most crunched for time, I try to resist quickly writing a prescription. It’s true, most patients will need at least one medication to manage their gout long term. But it makes a difference when I take the time to walk through the treatments’ different uses and side effects. Nothing will prompt a patient to quit taking a medication faster than an unexpected side effect. A well-informed patient is more likely to adhere the medications and avoid medication errors.
- Stay in touch. Having a patient start a treatment plan is just the first step to successful management. Long-term adherence is the goal. I try to enlist the other members of the care team to check in on patients. A registered nurse or pharmacist can be trained to monitor labs and adjust medication dosage for gout patients, as they do for patients taking blood thinners that need routine monitoring. Using technology such as online portal messages or pre-scheduled emails can help too. Regular contact can keep patients on the right track – and out of urgent care or the emergency room.
Gout is one of the few rheumatic conditions that can be “fixed.” Doing so will significantly decrease the burden of the disease, improving millions of lives. While researchers are working on developing even better treatments, it’s on health care providers to make sure we’re helping patients the best way we can.
We have a great opportunity to turn the tide on underdiagnosed and undertreated gout.
Abhijeet S. Danve, MBBS, MD, is assistant professor of medicine (rheumatology) at Yale School of Medicine and a member of the Alliance for Gout Awareness.