Gout Mismanagement

Gout Mismanagement

This is my review of a gout management study. In which I will explain the key points for gout sufferers. So this is for people who are concerned about how their gout is managed. Because it helps you discuss your concerns with health professionals. In the hope that you can agree better gout management plans with your doctor.

Citation for Gout Mismanagement

This is a GoutPal review of:
Doherty, Michael, Tim L. Jansen, George Nuki, Eliseo Pascual, Fernando Perez-Ruiz, Leonardo Punzi, Alexander K. So, and Thomas Bardin. “Gout: why is this curable disease so seldom cured?.” Annals of the rheumatic diseases 71, no. 11 (2012): 1765-1770.

At the time of writing, this study has been cited by 248 other studies.

Gout Mismanagement Purpose

The purpose of this study is to investigate the reasons why gout is mismanaged despite:

  1. Early diagnosis
  2. Accurate diagnosis
  3. Effective treatment
  4. Known severity
  5. Known consequences

Why, then, despite the possibility of early and accurate diagnosis, the availability of effective treatment and our insight into the severity and consequences of the disease, is gout managed so ineffectively?

Jargon-free Abstract

In the jargon-free abstract I present the key points of the original abstract. Replacing jargon with terms more familiar to unqualified people interested in gout. Note that my selection of jargon terms might not match yours. So please leave a note in the feedback form near the end of the page if you need clarification.

Background / Introduction
There is detailed explanation of the causes of gout and its progressive nature. Importantly, the cause (excess uric acid) is so effectively treatable that gout is considered to be curable. Yet only a minority of gout patients get effective treatment
The study reviews articles, books, conference papers, and other key gout reference works published between 1980 and 2011. Especially, those including therapy, management, cure, and treatment.
Results / Findings
Both patients and doctors have negative perceptions that reduce access to treatment and its effectiveness. Doctor factors that impede gout recovery include:
  1. Poor training
  2. Poor diagnostic procedures
  3. Underestimating long-term complications
  4. Failure to match treatment to individual patient needs
  5. Insufficient patient information
  6. Ignoring professional guidelines
  7. Gout is not interesting
  8. No new treatments

On the other hand, patients need to know their actual and target uric acid levels. Also the important differences between managing short-term gout pain and long-term uric acid levels.

Original Abstract

Gout is the most common inflammatory arthritis and one in which pathogenesis and risk factors are best understood. One of the treatment objectives in current guidelines is ‘cure’. However, audits show that only a minority of patients with gout receive adequate advice and treatment. Suboptimal care and outcomes reflect inappropriately negative perceptions of the disease, both in patients and providers. Historically, gout has been portrayed as a benign and even comical condition that is self-inflicted through overeating and alcohol excess. Doctors often focus on managing acute attacks rather than viewing gout as a chronic progressive crystal deposition disease. Urate-lowering treatment is underprescribed and often underdosed. Appropriate education of patients and doctors, catalysed by recent introduction of new urate-lowering treatments after many years with no drug development in the field, may help to overcome these barriers and improve management of this easily diagnosed and curable form of potentially severe arthritis.

Gout Mismanagement Conclusions

Among arthritis types, gout is uniquely curable. Yet many barriers prevent effective care. Including doctors with:

  • Negative patient stereotypes
  • Poor gout knowledge
  • Little interest in gout

However, there are opportunities to improve the management of gout care through:

  • Education
  • New treatments
  • New scientific evidence

There is a wide variety of barriers to effective care for gout, which is a very common and uniquely curable, chronic inflammatory arthritis. These barriers largely reflect commonly held negative stereotypes of the patient with gout and poor knowledge and interest in gout among doctors. Appropriate education, possibly assisted by recent drug development and new scientific evidence is opening a new ‘window of opportunity’ in gout management and should improve the standard of care.

Tophaceous Gout in the Hand
Gout is not managed effectively when this happens.

Cited By

Why does your gout doctor seldom cure gout?
Does your gout doctor stay up-to-date with current guidelines? Because most gout patients do not get the right uric acid treatment. So here are lists of reasons for not curing gout properly. See how to get better treatment from your gout doctor today.

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Gout Mismanagement Vocabulary

  • acute gout

    ⇢ short-term gout pain – a flare or attack

  • chronic gout

    ⇢ long-term uric acid arthritis

  • pathogenesis

    ⇢ how a disease develops

  • urate

    ⇢ uric acid (see MSU – monosodium urate)