Survey: Most physicians agree target goal for gout is imperative, yet half of patients fail to reach it

Posted: October 11, 2016 | Word Count: 1,150
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A new survey conducted among primary care physicians and rheumatologists found that despite their overall agreement that gout is a serious and chronic medical condition with potential long-term consequences, patients remain at risk.1 Of physicians surveyed, 89 percent agree that achieving serum uric acid (sUA) levels 1

Further, nearly all (94 percent) of health care providers (HCPs) surveyed indicated that gout needs to be treated aggressively given long-term consequences, but express frustration (82 percent) when treatments fail to control sUA levels.1 A majority (89 percent) of physicians surveyed expressed a desire for additional treatment options for their patients.1

“What I find most concerning about these findings is that we as physicians agree gout is not only a painful, often debilitating disease, but can have long-term consequences like permanent joint damage. Moreover, studies are showing a good deal of association between gout and comorbid conditions such as cardiovascular disease and kidney disease. Yet clinicians who treat patients with gout are only getting about half of those patients to their target sUA levels,” said Paul Doghramji, M.D., Family Physician, Collegeville Family Practice, Collegeville, PA. “I think there are two reasons why: we haven’t had enough treatment options to help manage the disease and there are continued misconceptions about gout that contribute to ineffective disease management.”

Gout is a highly symptomatic and painful form of inflammatory arthritis caused by an underlying metabolic disorder, hyperuricemia – or high sUA levels in the blood – and can lead to painful flares, characterized by excruciating pain, inflammation, swelling and tenderness in one or more joints.2,3 Living with uncontrolled gout can put patients at risk of long-term consequences such as inflammation, bone erosion and organ damage.4,5 The American College of Rheumatology (ACR) guidelines recommend gout patients maintain sUA levels below 6 mg/dL, a target that remains elusive for uncontrolled gout patients.6 The survey was conducted online among health care professionals (250 primary care physicians and 100 rheumatologists) in August 2016 to gain insight into their perceptions of and treatment practices for gout. Additional survey findings include:

Knowledge gap exists between physicians and patients with gout

Physicians surveyed take treating gout very seriously because of the potential long-term effects of the disease, such as joint damage (97 percent) and cardiovascular risks (83 percent).1 Nearly all of these physicians (95 percent) say gout has significant impact on patients’ physical abilities.1

However, 90 percent of physicians surveyed agree that their gout patients do not have a good understanding of the disease, and 95 percent say their patients’ focus remains on gout flares rather than the long-term impact of the underlying disease, despite these physicians’ efforts to educate their patients about the disease.1

Diet misperceptions prevail, impact action

While a majority of physicians surveyed disagree with the statement that diet is the primary contributor to elevated sUA levels, survey findings indicated physicians put an emphasis on the role diet plays, with 84 percent noting they focus on diet and nutrition as a major area when treating patients with gout, and 75 percent stating they believe most patients with gout could minimize the impact of the disease if they had more control over their diet and alcohol consumption.1

Further, nearly half of these physicians indicated their patients are not motivated to schedule follow-up visits to test their sUA level after experiencing gout symptoms. Seven in 10 feel their patients accept painful flares or “attacks” as part of living with gout.1

“Physicians who treat gout tend to emphasize the role of diet and nutrition with patients, especially since so many patients have failed to reach their target sUA levels. But now it’s time to also consider the importance of therapies that can help patients get to their target sUA level,” says Dr. Doghramji. “Dispelling myths of gout as a medieval ‘rich man’s diet’ disease, destigmatizing this disease and optimizing available treatments is, in my view, the most constructive path forward for the gout community.”

An estimated 2 million patients in the U.S. not at goal

The survey found that only 51 percent of physicians polled report their patients with gout are reaching target sUA levels below 6 mg/dL as recommended by ACR.1 Prevalence statistics indicate that of the approximately four million U.S. gout patients treated with a xanthine oxidase inhibitor (XOI) alone, approximately 50 percent are not able to maintain target sUA levels.4,8-14 This suggests about 2 million patients in the U.S. are suffering from uncontrolled gout.4,8-14

Education, getting patients to target sUA levels are priorities

Of physicians surveyed, educating patients about the long-term consequences of gout (75 percent) and encouraging patients with gout to get their sUA levels to target even when not experiencing flares (72 percent) are physicians’ main priorities.1

Findings also revealed key insights into how these physicians believe their patients perceive the disease, providing opportunities for further engagement and education. The survey was supported by Ironwood Pharmaceuticals.

About hyperuricemia and gout

Gout is a highly symptomatic and painful form of inflammatory arthritis affecting more than 8 million people in the U.S. It is caused by an underlying metabolic disorder, hyperuricemia – or high serum uric acid (sUA) levels in the blood – and can lead to painful flares, characterized by excruciating pain, inflammation, swelling and tenderness in one or more joints. Gout is commonly hereditary and not only a lifestyle disease. While diet and lifestyle changes are important in managing gout and its comorbidities, they are often not enough to get patient serum uric acid levels (sUA) levels to target.

More information about gout is available at www.goutisserious.com.

REFERENCES:

  1. Physician Survey Executive Summary. Ironwood Pharmaceuticals. 2016.
  2. Perez-Ruiz F, Herrero-Beites A. Evaluation and Treatment of Gout as a Chronic Disease. Adv Ther. 2012;29(11):935–946.
  3. Schumacher HR. The pathogenesis of gout. Cleve Clin J Med. 2008;75(5):S2-S4.
  4. Zhu Y, et al. Prevalence of Gout and Hyperuricemia in the US General Population. Arthritis Rheum. 2011;63:3136–41.
  5. Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318-328.
  6. Khanna D, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64:1431-1446.
  7. Scott J, Pollard A. Uric acid excretion in the relatives of patients with gout. Ann. Rheum. Dis. 1970;29(4):397-400.
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  10. Khanna P, et al. A world of hurt: failure to achieve treatment goals in patients with gout requires a paradigm shift. Postgrad Med. 2016;128(1):34-40.
  11. Meyer M, et al. Trends in Medication Utilization and the Cost of Treatment for Gout. Am J Pharmacy Ben. 2015;5(3):123-128.
  12. Primatesta P, et al. Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population. BMC Musculoskeletal Dis. 2011;12:130:1-7.
  13. Singh JA, Akhras KS and Shiozawa A. Comparative effectiveness of urate lowering with febuxostat versus allopurinol in gout: analyses from large U.S. managed care cohort. Arthritis Res & Ther. 2015;17:120:1-12.
  14. AZN/Decision Resource Market Research.

    NP-UNB-US-00079 10/16

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