The Concept of Gout Remission

Background: The systemic consequences of patients who suffer from gout and acute gout flares are associated with increased comorbidity,[1] cardiac and all-cause mortality,[2-4] and lower quality of life.[5] Patients with uncontrolled gout (high serum urate [SU] with ongoing flares or nonresolving tophi despite maximum-tolerated xanthine oxidase inhibitor dosing) experience an even higher health and quality of life burden.[6,7] Thus, managing gout to remission is emerging as an important clinical target. Yet, with no clear definition of gout remission, understanding how physicians view remission in gout remains an important unanswered clinical question.

Objectives: To examine how physicians who manage gout define and perceive gout remission.

Methods: Board-certified rheumatologists, nephrologists, and primary care physicians (PCPs) who were registered in the Physician Insights Platform (Sermo, New York, NY) were invited to participate in this study. Interested physicians who had practiced for 2-35 years, dedicated ≥75% of time to patient care, seen ≥150 patients in the prior month, and managed ≥10 gout patients in the prior month completed an online questionnaire in July 2023. Returned surveys were not included in analyses if data were of poor quality (completion time too long/short, poor quality open-ended responses, all items responded to with the same answer). The components, timing, and feasibility of gout remission were explored. Data collection, validation, and preliminary analysis were performed by buzzback LLC (New York, NY).

Results: 363 surveys were completed; 10 were excluded due to poor quality of open-ended responses. Of the 353 reporting physicians with validated responses, nearly all (90%) had familiarity and comfort with treating gout to remission. Rheumatologists (n=151) and nephrologists (n=100) viewed remission as the absence of flares, serum urate level (SU) control, and the absence of gout-related pain (includes tender/swollen joints). In contrast, PCPs (n=102) saw remission as general symptom control with the absence of gout flare and gout-related pain (Figure 1, Top). Most physicians agreed that patients needed to meet these goals for 6-12 months to be considered in remission. Most often, physicians cited medication non-adherence (83%), high monosodium urate (MSU) crystal burden (76%), patient lifestyle non-compliance (75%), and comorbidities (74%) as the top hinderances of reaching remission (score of 1-2 on a 7-point scale). PCPs rated patient lifestyle as a top hinderance for remission (83%) more often than both rheumatologists (72%) and nephrologists (70%) but MSU burden (59%) less often than rheumatologists (85%) and nephrologists (79%; Figure 1, Bottom).