Buzzback's second peer reviewed paper of the year! The abstract below was presented at the European Congress of Rheumatology, June 12-15 in Vienna, Austria, published in Annals of the Rheumatic Diseases, Volume 83, June 2024.
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).
Conclusion: Study findings indicate that despite lack of a consensus definition of remission in gout, physicians feel comfortable treating gout and including remission as a goal. However, in contrast to rheumatologists, a large proportion of PCPs and nephrologists do not see SU-control as an important component, relying more heavily on gout flare, pain, and disability. Observed differences between physician types may reflect differences in training, interest, experience, and gout management guidelines between the specialist[8,9] and primary care[10] communities. The current study highlights the need for a standardized definition of gout remission that includes proper SU-control. Widespread use of this definition would also serve to emphsize the importance of SU-control to PCPs who are often the first line of contact and management for gout patients.
REFERENCES: [1] Zhu Y, et al. Am J Med 2012;125:679-87 e1.
[2] Choi HK, Curhan G. Circulation 2007;116:894-900.
[3] Pérez Ruiz F, et al. RMD Open 2019;5:e001015.
[4] Kuo CF, et al. Rheumatology (Oxford) 2010;49:141-6.
[5] Singh JA, Strand V. Ann Rheum Dis 2008;67:1310-6.
[6] Francis-Sedlak M, et al. Rheumatol Ther 2021;8:183-97.
[7] Khanna PP, et al. Health Qual Life Outcomes 2012;10:117.
[8] FitzGerald JD, et al. Arthritis Care Res (Hoboken) 2020;72:744-60.
[9] Richette P, et al. Ann Rheum Dis 2017;76:29-42.
[10] Qaseem A, et al. Ann Intern Med 2017;166:58-68.
Acknowledgements: NIL.
Disclosure of Interests: Yael Klionsky MedIQ, Amgen, Inc., AstraZeneca, and Lilly, Eunice Luo Amgen, Inc., Amgen, Inc., Sara Vazquez Irizarry Amgen, Inc., Lissa Padnick-Silver Amgen, Inc., Amgen, Inc., Brian LaMoreaux Amgen, Inc., Amgen, Inc., Gordon Lam Amgen, Inc., Amgen, Inc.
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