Study explores struggles in managing gout

A study published online this month in the Arthritis Care and Research journal is shedding light on why gout, a painful and common form of arthritis, is not well-managed in many patients. The journal is published by the American College of Rheumatology.

Student is lead author of paper

Brian Coburn, first author of the paper, is a UNMC student enrolled in his fifth year of the UNMC M.D., Ph.D., program.









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Brian Coburn
“A nice feature of this work is it was done by a local MD/Ph.D. student start to finish,” Dr. Mikuls said. “It’s been Brian Coburn’s baby and he’s done a phenomenal job with it. It just shows what young trainees can do. The project was part of a UNMC fellowship grant Brian received as part of his MD/Ph.D. training.”

Coburn said the study was insightful in his training as a future physician-scientist.

“I’ve not had a chance to get into clinic fully yet, but after completing this study, I have a broader perspective of how thinking about patient populations can help inform what we do in clinics to best improve patients’ health,” said Coburn, first author of the article. “Similarly, I’m looking forward to my clinical training which will help me learn about barriers patients face during care. There are many research opportunities going forward to help patients and providers get better outcomes.”

Researchers at UNMC and at the VA Nebraska-Western Iowa Health Care System in Omaha found that only 14 percent of gout patients know the numerical treatment goal for the medication they are on. Patients in the study were on allopurinol, which helps keep the disease under control by reducing painful flare-ups and maintaining a certain level of uric acid in the body.

The study evaluated 612 questionnaires from patients at the VA Nebraska-Western Iowa Health Care System on their knowledge about gout and whether they knew what their numerical goal was.

“We found that there’s a real gap in patients’ understanding of our treatment goal in gout,” said Ted Mikuls, M.D., Umbach Professor of Rheumatology in the UNMC Department of Internal Medicine Division of Rheumatology, who also practices at the Omaha VA. “I think what was striking was most patients knew what causes gout, how it is treated, and what was going on with their disease, but they did not know what their level of uric acid should be. To us that’s compelling.

“It’s very well understood that there are targets for uric acid that should be reached to treat people effectively. I think physicians probably know the goal, but it’s not being clearly communicated at least in a fashion patients can recall. If patients don’t know the goal of therapy, it’s very hard for patients to be engaged in their care,” said Dr. Mikuls, senior author of the paper.

When long-term treatment is needed to avoid future attacks, Dr. Mikuls said typical treatment starts with low doses of drugs such as allopurinol and checking uric acid levels before changing doses as needed to reach and maintain the target uric acid level.

“Along with the other best practices — talking about diet and weight management, using anti-inflammatories for acute flares and for preventing flares when they start these therapies – it’s a fairly straight forward condition to treat. I think increasingly we’re seeing health care providers doing this better, but we have a long way to go,” he said.

2 comments

  1. James E. Davis says:

    Very interesting… as a sufferer of Gout myself, as I am reading this article I am struck that I too am not aware of what the ideal number should be. I am (was) just under the impression that you take Allopurinol and it controlled the Uric Acid, which will control the flare ups. This has worked for me as I have been flare up free for over 10 years.

    So reading this tells me there is more to it then that, and it makes me wonder if there is damage/problems later on in life that I am unaware of.

    Good read, hope the information about Gout can be straighten out so patients are more informed on it.

  2. Nancy Woelfl says:

    Great work on this study. Is there a way for gout patients to self-test or self-monitor their Uric acid levels as diabetics do with blood sugar? Is the goal to give gout patients as much control as diabetic patients need and have? If lab testing is the only option, then it may remain difficult for gout patients to have optimum control. Nancy Woelfl

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