Dietary changes a common self-management strategy in gout patients

Patients are commonly self-initiating dietary changes following a diagnosis of gout to manage the condition, despite little evidence of the clinical effectiveness of such intervention in preventing flares, research has found.

A team at Newcastle University in the UK sought to understand if, why and how patients choose to modify their dietary habits after developing gout, by undertaking a secondary analysis of qualitative data from  interviews and focus groups with 61 people with the condition.

The study, published in Rheumatology Advances in Practice found that patients commonly initiated dietary changes as part of a self-management strategy without professional, evidence-based advice, with key reasons driving these changes found to be desperation, a desire for control, and belief in successful management of gout through diet alone.

“Beliefs that dietary intake could potentially explain and/or modify the timing and frequency of flares (rather than dietary factors predisposing to hyperuricaemia and intervention lowering urate) were central to participants’ motivation for dietary modification,” said the authors, led by Dr Jennifer Liddle, a Senior Research Associate at the university’s Population Health Sciences Institute.

Responses suggested that belief in diet as a potential driver or modifier of gout flares gave patients a sense of control over their condition, but it also showed that this “appeared to be a barrier to acceptance of management with urate-lowering therapy (ULT)”, which is “highly effective at reducing flares”.

Also, there were disparities in food beliefs relating to gout. For example, one study found that more patients believed vegetables to be a trigger of gout flares than believed that beer did, while the researchers highlighted one interviewee as reporting drinking cherry juice because a friend with gout had advised her to do so.

While there is some evidence that consuming certain foods and alcohol could affect the risk of flares, “there is little evidence of the clinical effectiveness of dietary interventions to lower serum rate, prevent flares or reduce the volume of monosodium rate (MSU),” the researchers stressed.

Participants were also found to be largely aware of the link between being overweight and gout, but had not made any changes to diet with a view to losing weight to help manage the condition, highlighting a key opportunity for intervention and education.

A greater emphasis on the importance of lowering urate in patient education materials, reducing or preventing flares through ULT and ensuring that patients have access to evidence-based advice on diet are also key to improving management of the condition, the researchers note.

“Perception about gout and diet play a large role in the way patients make decisions about how to manage gout in everyday lives. Addressing reasons why patients explore dietary ‘solutions’, promoting the value of ULT and weight loss, and drawing on strong evidence to communicate clearly, will be crucial in improving long-term clinical management and patient experience,” the authors conclude.

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