Kicking inconsistencies in the language of gout

The ancient term of podagra can still be used for a gout flare at the first metatarsophalangeal joint, urate replaces uric acid from now on, and the term chronic gout is out of date.

These and other recommendations are the outcomes of an international effort to improve the consistency and precision of language about gout, which will hopefully underpin better management of the disease.

More than 80 gout experts from more than 20 countries participated in the literature review, Delphi exercise and/or face-to-face consensus meeting to define 11 fundamental elements of gout.

The final recommendations were endorsed by the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN).

Professor Nicola Dalbeth, from the Bone and Joint Research Group in the University of Auckland’s Department of Medicine, told the limbic it was important to reach agreement on so many elements especially the issue of acute versus chronic gout.

“One of the real issues that we have, is that because patients experience flares of disease, there is often a perception that if they are not having a gout flare, they don’t have gout.”

“And actually what we know now is that gout is a chronic disease of monosodium urate crystal deposition and one of the problems is the wide range of labels don’t allow people to recognise gout as a chronic disease.”

She said the terminology and choice of language was important for both patients and healthcare practitioners.

“I think that our sense is that gout is only active when there is a flare. Both for practitioners and for patients, it is really difficult to understand that, actually, gout requires long-term therapy.”

“We see very low rates of prescribing of long-term effective medication for gout in the form of urate-lowering therapy. And we hope that this change in terminology may provide some tools to have those conversations more effectively and to view the disease more as a chronic disease of crystal deposition.”

Gout flare, intercritical gout and chronic gouty arthritis received the collective nod for acute episodes of inflammation, the asymptomatic periods between flares and the persistent joint inflammation due to crystals respectively.

Gouty bone erosion was also the preferred term for evidence of a cortical break in the bone suggestive of gout.

Professor Dalbeth said the literature review revealed a wide range of different words used to describe aspects of gout.

“That was probably a wider range than for other forms of arthritis but we haven’t specifically looked at that. And it may well be that if we did the same kind of analysis for RA or spondyloarthropathy, we may see similar things.”

She said she hoped that with buy-in from so many gout researchers and clinicians as well as endorsement from G-CAN, the consensus statement will influence language change.

“I hope that journals will also adopt this as standard nomenclature but that has not yet been specifically addressed.”

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