Gout

Rebrand gout as an arthritic condition to improve ULT use  


Gout should be renamed ‘urate crystal arthritis’ to overcome the misperception that it is a self-inflicted glutton’s disease best treated with lifestyle change, rheumatologists say.

A rebranding of gout is needed to address the paradox of it being the only form of arthritis for which an accessible and cheap ‘cure’ is widely available and yet urate lowering therapy (ULT) has the poorest medication adherence rates of any chronic disease, they argue.

The stigma and historical beliefs around the term gout mean that people with the condition are reluctant to seek medical help and mistakenly believe it is best treated by avoiding a poor diet, according to Professor Ric Day and Dr Matthew Coleshill of the University of NSW.

And with current educational efforts to improve uptake and up-titration of ULT in gout proving disappointing, they say the best way forward may be a complete ‘rebranding’ of the condition with a more scientific name to change perceptions of both patients and practitioners of what causes the disease and how it should best be treated.

“Recent research suggests that when gout is referred to as ‘urate crystal arthritis’  … the perception of the disease by members of the public was more accurate. It was viewed as being less under personal control (i.e. less appropriately managed by behaviours such as dietary intake), and more appropriately managed by long-term medical treatment,” they write in a paper published in Therapeutic Innovation & Regulatory Science.

Being explicitly labelled as arthritis would also encourage practitioners to think of gout as a chronic arthritic disease with a genetic basis rather than a lifestyle disease, and treat it according to evidence-based ‘treat to target’ protocols, they say.

“Coupled with an educational campaign drawing prescribers’ attention to guidelines alongside a name change, this rebranding may then benefit those living with the disease by increasing engagement with medical care and ultimately uptake of, and adherence to, guideline-recommended treatment. In this manner, changing the name of gout represents a novel method by which prescription and use of ULT may be improved,” they write.

“Certainly, with a greater emphasis on long-term medication as the appropriate means of treatment, this persistent and pernicious, yet eminently manageable, disease might finally be controlled,” they add.

A name change would be a major undertaking for a medical condition that has been known as gout for centuries, they concede, but there are recent precedents such as changing names with stigma such as primary biliary cirrhosis to cholangitis and schizophrenia to ‘integration disorder’.

“Even if completely removing the use of the name gout is not feasible, a movement towards this goal by emphasising gout as a form of arthritis through educational material and during diagnosis may still be a beneficial and more feasible outcome to change illness perceptions in gout for the better,” they conclude.

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