Gout patients unsure what their level of uric acid should be, study suggests
A study published recently in Arthritis Care and Research, has shed light on why gout is not always well managed by people suffering from the condition.
Gout, a painful and common form of arthritis, results from a build-up of uric acid in the body, which causes an intense inflammation that affects the big toe, ankles, feet, knees and many other joints. Patients are often prescribed drugs to reduce the amount of uric acid in the body to reduce the risk of an attack of gout. However, researchers have found that many people do not know what their target uric acid level should be.
Researchers at the University of Nebraska Medical Center and at the VA Nebraska-Western Iowa Health Care System in Omaha, US, found that only 14% of gout patients know the numerical treatment goal for the medication they are on.
Patients in the study had been prescribed allopurinol, a xanthine oxidase inhibitor, which keeps gout under control by reducing painful flare-ups and maintaining a certain level or uric acid in the body.
In America, it’s estimated that over 4% of the population are affected by gout and about 10% of men over the age of 60. The disease is said to be more common in women after menopause.
Lead researcher, Dr Ted Mikuls, Prof of Rheumatology in the UNMC Department of Internal Medicine Division of Rheumatology, says, “We found that there’s a real gap in patients’ understanding of our treatment goal in gout. 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.”
Dr Mikuls suggests that while it is very well understood that there are targets for uric acid that should be reached to treat people effectively, and that doctors probably know that goal, it is not being clearly communicated in a way that patients can easily recall. “If patients don’t know the goal of therapy, it’s very hard for patients to be engaged in their care,” he says.
For long-term treatment to avoid future attacks, Dr Mikuls says 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 says.
Dr Mikuls and his team of researchers hope the study will stimulate conversation between doctors and patients to improve the quality of care of gout patients.
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