Gout patients suffering in silence

The results of a 14 country pan-European survey presented at the Annual European Congress of Rheumatology (EULAR 2019) suggest gout is being diagnosed late, is not well controlled, and is not regularly monitored.

The survey included 1,100 patients with gout and found a quarter were not diagnosed until they had four or more flares. Furthermore, over 70 per cent had flares in the last year (a third of these had more than three). Less than half are monitored for serum uric acid two or more times a year and 59 per cent do not have regular follow up appointments. Despite this, eight-out-of-10 patients claim they are satisfied with their current treatment and do not expect better management of their disease.

“Our results demonstrate that, across Europe, gout has a significant impact on the lives of patients and their families. Although it is easily treatable, there are significant gaps in the current management of gout,” said Dr Marc de Meulemeester, GP with a special interest in gout, Belgium. “This should be a call to action to educate patients and their doctors about adequate management of gout.”

Results suggest that mainly GPs versus rheumatologists are involved in the diagnosis of the disease (73 per cent vs 8 per cent), discussion of gout (68 per cent vs 15 per cent), and treatment of the last gout flare (59 per cent vs 11 per cent). Over three-quarters of the patients suffered from co-morbidities such as high blood pressure (52 per cent), high cholesterol (41 per cent), and type 2 diabetes (23 per cent). Regarding treatment, 58 per cent receive uric acid lowering therapies, 43 per cent painkillers, 25 per cent colchicine, 13 per cent non-medical pain relief and 12 per cent corticosteroids.

“Gout is a disabling condition with increasing incidence across Europe,” said Prof John D Isaacs, Chairperson of the Abstract Selection Committee, EULAR. “It is very disappointing to see that, despite effective treatments, gout is being sub-optimally managed, and patients are suffering as a result. The findings of this survey support the high unmet need of gout patients as described in the EULAR RheumaMap. Strategies need to be developed to improve the care of people with gout.”

Meanwhile, a separate study on gout presented at EULAR 2019 showed that occupational exposure to inorganic dust (such as asbestos, silica and coal) is a previously unknown risk factor for gout and also confirmed known risk factors, such as alcoholism and obesity. Occupational exposure of inorganic dust has already been linked to an increased occurrence of other inflammatory rheumatic diseases such as rheumatoid arthritis but this was the first study to look at a potential link with gout.

The study included 6,120 cases who were diagnosed with gout between 2006 and 2012 (with no additional gout diagnoses during the previous six years) from the population-based healthcare database of the Western Swedish Health Care Region. Initial analysis demonstrated a significant association between gout and occupational exposure to inorganic dust in all patients (odds ratio: 1.10, 95% CI: 1.04-1.17).

Nearly 5,000 abstracts were submitted to the EULAR Congress in 2019 alone, with over 14,000 delegates from across Europe and beyond attending over the three days, to discuss the latest in rheumatology, including paediatric rheumatology through joint participation of the Paediatric Rheumatology European Society (PReS)