Background Gout is an inflammatory condition caused by chronic hyperuricemia, often causing physical and emotional distress and a lower quality of life (QOL).1-3 Gout stigma is common and impactful,4 with physicians often perceiving gout as a “lifestyle” disease caused by personal dietary and exercise choices. Further, patients can internalize and anticipate this stigma, influencing how they seek healthcare and adhere to medical therapies.5
Objectives This study investigated whether or not a gout stigma exists among rheumatologists and, if so, how it influences physicians’ perceptions of patients and treatment decisions. Rheumatoid arthritis (RA) was used as a comparator disease.
Methods 106 practicing rheumatologists completed an online survey regarding perceptions of, experiences with, and recommendations for patients with controlled gout, uncontrolled gout, and rheumatoid arthritis (RA). Disease states were presented in random order. Each set of measures examined rheumatologists’ perceptions and judgments of each disease condition on a range of dimensions, including (a) perceptions of patient’s compliance with treatment recommendations and responsibility for their disease condition, (b) causal attributions for contributing factors to disease condition, and (c) efficacy of recommended treatment decisions. Answers were provided using a 7-point Likert scale (e.g., patient compliance: 1 = will not comply, 7 = will comply; patient responsibility for condition: 1 = not responsible, 7 = responsible). Prior to analyses, all responses were converted to a 0 to 1 scale for ease of comparison and interpretation.
Results Responses regarding controlled and uncontrolled gout patients were not significantly different, so these two groups were pooled. Compared to patients with RA, rheumatologists perceived patients with gout as significantly more responsible for their disease (p<0.05) and significantly less likely to comply with prescribed treatment regimens (p<0.05, Figure 1). Further, rheumatologists perceived patient personal behavior, diet, BMI, and patient adherence as greater contributing factors to gout than to RA (all p<0.01). Similarly, change in diet, increased exercise, and weight loss were perceived as more beneficial for managing gout than RA (all p<0.01), and biological treatments were perceived as more effective for managing RA than gout (p<0.01).
Conclusion Despite good intentions when treating gout patients, rheumatologists appear to have causal beliefs and illness perceptions that reflect negative gout-related stereotypes. Compared to RA patients, gout patients were perceived as being more responsible for their condition and were expected to be less compliant with medications and less likely to benefit from biological therapies. Interestingly, there were no differences in rheumatologists’ judgments between patients with controlled and uncontrolled gout, suggesting that their beliefs may refer to gout itself rather than the degree of control or management. Educating physicians, particularly rheumatologists, on the myths surrounding gout may improve clinical care and, therefore, patient outcomes.
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Acknowledgements Medical writing support was provided by Lissa Padnick-Silver, PhD, an employee of and stockholder in Horizon.
Disclosure of Interests N. Lawrence Edwards Consultant of: Horizon Therapeutics, Astra Zeneca, and Selecta Biosciences, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Adam Magerman: None declared, Jeffrey Hunger: None declared, Joseph Vitriol: None declared
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