Gout is a form of arthritis that is largely characterized by its unpredictability. Some patients with gout will experience just one flare in a lifetime. Others, however, will regularly suffer from the severe pain and joint swelling that typically begins in the large toe but can also spread to or originate in patients’ feet, ankles, wrists, hands, and elbows. Untreated, gout can cause permanent joint damage.1 Additionally, a buildup of uric acid can also lead to gout-associated cardiac and kidney complications.
Fortunately, following a gout-friendly diet along with medications such as probenecid, sulfinpyrazone, and allopurinol can help prevent flares. And, even when flares occur, patients can effectively prevent joint damage or further disease progression and complications with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other medications and/or injections. Yet many patients with gout never seek treatment. Even patients who consult with physicians often fail to follow prescribed protocols and stop taking their medications or miss doses on a regular basis. As a result, gout flares are prevalent in the US patient population.
Given this fact, much of the ongoing research in gout is focused on improving patient adherence to treatment, as well as treatment protocols. In this article, we will profile the country’s top experts in gout treatment, as identified by the online Expertscape search tool, highlighting their current research focuses as well as their efforts to improve outcomes and quality of life for patients affected by gout.
Studying Patient Behavior to Improve Outcomes in Patients With Gout
Jasvinder Singh, MD, is Expertscape’s top-ranked gout specialist in the United States. Dr Singh is professor of medicine and epidemiology at the University of Alabama at Birmingham, director of the gout clinic at the University of Alabama Health Sciences Foundation, and staff rheumatologist at the Birmingham Veterans Affairs Medical Center.
Recently, Dr Singh spoke with Rheumatology Advisor about the current focus of his gout research. He explains, “I’m interested in health disparities with gout,” he mentioned, especially as a large portion of his patient base are underinsured or uninsured. To improve parity, he is focusing his research on factors that can affect patient outcomes. For the past 6 years, in his role co-leading the University of Alabama gout clinic, Dr Singh has “been interested in investigating patterns of medication use and laboratory monitoring with gout.”
Today, that interest has developed into a clinical study, the results of which Dr Singh expects to be published within a year. “At the VA, we’re exploring the effect of behavioral story-telling, to see if specific narratives can change patient behavior in taking their medications,” he says. For the purposes of his research, story-telling involves adherent patients sharing their positive results to offer encouragement to other patients, likely improving outcomes in the process.
Of course, this treatment approach isn’t entirely new; Dr Singh points out that story-telling has been effective at improving medication adherence in patients with blood pressure problems. Now, says Dr Singh, he hopes that gout story-telling (where patients share news of their successful outcomes) will prove similarly effective.
Building the Gout Clinical Resource Library
Hyon K. Choi, MD, takes a different approach to gout research. As director of clinical epidemiology at Massachusetts General Hospital in Boston, Dr Choi has worked to provide research-based evidence to support generally accepted methods of gout management.
With more than 200 publications, Dr Choi has secured research funding from the National Institutes of Health and the Rheumatology Research Foundation. To date, his key advancements include findings on the protective power of adding dairy, coffee, and vitamin C to the diets of patients with gout. He has also discovered the harmful impact of allowing patients with gout to consume sugar- and fructose-sweetened beverages and foods. He has identified the efficacy of adding the blood pressure medication losartan and calcium channel blockers to a gout treatment protocol, as well as the hazard of allowing patients with gout to take other classes of antihypertensive medications.
Keeping an Eye on Gout Prevention
Tuhina Neogi, MD, PhD, devotes much of her expertise in gout to researching specific risk factors. She is professor of medicine at Boston University School of Medicine, professor of epidemiology at Boston University School of Public Health, and chief of the rheumatology section at Boston University School of Medicine and Boston Medical Center.
Dr Neogi’s gout research focuses primarily on gout epidemiology; namely, risk factors and triggers for gout attacks. Her findings have helped inform gout treatment protocols, including the use of NSAIDs, as well as steroidal anti-inflammatory agents, in managing gout flares. In recognition of her research, Dr Neogi received the 2014 American College of Rheumatology Henry Kunkel Young Investigator Award for outstanding and promising independent contributions to rheumatology research.
Hopes for Improved Gout Care
Together, the top 3 experts in gout are advancing patient outcomes with 3 different approaches: improving patient adherence to treatment, testing helpful and harmful additions to gout treatment regimens, and identifying potential gout triggers. Thanks to their continued efforts, and their willingness to share their findings through published research, these clinicians are advancing the cause of improved care for gout patients. And their contributions to this effort rightfully earn them the top 3 spots in Expertscape’s ranking of gout specialists in the United States.
What is gout? Gout Education Society. https://gouteducation.org/what-is-gout/. Accessed August 25, 2020.