Patient perspectives are important and were found to be valuable to the development of the 2020 American College of Rheumatology (ACR) gout treatment guideline, according to an analysis published in ACR Open Rheumatology.
During the development of the ACR gout treatment guideline, a patient panel was included with individuals with varying degrees of disease severity to provide key insights into different clinical scenarios for which gout management was frequently debated among primary care physicians (PCPs) and rheumatologists.
Study authors sought to understand patient perspectives and values to inform the voting process for the 2020 ACR gout treatment guideline.
The current patient panel discussion intended to inform the voting process for the 2020 ACR gout treatment guideline included patients with gout from Birmingham, Alabama. Mild gout was defined as no gout flares in the last year, 1 occasional disease flare in the last 5 years, serum urate levels under control, and mild or no impairment in quality of life (QOL) and functional ability; moderate gout was defined as 1 gout flare in the previous year, elevated serum urate levels, and moderate impairment in QOL and functional ability; and severe gout was defined as 2 or more gout flares in the last year, very high serum urate levels, multiple visible tophi, and severe impairment in QOL and functional ability.
A total of 8 participants were referred to the study by private and academic rheumatologists in the Birmingham area, and received orientation related to the guideline development process and evidence rating at the start of the meeting. With the assistance of a physician moderator, the patient panel reviewed 9 key clinical scenarios and the supporting evidence for each, and discussed their views and perspectives related to all of them. In addition, participants offered their preference for 1 of the 2 treatment options provided for each of the clinical scenarios.
All 8 participants were men with gout, of whom 7 received gout care from a rheumatologist and 1 from a primary care physician. Overall, the panel preferred more active management of gout, favoring a treat-to-target strategy (regardless of increased laboratory testing and/or healthcare provider visits), the use of pegloticase in patients with severe manifestations of their disease, and joint injections over oral medications for the treatment of gout flares. Further, the patient panel also preferred the use of earlier urate-lowering therapy (ULT), both by the initiation of ULT in patients with mild or earlier disease and during a gout flare.
Study limitations included time constraints because of which all clinical scenarios could not be assessed, the single-center design with a small sample size, and the lack of adequate representation, in terms of race/ethnicity and those from private vs academic rheumatology offices, of all patients with gout.
Study authors concluded, “In the absence of high- or moderate-quality evidence, or when there is a balance between benefits and risks, patient values and preferences become very important in making shared treatment decisions.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Singh JA, Neogi T, FitzGerald JD. Perspectives on gout and gout treatments: a patient panel discussion that informed the 2020 American College of Rheumatology treatment guideline. ACR Open Rheumatol. Published online November 22, 2020. doi:10.1002/acr2.11199