Why Gout Patients Need GoutPal#1 – Doctor Dispute

Gout Doctor Dispute is my first in an occasional series explaining why gout patients need GoutPal. So, in this article, I explain how rheumatologists and physicians disagree about gout treatment. Then I explain how GoutPal can guide you through this dispute towards full Gout Recovery.

Gout Doctor Dispute Audience

I wrote Gout Doctor Dispute for gout patients who want to improve the relationship with their doctor. Because I know from my forum that many gout patients disagree with, or misunderstand, their doctor’s advice about gout. So, my initial review of new professional guidance should create a better platform for doctors and gout patients to work together.

Gout Doctor Dispute

Regular GoutPal readers are aware of my joy when rheumatologists produced clear guidelines for doctors in 2012. But, I’ve become increasingly disturbed by the lack of change. Because my forums continue to be busy with gout patients suffering as much from 20th-century doctoring as they suffer from gout.

Then, in 2016, the reasons for the lack of progress in front-line gout management became clear. Because American College of Physicians (ACP) published a guideline that went against the advice of American College of Rheumatology (ACR). Also, it conflicts with other major international gout guidelines.

Last week, a new group published an expert review of current professional guidelines[1]. So, I hope to do an in-depth layman’s guide to that soon. But, I am keen to offer confused gout patients a clear way forward now. Because I’m uncertain how long it will take for:

  1. Results from clinical trials to resolve the dispute.
  2. The possible new agreement to filter down to front-line gout doctors.

Yet, when it finally arrives, will an agreement between professionals actually help people that matter? Will gout patients get the right treatment? Because we know that gout patients need a package of gout care[2]. Importantly, that package must educate patients so they understand their gout treatment program enough to stick with it. But medical advice is famously hard to understand. So, I believe you need GoutPal to be able to ask the right questions and understand your doctor’s answers.

Gout Doctor Dispute Made Clear

To explain, let’s look at this latest review. Because it is encouraging to see a diagram showing why the gout doctor dispute is so important.

Treat to Safe Uric Acid vs Treat to Avoid Gout Symptoms

In the report, the original caption for this diagram reads:

Figure 1: Schematic comparison of expected clinical-pathologic outcomes of gout from guidelines for the management of gout.

So, I think my 11-word caption, compared to the original caption, shows the real reason why you need GoutPal. Because I explain gout facts for ordinary gout sufferers. Then you can learn what treatment is right for you. Before you demand the best treatment for full gout recovery.

Next, let’s look at the explanations in the diagram. Because we start with the situation of “Articular urate crystal deposition in gout”. Which means “Uric acid crystals in gouty joints”. So, as part of the background to gout (not part of this report), we know that we have to get rid of those uric acid crystals to stop gout pain returning.

Comparing Gout Doctor Dispute Aims

For each set of arguments, I will try to explain the statements in layman’s terms.

Rhuematologists View

Ultimate resolution of gouty arthritis symptoms.
Permanently stop gout pain returning.
Intermitent anti-inflammatory treatment for acute flare.
Stop gout pain as required.
Limited-term anti-inflammatory flare suppression.
Prevent gout pain until uric acid is under control.
Long-term ‘treat to target’ ULT to lower serum urate level and steadily reduce articular and periarticular urate crystal deposits.
Get uric acid levels safe to reduce uric acid crystals in and around joints.
Prevention of joint damage.
Prevent joint damage.
Rheumatologist End Result: Dissolution of urate crystals.
Gout Recovery.

Physicians View

Intermitent anti-inflammatory treatment for acute flare.
Stop gout pain as required.
‘Treat to avoid symptoms’
Stop patient moaning but make sure they keep coming back.
No clear recommendations for ULT, serum urate target, serum urate monitoring or ULT duration.
Er, let’s wait and see.
No clear objective to reduce articular and periarticular urate crystal deposits or prevent joint damage.
I know a surgeon who is short of work.
Physician End Result: Chronic synovitis and joint damage.
Gout Victim.

Dealing with Your Gout Doctor Dispute

In conclusion, you now understand that rheumatologists and physicians have had different views about gout treatment. But new recommendations are in the pipeline which should make treatment clearer in future. However, there is no need to wait for new guidelines. Because GoutPal can help you work with your doctor now. Also, in future, you get better gout treatment when you can discuss your progress with someone who understands gout.

So, start using the GoutPal forums today.


Gout Doctor Dispute References

  1. Dalbeth, Nicola, et al. “Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN).” Nature reviews. Rheumatology (2017). GoutPal Members might download from Gout Doctor Dispute PDF.
  2. Taylor, Keith C. “Managing gout needs more than drugs.” GoutPal Gout Facts (Resources) June 2017.

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