Background/Purpose: Pegloticase is FDA-approved for uncontrolled gout and effectively lowers uric acid levels by conversion of circulating uric acid to allantoin, which is readily removed renally.1 One potential factor contributing to the hesitancy among rheumatologists in recommending pegloticase is the longstanding stigma associated with gout patients and perceptions of their ability or willingness to adhere to pharmacological treatments.3 Although rheumatologists may not explicitly endorse negative gout related stereotypes, it is possible that such stigma may unconsciously influence their perceptions of patients’ illness and treatment efficacy, attributions for contributing factors, and treatment decisions. Therefore, we investigated, among practicing rheumatologists, the existence of stigmas associated with gout (compared to rheumatoid arthritis), perceptions of patient behavior, and treatment decisions in these conditions.

Methods: A sample of 27 practicing rheumatologists participated in an online survey that evaluated their causal beliefs, illness perceptions, and treatment recommendations for patients with gout, uncontrolled gout (UG), and rheumatoid arthritis (RA). Questions also focused on rheumatologists’ perceptions of patient adherence in gout, UG, and RA, as well as the responsibility of patients’ for their condition. All participants completed questions with reference to gout, UG, and RA, which were blocked and presented in random order. This design allows for an assessment of how rheumatologists’ beliefs, perceptions, and recommendations vary across disease condition and its potential impact on treatment recommendations

Results: Mean-level (95% CI) responses across disease condition are represented in the Figure. Responses to questions about gout and UG did not differ significantly (p > 0.10). However, patients with gout/UG vs RA were perceived as significantly more responsible for their own disease condition and less likely to adhere to prescribed treatments (p < 0.05). Additionally, patient personal behavior, diet, BMI, and lack of treatment adherence were perceived as greater contributing factors to gout/UCG vs RA; p < 0.01. Similarly, change in diet, increased exercise, and weight loss was perceived as more beneficial to the management of gout/UG vs. RA; p < 0.01, whereas biological pharmacological treatment was perceived as more effective at managing RA vs. gout or UG; p < 0.01.

Conclusion: Despite advanced training and high knowledge of gout, rheumatologists’ causal beliefs and illness perceptions for patients with gout/UG compared to RA reflect negative gout related stereotypes, with implications for treatment recommendations. Patients with gout/UG vs. RA were perceived as more responsible for their own condition and less likely to adhere to or benefit from biological pharmacological treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-stigma-investigating-the-existence-of-gout-stigma-and-its-impact-on-patient-perceptions-and-treatment-decisions/