Gout, the most common form of inflammatory arthritis, can wreak havoc on the body. The good news? It’s easily managed with the right help. Whether you’ve been recently diagnosed, care for someone suffering, or are a medical professional treating the disease, the Kicking Gout in the Acid podcast can help you learn more.
In this episode of Kicking Gout in the Acid, Dr. Larry Edwards is joined by Gout Education Society International Advisory Council member Dr. Jasvinder Singh, rheumatologist at Baylor College of Medicine. The two discuss the socioeconomic impact of gout and barriers to proper treatment to showcase how the disease affects more than just the body.
Key Takeaways:
Gout comes with a variety of indirect costs (work absenteeism and loss of productivity) and direct costs (doctor visits, medications, and lab tests) that are often unseen by those with the disease.
Early and ongoing management of the disease is vital to reducing the economic burden on patients.
A lack of rheumatologists in the United States puts additional pressure on primary care physicians to manage the disease early; however, delayed referrals to rheumatologists can negatively impact patient outcomes.
While new, there is potential for new therapies and management strategies. The current priority for gout management lies in addressing adherence issues for patients and knowledge gaps for medical professionals.
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Educational Materials:
Gout Patient Brochure
Medical Professional Guide
Kicking Gout in the Acid is sponsored by Sobi.
Podcast Transcript
Ian PonitzHello, and welcome to Kicking Gout In The Acid, a podcast from the Gout Education Society. My name is Ian Ponitz, and I'm your host for this series. Kicking Gout In The Acid features conversations between Dr. Larry Edwards, chairman and CEO of the Gout Education Society, and experts on the disease.
Each episode will dive into important topics that you, the listener, should know about gout. The goal? To feel empowered to get gout under control.
In this episode, Dr. Edwards will be joined by Dr. Jasvinder Singh, rheumatologist from Baylor College of Medicine, to look at the socioeconomic impact of gout, barriers to treatment, and the importance of educating both those with the disease and those involved with its treatment. Dr. Edwards, take it from here.Dr. Larry EdwardsThanks, Ian. Now, I'm joined today by Gout Education Society international advisory council member Dr. Jasvinder Singh. Jas, would you be able to tell the listeners just what your interest in gout has been over the years and what your current role is with Baylor University in Houston?Dr. Jasvinder SinghThanks, Larry, for the invitation, and thanks to the Gout Education Society for having this conversation. I am a rheumatologist here at Baylor College of Medicine and a staff physician at the Michael E. DeBakey VA Medical Center. I've been interested in gout as a condition since the beginning of my career as a rheumatologist.
I got drawn to this disease after my fellowship completion as a staff physician at the Minneapolis VA Medical Center, where the majority of our inpatient consults tended to be either sick people with vasculitis and lupus or people with gout flares and concomitant septic arthritis in gout or a question of gout or management of gout.
So, I clearly sensed that there was a big need for understanding this disease and controlling it better, and I got drawn into research as I saw other people in the field who were very passionate about this research, including Ralph Schumacher, Michael Decker, and obviously you as well, Larry, through my connections to all three of you through the Omri.
So, I still feel like there's a lot to be done in this field, and I continue to enjoy working in this disease, disease mechanisms, and treatment, and still find it very exciting and an important area to continue to work in, both as a clinician and as a researcher.
Dr. Larry EdwardsThanks, Jas. We're delighted to have you with us today. In our previous three podcasts that we've done for the Gout Education Society, we focused on how gout affects a person's health and happiness.
For this episode, I'd like us to focus instead on how gout may affect a person's wallet, and in that regard, look at the costs of gout, the direct costs as far as doctor's visits, laboratory testing, hospital visits, medications, and the indirect costs as far as being absent from work. Then, I think we could discuss a little bit on whether or not early management, treatment, and recognition of gout could reduce some of these economic burdens for patients who have gout.
Can you tell us a little bit about these direct costs and indirect costs?
Dr. Jasvinder SinghYeah. So Larry, I think that is really a very important aspect of gout management. The direct cost obviously hits the patient right in the pocket and makes it challenging for patients to take good care of the condition. And there are humongous amounts of indirect costs in gout, primarily because it's not recognized as a serious disease or a chronic disease. And many times, patients and sometimes even providers in the initial few years of gout think of it as separate acute attacks by years and not requiring treatment. And that's what leads to a significant impact on work productivity, days of work lost. People might have challenges keeping their jobs because of recurrent attacks and not being able to show up at work.
It has impacts on their social lives in addition to having direct effects on productivity, and that's what leads to a lot of indirect costs of gout. The reason we have humongous amount of indirect costs from gout is related to not only the fact that gout is the most common inflammatory arthritis in adults, but also that it may not get the same respect and attention that something similar to it, like rheumatoid arthritis, gets in terms of the need to treat the target and manage it and keep it under control.
Keeping gout under control obviously will lead to fewer flares and less effect on quality of life, less pain, better function, but also better productivity and fewer days of work loss in absenteeism and decreased presenteeism, both at work and for people at home who are running and taking care of their families.
We are also aware of a lot of research that has already shown us that people who have gout with frequent flares tend to accumulate both a higher direct cost out of pocket, as well as higher indirect costs due to all of these downstream effects. Better management, potentially, to treat the target, an approach where you have a goal for the patient to get their disease treated and kept under control, has the potential to decrease not only the humongous indirect cost, but also the direct cost of this. Some of this comes from expensive urgent care, emergency room, inpatient visits, and hospitalizations, a majority of which can be avoided and lead to not only cost savings, but also better outcomes for the patient and less resource utilization overall.
Dr. Larry EdwardsSure. A lot of this stems from what you mentioned earlier, that the disease itself. Gout, although it's excruciatingly painful and a major disease to those that have it, a lot of times healthcare providers view it as not as important as the other comorbid conditions like blood pressure, kidney disease, and heart disease that these patients may also have.
I think getting focused early on and making it imperative that, not only do we have a firm diagnosis that what the patient's complaining about is gout, but also that they have a care provider that understands the importance of treating this, not just to eliminate the flares, but also to help control the other comorbid problems like the diabetes and blood pressure as well. Yeah, I think that's the case. If we could treat everybody early, then this would be a rather inexpensive disease to have cured, but it's unfortunately not that way.
Let's turn from those costs and talk about the barriers to treatment access and the role this plays in the overall socioeconomic impact of gout. We know that the overwhelming percentage of gout patients are initially seen and cared for by primary care physicians, like GPs, family medicine internists, and ER physicians, especially in the early stages of gout. Patients who have more advanced disease or those who don't respond well to initial therapies for the gout are frequently referred to arthritis specialists or rheumatologists.
How are the economics of gout affected by this referral pattern?
Dr. Jasvinder SinghI think that, as you correctly stated, the majority of gout is cared for by primary care physicians and only those that they think are not optimally controlled are referred to rheumatologists. But this does reflect the harsh reality, which is that there's a lack of a big army of rheumatologists available in the United States, at least. There's a shortage of rheumatologists, and, therefore, access to rheumatology care is somewhat limited in many parts of the country. Even in parts of the country where you have a lot of rheumatologists, such as in big cities, they have long wait times. Primary care providers frequently refer all of their rheumatoid arthritis patients and lupus patients to rheumatologists, but not every gout patient.
I think one of the other issues that surprises you and me a lot is that we don't have lots of folks focused on gout. A lot of rheumatologists are focused on gout. Obviously, this is something that is a passion for you, me, and several of us, that a lot of rheumatologists sometimes may be interested in autoimmune diseas
