An often-misunderstood condition, gout is the topic for this month’s Spotlight on our eLearning platform. We speak to Prof Ed Roddy of Keele University and the Midlands Partnership NHS Foundation Trust about some of the challenges with gout, and what to look out for.
Tell us about your training.
I qualified from Nottingham in the late 1990s and did my SpR training in the East Midlands. I saw lots of patients with gout referred from GPs and inpatient referrals. It was a case of being in the right place at the right time, because when I approached Prof Mike Doherty in Nottingham about what research opportunities might be available, he was looking for somebody to do a project on gout and it went from there.
It's a fascinating condition. There’s a strong historical legacy which still influences people's experiences today. It’s a complex disorder and we know that management is particularly difficult in people with comorbidities. However, applying our well-developed understanding of the pathophysiology of both hyperuricaemia and gout makes treatment decisions easier.
What are some of the biggest challenges in gout?
Gout is a victim of its own image and historical legacy. Many still think it’s a self-inflicted condition that people bring upon themselves by what they eat and drink. Really, we know that for many people with gout, comorbidities, medications and genetics are more important. Often the focus is on anti-inflammatory treatment of flares rather than long-term ‘curative’ urate-lowering therapy to facilitate crystal dissolution.
There needs to be a shift in narrative where we no longer think of gout as an acute, episodic inflammatory condition. We should view it instead as a complex chronic metabolic disease and monosodium urate crystal deposition disorder. That way we can ensure that all people with gout are made aware of the benefits of definitive treat-to-target urate-lowering therapy.
What’s new in gout?
For the wider management of gout, it’s trying to improve suboptimal management and steer away from an overemphasis on lifestyle modification and towards earlier drug treatments.
Prof Mike Doherty published a trial (external link) which investigated nurse-led treat-to-target. It’s a key piece of evidence for demonstrating how people with gout can be managed in primary care. It looked at nurse-led treatment versus GP-led care; over 90% of participants in the nurse-led treatment group achieved a serum urate level below 360µmol/\L.
NICE is releasing a new guideline on the diagnosis and management of gout in June this year, an exciting development which will help clinicians manage the condition.
What’s your role working with BSR's guideline group?
I've been involved in quite a few guidelines over the years. My first experience of BSR guideline development was as a member and then lead of the BSR gout guideline, which launched in 2017.
After that, I joined the Standards, Audit and Guidelines working group as a member and I’m now deputy chair. It’s been good to extend my involvement in guideline development across the whole breadth of rheumatology practice. For individuals, it's an important and valuable way to contribute to the work of BSR and to guide and facilitate best practice in rheumatology across the UK.
Many thanks to Prof Roddy for sharing his expertise. Log onto our eLearning platform to improve your skills and knowledge on gout. There is a webinar on gout and pseudogout delivered by Prof Roddy, a podcast about improving inpatient management, links to articles and guidelines, as well as an eLearning case to test your knowledge.