Brian LaMoreaux, MD, MS: Expanding on Gout Management

In recent years, the rise of gout has been particularly concerning for both patients and health care professionals alike. While treatments do exist, many people who suffer from gout and gout flares do not know how to properly treat this form of arthritis.

Additionally, the stigma surrounding gout has contributed to the general unease patients have about their condition.

In an interview with HCPLive, Brian LaMoreaux, MD, MS, Medical Director of Medical Affairs at Horizon Therapeutics, spoke about gout, gout management, transparency between doctors and patients, and the importance of involving the appropriate medical professionals in the management of gout.

“Gout is preferably managed, like many things on an outpatient basis, (by) either your primary care doctor or your specialist,” LaMoreaux said. “Often, a rheumatologist is going to be following up with these patients and giving them medicines not just to prevent flares, but also importantly, to lower their uric acid level.”

When patients do not manage their uric acid levels, more gout crystals are deposited in the body. This results in gout flares, as well as possible admissions to the emergency room.

LaMoreaux believed that gout management was built upon two “pillars”, one of which is anti-inflammatory methods. Non-steroidal, anti-inflammatory drugs such as colchicine, could be used to treat joint flaring in patients with gout. Steroids have also been considered.

“The other part, which is the more definitive long-term part is lowering that uric acid level in the blood, which makes these flare causing crystals go away over time,” LaMoreaux said. “So, you need both together, because the catch is that the medicines that lower uric acid, they can cause gout flares.”

LaMoreaux understood how this could be confusing for some patients. Some medicines may not be effective in treating an individual patient’s gout, which might leave the impression that none of their medicines work.

In order for patients to be exposed to the right medications, diets, and various other treatment methods, LaMoreaux believed that doctors must establish credibility and trust with their patients, and help fight the stigma surrounding the condition.

"This just starts with trust, like everything,” LaMoreaux said. “You need to establish that. If you keep in mind, gout patients often don't like talking about their gout. The media portrayal of gout is not kind, it's not accurate. It portrays it often as a humorous condition with reality is far from that."

He added that the stigma surrounding gout often deals with lifestyle decisions, being overweight, eating the wrong foods using too much alcohol, and considered the real contributors of gout to be family history, genetics, and your function.

“Those are the main things that are going to lead people to have gout flare, so the doctor needs to hopefully be aware of all those stigma and preconceptions and just check them (and) not let them come into the relationship at all with the patient. I often start by just saying ‘This is not your fault, I will help you take care of this’.”

Listen to Dr. LaMoreaux speak on a rheumatologist’s role in gout management, how medical professionals can help educate gout patients, and more in the video above.