Patient Perspectives on Gout and Gout Treatments: A Patient Panel Discussion That Informed the 2020 American College of Rheumatology Treatment Guideline

Objective: The objective of this study was to understand patient perspectives to inform the voting process for the 2020 American College of Rheumatology (ACR) gout treatment guideline.

Methods: We conducted a panel meeting of eight patients with gout in Birmingham, Alabama. Patients were referred to the project by private and academic rheumatologists in the Birmingham area. All participants received orientation related to the guideline development process and evidence rating at the beginning of the meeting. With the help of a physician moderator, the patient panel reviewed nine key clinical scenarios and the supporting evidence and discussed their views and perspectives related to each. They also provided their preference for one of the two treatment options for each clinical scenario.

Results: The patient panel included eight men with gout. Of these eight participants, seven received their gout care from a rheumatologist and one from a primary care physician. Patients favored more active urate-lowering therapy (ULT) management and interventional management of gout flares to achieve desired clinical outcomes, resulting in unanimous consensus on choices related to six clinical scenarios: ULT initiation in gout, treat-to-target management strategy, use of pegloticase for refractory gout, starting ULT during a gout flare, using injectable treatments (over oral) for acute gout flares, and use of febuxostat in people with cardiovascular disease.

Conclusion: Knowledge of patient preferences and values is valuable and was influential for the development of the 2020 ACR gout treatment guideline.