Jeff Peterson, MD, on Reframing Gout as a Chronic Disease

Jeff Peterson, MD, a rheumatologist at Western Washington Medical Group, challenges persistent misconceptions about gout management, particularly among non-specialists. He emphasizes that the central barrier to optimal outcomes is not a lack of effective therapies but the under-recognition of gout as a chronic, progressive disease requiring long-term urate-lowering strategies.

Peterson notes that many primary care providers still approach gout as an episodic inflammatory condition, managing it primarily with short-term flare treatments rather than implementing guideline-based, lifelong urate-lowering therapy. This practice gap results in inadequate control and prevents patients from achieving remission.

Importantly, Peterson discusses clinical variability in serum uric acid levels, noting that flares can still occur in patients with normal lab values. This can mislead providers and delay proper diagnosis or treatment intensification. He points to evolving research investigating mechanisms such as reduced joint lubrication and microcrystal formation that may help explain this discrepancy.

Looking ahead, Peterson outlines promising developments in pharmacotherapy, including two novel agents—one oral and one intravenous—currently in the pipeline. One candidate shows potential to improve renal urate clearance, offering a new alternative for patients who cannot tolerate or do not respond to standard xanthine oxidase inhibitors.

Peterson and his research partner, John Botson, MD, have also been investigating the prophylactic use of IL-1 blockade prior to initiating urate-lowering therapy. Their clinical trial demonstrated that this approach reduced flare incidence from 70% to zero in the study cohort. While the medication is not yet US Food and Drug Administration (FDA) approved for this indication, the data were recently presented at a European rheumatology conference and suggest significant implications for future treatment protocols.

Peterson closes by urging clinicians to debunk myths about diet being the primary driver of gout. He reinforces that the condition is genetically and metabolically driven and is highly manageable with pharmacologic intervention. He recommends CreakyJoints, the Gout Education Society, and the Arthritis Foundation as trusted sources of patient education and engagement.