John Botson, MD: Gout Should be Treated as a Lifelong Disease

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Dr. John Botson explains that gout is not a patient problem, it's a disease problem, and it needs to be approached as a lifelong rheumatic disease as opposed to an episodic one.

The combination therapy pegloticase (Krystexxa) plus methotrexate (MTX) was approved earlier this month for patients with uncontrolled gout. One of the lead investigators on the phase 4 MIRROR study that supported the US Food and Drug Administration (FDA) approval spoke with HCPLive about the impact of this decision and how it can improve care for this patient population.

"This was a big step," John Botson, MD, RPh, said in the interview. "I'll be honest, this was one of the big steps for a medicine that really was forgotten about when it when it first came out because of the concerns about side effects. And, so now that we have a way to make the medication not only more efficacious, but also safer, I think the next step is looking at the patient experience."

In addition to conducting research, Botson treats patients and serves as the Director of Rheumatology at Orthopedic Physicians Alaska. He emphasized that gout is not a patient problem, it's a disease problem, and the biases associated with the disease can inhibit patients from receiving the best treatment.

"We all fall into this stereotype that these patients are the reason that they have gout, 'it's because the patient has a bad diet, because they drink too much, because they don't take care of themselves,' and really, the more we learn about gout, we've learned that this is a genetic problem," he said. "It's probably been passed down from your parents much like high cholesterol or high blood pressure."

With a rheumatic disease, the treating physician and the patient have to approach it as a chronic condition that likely calls for lifelong treatment. However, Botson explained that historically gout has been treated as an episodic disease.

"We really are trying to change this perception," he said. "It's been treated as a disease where the person has a sore toe and they come in, and they get their medications for that day to get through the episode. But then 6 weeks later, they have another episode. And in between that 6 weeks, they don't think about gout at all. They don't think about treating it, they don't think about having any pain until the next episode happens."

There are patients, like those who participated in the clinical trial, who have more advanced cases where they experience gout flares on a daily basis and end up living with a flare more often than without.

"It really becomes a life changing event, and so that's the difference in what we're trying to get across: these patients need to be treated as if they have a rheumatic disease that is lifelong," Botson said. "So, you might be able to treat that flare, but it's a lot better to treat the disease so that those flares don't happen."

Watch the rest of HCPLive's interview with John Botson.