Treating Gout as a Systemic and Emotional Disease, with Peter Hennis, NP

In this episode of the Managing Uncontrolled Gout series, Peter Hennis, NP—an accredited nurse practitioner through the American College of Rheumatology at Summit Rheumatology—presents a nuanced and pragmatic approach to gout management. He integrates pathophysiology, lifestyle assessment, and mental health awareness to support patient adherence and optimize outcomes.

Hennis begins by reframing uric acid as a dual-natured molecule. While it contributes to antioxidant capacity and neuroprotection, its pathological role emerges when serum levels exceed solubility thresholds, promoting monosodium urate crystal deposition—particularly in distal joints where cooler temperatures favor crystallization. He stresses that elevated uric acid is not solely diet-driven. In many patients, genetic predisposition and impaired renal clearance are the primary contributors, with diet and lifestyle serving as modifiers rather than root causes.

Addressing dietary influence, Hennis acknowledges that traditional high-purine foods—red meat, shellfish, alcohol (particularly beer), and high-fructose corn syrup—can exacerbate hyperuricemia. However, he cautions clinicians against overly restrictive dietary protocols that may lead to disengagement. Instead, he promotes an individualized, sustainable nutritional plan that considers patient-specific triggers, encourages hydration, and maintains metabolic health.

Crucially, Hennis draws attention to the mental health burden of recurrent flares, reduced mobility, and social stigma. He urges clinicians to recognize the emotional and psychological distress often associated with chronic gout and to incorporate psychosocial support and patient education into routine care. He also advocates for the expanded use of dual-energy CT imaging in complex cases to detect crystal burden and guide treatment.

Hennis concludes by reinforcing a treat-to-target approach, aiming for serum uric acid levels below 6 mg/dL and emphasizing that remission is achievable. Through consistent monitoring, patient engagement, and appropriate urate-lowering therapy, clinicians can help patients regain functionality, reduce flare frequency, and improve overall quality of life.