Q&A With Healio Rheumatology

'Gout Lies' campaign helps physicians target disease myths

Ingrid McPhilliamy

There is no shortage of myths and falsehoods regarding gout, and all of them can be easily found and absorbed by any patient with an internet connection. In addition, even well-intentioned, fact-based education may not include the latest research and data.

To help physicians develop better conversations with their patients with gout regarding their disease, dispel the myths and provide care based on the latest research, Horizon Therapeutics recently launched “Gout Lies,” a new information campaign aimed at reframing the dialogue around gout pain resolution and progression.

According to Ingrid McPhilliamy, MBA, BFA, vice president of marketing for rheumatology at Horizon Therapeutics, new research into the pathophysiology of gout during the past decade has redefined how the disease should be addressed. Through a series of expert videos, clinical data and visuals, Gout Lies calls attention to data suggesting that gout-related damage can continue even after the end of a flare. The campaign also illustrates how, according to data, tophi can be a clinical concern and not just a cosmetic issue.

“The fact is that when the pain goes away, the discussion goes away, and so does the urgency to treat gout,” McPhilliamy said. “Gout is one disease which gives us visible signs there is something wrong and an opportunity to increase the urgency at which conversations about the true impact occur.”

Healio Rheumatology spoke with McPhilliamy about the myths surrounding gout, as well as the Gout Lies campaign and how it can help physicians improve dialogues with patients with the disease.

Q: How has the nature of how researchers have viewed gout changed during the past decade?

McPhilliamy: Over the past decade the understanding of the pathophysiology of gout has shifted through research on how aggregated NETs (aggNETs) — essentially anti-inflammatory structures — can mask gout disease progression by resolving gout flares and pain without removing deposited urate in the body, as well as how tophi create an imbalance in the bone-remodeling process that can cause bone erosions.

Rethinking the nature of gout as a more chronic disease, and a damage-inducing disease, moved research to look beyond the activation of inflammation, which remains important, to understand how gout resolves, which had largely been elusive. In addition, although bone erosion is a known consequence of chronic gout, recent research improved the understanding of what was actually contributing to the joint damage so often seen in patients with long-standing, severe disease.

This last decade of research provides a deeper understanding and comprehensive view of the chronic, systemic nature of gout and the consequences of gout under-management.

Q: What are some of the most prominent myths or falsehoods about gout?

McPhilliamy: There are a number of misconceptions about gout, namely that damage only occurs during flares, and that tophi — urate deposits that look like lumps under the skin — are a cosmetic issue and not a clinical concern. The complex relationship between pain resolution and gout progression, given the mechanism that resolves acute pain, creates perhaps the most challenges for optimally managing the disease. Gout has been closely associated with the acute pain of a flare, which often delays conversations about the true impact of the disease because the pain has “resolved.”

We see this as an important educational opportunity to reset the dialogue about gout. Our goal is to draw attention to this misleading dynamic and ultimately help reduce any long-term consequences for those living with gout.

Q: How do these myths spread?

McPhilliamy: The myths about gout come from decades of conversation focused on the acute aspects of the disease, and a void of conversation around the pathophysiology of gout and its chronic, systemic nature. Gout has not been at the forefront of research and scientific conversations compared to other rheumatological diseases and we see the impact of these myths often perpetuated throughout the continuum of care, from primary care and even into rheumatology.

This is why Gout Lies was founded in the data and science of the past decade, and aims to provide a comprehensive, new look at the disease.

Q: How damaging are these ideas for patients with gout? What are the repercussions for people believing these myths?

McPhilliamy: The fact is that when the pain goes away, the discussion goes away and so does the urgency to treat gout. Gout is one disease which gives us visible signs there is something wrong and an opportunity to increase the urgency, at which conversations about the true impact occur.

This urgency is critical because in addition to bone erosion and joint damage, people with gout are more likely to have other serious health conditions, including hypertension, type 2 diabetes, chronic kidney disease and cardiovascular disease.

Moreover, research shows that a person who has had gout for less than 10 years has a twofold increased risk of death compared with the general population.

Q: How can physicians break through these myths and explain the facts regarding gout to patients?

McPhilliamy: The campaign images are intended to call greater attention to gout and start a conversation about the science behind what is going on. In addition, we have focused on resources that can help physicians show their patients the progression of gout that occurs even when the flare resolves which opens the door to a more frank and productive conversation about disease impact in a way patients can understand.

Q: What is the target audience for Gout Lies? Patients? Physicians? Both?

McPhilliamy: Gout Lies is focused on reaching rheumatologists. The myths are overtly incorrect statements intended to incite a second look because rheumatologists know these myths to be untrue. The goal is to question why it is out there and drive to key research, led by professors Nicola Dalbeth [MBChB, MD, FRACP, of the University of Auckland in New Zealand] and Georg Schett [MD, of the University of Erlangen-Nuremberg in Germany], which may not have been a focus of recent literature nor top of mind today.

Q: How can Gout Lies help physicians who care for patients with gout?

McPhilliamy: Our goal with this campaign is to advance the understanding of the complex relationship between pain resolution and gout progression. Gout Lies brings this latest research into the forefront and encourages rheumatologists to talk with their patients in a new way to uncover the true severity of the disease.

Many times, if they are not in an acute flare, patients won’t bring up the ongoing nature of their gout. This campaign urges physicians to ask new questions that help better open the dialogue with their patients and ultimately enable better outcomes.

Q: What went into the design of the visuals of the posters? What messages are they trying to get across?

McPhilliamy: Gout has been well documented as a disease for centuries, so to change the dialogue we knew the campaign needed to be thought-provoking and provocative. The visuals and statements overtly show the many ways gout can be deceptive and incite the viewer to stop and ask what more is behind this known myth.

The campaign drives physicians to the leading scientific research about gout and provides actionable insights through a series of expert videos and research overviews.

Q: Can you tell us more about the researchers involved?

McPhilliamy: Over the past year, we have worked closely with professors Schett and Dalbeth, two prominent researchers who are receiving a great deal of attention for their work in rheumatology — calling attention to how our collective understanding of gout has evolved.

They have led the way in examining aggNETs — the mechanisms behind gout-flare resolution, the formation of tophi and the consequences, such as bone erosion and joint damage — of gout. Their research has shown the need for deeper understanding about damage occurring the absence of a flare, and we wanted to bring this to life in a visual, thought-provoking way.

Georg Schett is professor of internal medicine and, since 2006, is head of the department of internal medicine, rheumatology and immunology at the University of Erlangen-Nuremberg in Germany. Nicola Dalbeth is a rheumatologist and professor at the University of Auckland, leading a clinical and laboratory program of research in gout.

Q: Where does the clinical data used by the campaign come from?

McPhilliamy: The data primarily comes from recent research published by professors Dalbeth and Schett in journals such as the Annals of the Rheumatic Diseases, Arthritis & Rheumatology, Rheumatology Disease Clinics of North America and RMD Open.

Q: How important is it to have a “data-driven” campaign regarding gout?

McPhilliamy: To change perceptions, we must be grounded in science and lead with the data. The expression of the information is thought-provoking and visual, but the drive behind it is data.

The research on the pathophysiology of gout is in a sense groundbreaking. It shows how the understanding of gout as a disease has evolved and provides a foundation for physicians to offer more precise management of the disease and ultimately enables better outcomes for patients. – by Jason Laday

For more information:

Ingrid McPhilliamy , MBA, BFA , can be reached at Horizon Therapeutics Lake Forest-U.S. Operations, 150 S. Saunders Road, Lake Forest, IL. 60045; tel: (224) 383-3000; email contact: aphraner@horizonpharma.com.

Disclosure: McPhilliamy reports being vice president of marketing for rheumatology at Horizon.

Ingrid McPhilliamy

There is no shortage of myths and falsehoods regarding gout, and all of them can be easily found and absorbed by any patient with an internet connection. In addition, even well-intentioned, fact-based education may not include the latest research and data.

To help physicians develop better conversations with their patients with gout regarding their disease, dispel the myths and provide care based on the latest research, Horizon Therapeutics recently launched “Gout Lies,” a new information campaign aimed at reframing the dialogue around gout pain resolution and progression.

According to Ingrid McPhilliamy, MBA, BFA, vice president of marketing for rheumatology at Horizon Therapeutics, new research into the pathophysiology of gout during the past decade has redefined how the disease should be addressed. Through a series of expert videos, clinical data and visuals, Gout Lies calls attention to data suggesting that gout-related damage can continue even after the end of a flare. The campaign also illustrates how, according to data, tophi can be a clinical concern and not just a cosmetic issue.

“The fact is that when the pain goes away, the discussion goes away, and so does the urgency to treat gout,” McPhilliamy said. “Gout is one disease which gives us visible signs there is something wrong and an opportunity to increase the urgency at which conversations about the true impact occur.”

Healio Rheumatology spoke with McPhilliamy about the myths surrounding gout, as well as the Gout Lies campaign and how it can help physicians improve dialogues with patients with the disease.

Q: How has the nature of how researchers have viewed gout changed during the past decade?

McPhilliamy: Over the past decade the understanding of the pathophysiology of gout has shifted through research on how aggregated NETs (aggNETs) — essentially anti-inflammatory structures — can mask gout disease progression by resolving gout flares and pain without removing deposited urate in the body, as well as how tophi create an imbalance in the bone-remodeling process that can cause bone erosions.

Rethinking the nature of gout as a more chronic disease, and a damage-inducing disease, moved research to look beyond the activation of inflammation, which remains important, to understand how gout resolves, which had largely been elusive. In addition, although bone erosion is a known consequence of chronic gout, recent research improved the understanding of what was actually contributing to the joint damage so often seen in patients with long-standing, severe disease.

PAGE BREAK

This last decade of research provides a deeper understanding and comprehensive view of the chronic, systemic nature of gout and the consequences of gout under-management.

Q: What are some of the most prominent myths or falsehoods about gout?

McPhilliamy: There are a number of misconceptions about gout, namely that damage only occurs during flares, and that tophi — urate deposits that look like lumps under the skin — are a cosmetic issue and not a clinical concern. The complex relationship between pain resolution and gout progression, given the mechanism that resolves acute pain, creates perhaps the most challenges for optimally managing the disease. Gout has been closely associated with the acute pain of a flare, which often delays conversations about the true impact of the disease because the pain has “resolved.”

We see this as an important educational opportunity to reset the dialogue about gout. Our goal is to draw attention to this misleading dynamic and ultimately help reduce any long-term consequences for those living with gout.

Q: How do these myths spread?

McPhilliamy: The myths about gout come from decades of conversation focused on the acute aspects of the disease, and a void of conversation around the pathophysiology of gout and its chronic, systemic nature. Gout has not been at the forefront of research and scientific conversations compared to other rheumatological diseases and we see the impact of these myths often perpetuated throughout the continuum of care, from primary care and even into rheumatology.

This is why Gout Lies was founded in the data and science of the past decade, and aims to provide a comprehensive, new look at the disease.

Q: How damaging are these ideas for patients with gout? What are the repercussions for people believing these myths?

McPhilliamy: The fact is that when the pain goes away, the discussion goes away and so does the urgency to treat gout. Gout is one disease which gives us visible signs there is something wrong and an opportunity to increase the urgency, at which conversations about the true impact occur.

This urgency is critical because in addition to bone erosion and joint damage, people with gout are more likely to have other serious health conditions, including hypertension, type 2 diabetes, chronic kidney disease and cardiovascular disease.

Moreover, research shows that a person who has had gout for less than 10 years has a twofold increased risk of death compared with the general population.

PAGE BREAK

Q: How can physicians break through these myths and explain the facts regarding gout to patients?

McPhilliamy: The campaign images are intended to call greater attention to gout and start a conversation about the science behind what is going on. In addition, we have focused on resources that can help physicians show their patients the progression of gout that occurs even when the flare resolves which opens the door to a more frank and productive conversation about disease impact in a way patients can understand.

Q: What is the target audience for Gout Lies? Patients? Physicians? Both?

McPhilliamy: Gout Lies is focused on reaching rheumatologists. The myths are overtly incorrect statements intended to incite a second look because rheumatologists know these myths to be untrue. The goal is to question why it is out there and drive to key research, led by professors Nicola Dalbeth [MBChB, MD, FRACP, of the University of Auckland in New Zealand] and Georg Schett [MD, of the University of Erlangen-Nuremberg in Germany], which may not have been a focus of recent literature nor top of mind today.

Q: How can Gout Lies help physicians who care for patients with gout?

McPhilliamy: Our goal with this campaign is to advance the understanding of the complex relationship between pain resolution and gout progression. Gout Lies brings this latest research into the forefront and encourages rheumatologists to talk with their patients in a new way to uncover the true severity of the disease.

Many times, if they are not in an acute flare, patients won’t bring up the ongoing nature of their gout. This campaign urges physicians to ask new questions that help better open the dialogue with their patients and ultimately enable better outcomes.

Q: What went into the design of the visuals of the posters? What messages are they trying to get across?

McPhilliamy: Gout has been well documented as a disease for centuries, so to change the dialogue we knew the campaign needed to be thought-provoking and provocative. The visuals and statements overtly show the many ways gout can be deceptive and incite the viewer to stop and ask what more is behind this known myth.

The campaign drives physicians to the leading scientific research about gout and provides actionable insights through a series of expert videos and research overviews.

PAGE BREAK

Q: Can you tell us more about the researchers involved?

McPhilliamy: Over the past year, we have worked closely with professors Schett and Dalbeth, two prominent researchers who are receiving a great deal of attention for their work in rheumatology — calling attention to how our collective understanding of gout has evolved.

They have led the way in examining aggNETs — the mechanisms behind gout-flare resolution, the formation of tophi and the consequences, such as bone erosion and joint damage — of gout. Their research has shown the need for deeper understanding about damage occurring the absence of a flare, and we wanted to bring this to life in a visual, thought-provoking way.

Georg Schett is professor of internal medicine and, since 2006, is head of the department of internal medicine, rheumatology and immunology at the University of Erlangen-Nuremberg in Germany. Nicola Dalbeth is a rheumatologist and professor at the University of Auckland, leading a clinical and laboratory program of research in gout.

Q: Where does the clinical data used by the campaign come from?

McPhilliamy: The data primarily comes from recent research published by professors Dalbeth and Schett in journals such as the Annals of the Rheumatic Diseases, Arthritis & Rheumatology, Rheumatology Disease Clinics of North America and RMD Open.

Q: How important is it to have a “data-driven” campaign regarding gout?

McPhilliamy: To change perceptions, we must be grounded in science and lead with the data. The expression of the information is thought-provoking and visual, but the drive behind it is data.

The research on the pathophysiology of gout is in a sense groundbreaking. It shows how the understanding of gout as a disease has evolved and provides a foundation for physicians to offer more precise management of the disease and ultimately enables better outcomes for patients. – by Jason Laday

For more information:

Ingrid McPhilliamy , MBA, BFA , can be reached at Horizon Therapeutics Lake Forest-U.S. Operations, 150 S. Saunders Road, Lake Forest, IL. 60045; tel: (224) 383-3000; email contact: aphraner@horizonpharma.com.

Disclosure: McPhilliamy reports being vice president of marketing for rheumatology at Horizon.