Improving the Treatment of Gout
Dr Philip Robinson (ARA-RACP-Starr Research Fellow at Queensland Brain Institute) is trained in medicine and completed specialty training in general and acute care medicine and rheumatology in New Zealand. He then completed a PhD in genetics at the University of Queensland Diamantina Institute. He currently works clinically at the Royal Brisbane and Women's Hospital as a rheumatologist where he runs the gout clinic.
In spring the 2015 issue of Join News, Dr Robinson talks about gout, its causes, how it can be treated and his past and current research endeavors into the condition.
How do you treat gout? Is there a special diet?
What I tell my patients when I treat them is that we can get your urate levels down in your blood by using medication and if you would like to, you’re certainly welcome to try changes in diet. I always talk to patients about the things that can cause a flare up in their gout. For example alcohol binges, seafood binges and sugar sweetened soft drinks are the three things that I talk to my patients about.
Very prescriptive diets aren’t so effective, primarily for the reason that people don’t stick to them, and people eat what they eat because they like doing that or because that’s their culture. So generally what I say to my patients is, we need to use medication to treat your gout because changing your diet, if it does have any effect, is not going to have the effect that we need it to have. We will get your serum urate down with the medications and then you are going to have more leeway to eat the foods that potentially in the past, have made your gout worse.
What are the issues you have identified with people taking their medication?
One of the complicating factors that’s frequent when we have gout, is sometimes the gout medications that we use can actually flair the gout in the short term. I can see a long term goal for a patient and I start them on a medication, but unless the patient sees that vision and sees the fact that we’re aiming for this long term goal, they may stop taking the medication.
Also because it’s a chronic condition, often patients don’t end up taking their medication, for a number of reasons. They lose faith in either the doctor or the medication, or they just haven’t got the systems in place to remind them to regularly take their medications.
What is the focus of the research you are doing next year?
The research aims to identify where patient knowledge of their treatment is lacking and help provide patients assurance to take their medication.
It is aimed at really helping the patient on the ground. There are lots of different types of research you can do. You can study genetics and you can study biology and often those things take a lot longer to filter through to the patient, but this research is very exciting.
I really hope that at the end of it we can institute something that’s going to help patients directly with making sure that they understand what’s going on with their treatment, so they can understand the things that are going to help them be successfully treated.
We have a lot of good treatments currently for gout, but if people, for whatever reason, aren’t taking them, then we may as well not have them.
General Practitioners play a large role in the treatment of people with gout. Will they be involved in the research as well?
Yes, absolutely, as well as talking to groups of patients and bringing out those issues, I am also going to be talking to groups of GPs both in Brisbane and Hervey Bay and looking at their knowledge of treating gout and the things that influence them as to when they start treatment and when they don’t start treatment and what their knowledge of gout is.
We can have great knowledge and strategies for treating this but if people aren’t applying them in practice then again, we are a bit lost, so that’s the other half of the study. To look at the people who treat the vast majority of gout and they are the GPs and asking, are they doing it the best they can and what can we do to help them do it even better. Do we provide educational resources, do they need strategy, do they need consultations, do they need people they can talk to about physical cases? What is stopping them treating patients the best way they can be treated?
What do you hope will be achieved by your research?
Historically people haven’t seen gout as a very important condition, but it’s important as it stops people going to work, it stops them enjoying their life and their sport and their family and it has costs to both individuals and communities and families. People need to sit up and take more notice of it. I think the results of that study essentially reflect the fact that people have a very historical attitude to it and they need to think about it again and see the effect that it’s having on lives. Hopefully that’s a study that we can repeat in five or ten years’ time and show that there has been significant change. That would be my hope.
Where does the funding come for your research?
As a researcher, I am constantly spending significant amounts of my time trying to get access to research funds to do this type of research and when I am unable to get funding, this type of research just doesn’t get done. So, if people have the capacity to give a little bit and support research, then it actually flows through to getting results and getting both new treatments, but also, with this type of research that I’m doing as well.
I have put in an application for funding to Arthritis Australia to complete the research and it’s not going to happen unless I am able to get some research funding, so that all those exciting things that people are potentially going to read about, that you’re going to write about are really critical to people supporting it. It does make a difference when people make donations to funding bodies such as Arthritis Queensland and Arthritis Australia.
Each year through the generosity of donors Arthritis Queensland provides $50,000 funding for a post-doctoral research fellowship to support medical and clinical research into treatments for arthritis. The funding is coordinated through the Arthritis Australia National Research program and awarded to a researcher based in Queensland.