The beginning of a new year is a time of resolution setting and recovery from the festive season. We enjoyed plenty of ham, turkey, Christmas pudding and maybe a few alcoholic beverages. But merriment has consequences. In fact, the head of the Royal College of General Practitioners has asserted that due to poor diet and lifestyle habits, Santa Claus probably has a few health problems, one of which being gout. We all know what gout is: that self-inflicted illness of excess, caused by an over-indulgence of rich food and alcohol.
Except that’s a common misconception. Gout is a type of inflammatory arthritis caused by high levels of urate in the body, which forms painful crystals in an individual’s joints. While some dietary factors do increase the risk of gout, biological factors such as aging, kidney disease and genetics play a greater role in urate regulation and contribute to the development of gout. This misperception of gout can result in people avoiding effective urate-lowering medications and instead utilising less helpful strategies like alcohol reduction, diet changes and weight loss. Relying on these strategies long-term leads to unnecessary pain, discomfort and further joint damage.
The common lay perceptions of gout can also have a psychological effect. Due to causal beliefs relating to lifestyle and the overconsumption of alcohol, gout and its sufferers can be the punch line of many jokes and are often lampooned in newspaper articles. People with gout are made to feel that the condition is their own fault and not serious enough to warrant concern. As such, people can be left feeling guilty and embarrassed due to having gout.
It is clear that the general population’s perception of gout needs to be updated in order to improve the management of the condition. My colleagues and I investigated whether changing the name of gout to a more pathophysiological name that better reflected the condition’s origins would make a difference. We tried out several names but settled on urate crystal arthritis as it implies a chronic condition and highlights the central role of urate levels in the formation of crystals in the joints. We then tested whether a name change would influence perceptions of the condition. We asked 189 participants to read a short description of a type of arthritis and then rate their perceptions of the illness, the likely causes and potential management strategies. The descriptions were identical except in half the questionnaires the condition was labelled gout and the other half urate crystal arthritis.
The results showed that people perceived the gout-labelled condition to be more likely caused by a patient’s own behaviour, dietary factors and alcohol consumption. Conversely, aging was believed to cause urate crystal arthritis. Urate crystal arthritis was also rated as being a more chronic and serious condition compared to gout. Gout was viewed as being more under one’s personal control and was considered to be a more embarrassing condition than urate crystal arthritis. In regards to the management of the condition, changing to a more healthy diet was perceived as being more helpful for the gout-labelled illness, while taking long-term medications was considered necessary for urate crystal arthritis.
So what’s in a name? These findings suggest there is quite a lot. Renaming gout changed people’s perceptions of the illness, their causal beliefs and management strategies. The new name was able to better align the lay perception of the condition with the medical reality and so an actual name change could benefit the condition and lead to more effective management. We have since replicated this study in three different samples with the aim of providing further evidence and support for a gout rebrand. It is a simple change but has resulted in a significant shift in the perceptions of gout. The next challenge is implementing this change in a clinical setting with real patients. Watch this space.
Kate MacKrill is a PhD in Health Psychology candidate, Department of Psychological Medicine at the University of Auckland. You can find her on twitter at @KateMacKrill