Rheumatologists, nephrologists split on best care pathway for uncontrolled gout, survey suggests
Presenter: Shilpa Sharan, PhD, MS, The HWP Group, Upper Saddle River, NJ
Co-authors: Clare Sonntag, MA, Beth Miller, PharmD, Kaitlyn Mayer, BS, The HWP Group, Upper Saddle River, NJ, Nissreen Elfadawy, MD, MS, FASN, Geauga Medical Center - University Hospitals, Chardon, OH
Survey of healthcare providers’ knowledge and attitudes toward the management of uncontrolled gout. Abstract 2192. Presented October 28, 2025.
Although they agree on the systemic complexity of the disease, rheumatologists and nephrologists may not see eye-to-eye on the optimal approach to care delivery in patients with uncontrolled gout.
In results of a recent survey, nearly all rheumatologists favored rheumatology-led management of patients with uncontrolled gout. By contrast, most nephrologists completing the survey envisioned a comanaged or even a nephrology-led approach to care, according to results shared at ACR Convergence 2025.
The divergence in perceived ownership of care was especially apparent among early-career nephrologists, says study author Shilpa Sharan, PhD.
“This generational difference suggests that attitudes toward interdisciplinary care may be evolving faster among nephrologists than rheumatologists, challenging the traditional assumption that gout management should reside primarily within rheumatology,” Dr. Sharan said in an interview.
While uncontrolled gout is recognized as an inflammatory arthritis, increasing evidence supports its classification as a systemic disorder with significant renal implications.
“Despite this shift, management often remains siloed, with rheumatologists and nephrologists approaching the condition from different vantage points,” said Dr. Sharan. “Our goal was to capture these perspectives and identify barriers that may prevent a more integrated model of care.”
A total of 63 specialists completed the 10-question online survey, including 49 nephrologists and 14 rheumatologists. Most (82%) said they worked in an academic setting, and 52% had been practicing for more than 10 years.
Rheumatologists and nephrologists largely agreed on the systemic nature of uncontrolled gout, according to the report. However, when asked about preferred disease management strategies, their responses sharply diverged.
Twelve (91%) of the 13 rheumatologists favored rheumatology-led care. By contrast, only 11 (23%) of the 48 nephrologists favored rheumatology-led care. Thirty (63%) of the nephrologists preferred comanagement with a rheumatologist, while five (10%) said uncontrolled gout should primarily be managed by nephrologists.
The authors said comanagement was favored by 57% of the early-career nephrologists, defined as those with 0 to 10 years in practice, compared with only 23% of the nephrologists in practice for 20 years or more.
In addition, 50% of the early-career nephrologists believed that over the next 5 years, nephrologists will increasingly manage uncontrolled gout, versus 20% of the nephrologists practicing for more than 10 years, and 31% of the rheumatologists overall, according to the authors.
Specialists in both groups cited a lack of nephrologist-focused treatment guidelines, limited availability of renal-safe therapies, and insufficient training or educational resources as barriers to improved collaboration.
“These gaps make it difficult for nephrologists to confidently assume a greater role in care, even when they see the clinical need to do so,” Dr. Sharan said.
Improving collaboration may require both educational and structural interventions.
“Developing clear, evidence-based treatment algorithms that include renal considerations would empower nephrologists to engage more fully in gout management,” Dr. Sharan said.
Fostering joint educational initiatives and CME programs across specialties may accelerate adoption of a more integrated, patient-centered approach to uncontrolled gout, Dr. Sharan added.
Disclosures
Shilpa Sharan, PhD, MS, Beth Miller, PharmD, Clare Sonntag, MA, and Kaitlyn Mayer reported no disclosures. One study co-author reported disclosures related to Amgen, AstraZeneca, Otsuka, and Sobi.
References
Sharan S, Sonntag C, Miller B, Mayer K, Elfadawy N. Survey of healthcare providers’ knowledge and attitudes toward the management of uncontrolled gout [abstract]. Arthritis Rheumatol 2025; 77 (suppl 9). https://acrabstracts.org/abstract/survey-of-healthcare-providers-knowledge-and-attitudes-toward-the-management-of-uncontrolled-gout/. Accessed October 29, 2025.