Gout is one of the most common forms of inflammatory arthritis, yet it remains underdiagnosed and undertreated. Affecting approximately four to five percent of adults in the United States, gout is often dismissed as a nuisance arthritis rather than a serious metabolically-associated disorder with potentially significant systemic implications if left untreated or optimally controlled.
At UPMC, Benjamin Plotz, MD, is leading an initiative to change this perception through the creation of a dedicated gout clinic within the Division of Rheumatology and Clinical Immunology.
Dr. Plotz joined UPMC and the University of Pittsburgh School of Medicine in August 2024 after serving as an attending rheumatologist and core clinical instructor at MedStar Washington Hospital Center in Washington, D.C. Prior to that, he completed his fellowship training in rheumatology at NYU Grossman School of Medicine, his internal medicine residency at George Washington University Hospital, and earned his medical degree from the State University of New York Downstate College of Medicine.
His interest in rheumatology stems from a passion for solving complex medical puzzles.
“Rheumatology is often the last stop for patients when other specialties cannot determine the cause of their symptoms. We get the tough cases, the medical mysteries, and that challenge is what drew me to this field," says Dr. Plotz.
Within rheumatology, gout has emerged as a particular focus for Dr. Plotz.
“Gout is the most common inflammatory arthritis worldwide, yet it is frequently overlooked in primary care and even within rheumatology," says Dr. Plotz.
“People know about gout, but not enough people care enough about gout. That needs to change.”
Creating a Dedicated Gout Clinic
Despite the prevalence of gout in the general population, dedicated gout clinics are rare in the United States according to Dr. Plotz. His developing clinic at UPMC is one of the few programs in the country focusing solely on the disease.
“My goal is to build a comprehensive program and center of excellence where we not only treat the acute manifestations of gout but also focus on long-term management and patient education, and research, including clinical trials," says Dr. Plotz.
A big part of the clinic’s approach is patient-centered education about the very real and damaging consequences of the disease if ignored or undertreated.
“Most patients — and even some physicians — see gout as just an intermittent problem, something that flares up, causes an acute painful arthritis in a joint, and then goes away,” says Dr. Plotz. “But gout is a chronic condition, and if left untreated, it can lead to severe joint damage in multiple joints, chronic pain, and an increased risk of cardiovascular disease.”
To tackle these challenges, Dr. Plotz emphasizes early and aggressive treatment with urate-lowering therapy for patients.
“Gout is a highly treatable disease if managed correctly,” says Dr. Plotz. “With appropriate medication, lifestyle adjustments, and patient adherence, we can prevent flares by keeping uric acid levels below the threshold at which it precipitates out of the blood and crystalizes in the intraarticular space, reduce complications, significantly improve quality of life and avoid long-term joint damage and dysfunction.”
Ongoing Challenges in Gout Management
While effective medications for gout exist, and have existed or some time, their utilization remains suboptimal.
“Of the millions of people living with gout in the U.S., only about one-third receive appropriate urate-lowering treatment. Of that group, less than half actually adhere to their prescribed regimen,”1 says Dr. Plotz.
One of the primary barriers to effective treatment is physician hesitancy in prescribing urate-lowering therapy, particularly in patients with chronic kidney disease.
“There’s a long-standing misconception that allopurinol, the first-line treatment for gout, is too risky in patients with kidney disease,” says Dr. Plotz. “While there are rare cases of hypersensitivity reactions, the vast majority of patients can tolerate it well with appropriate dose adjustments.”
Another significant challenge, again, is patient adherence to their treatment regimens.
“Many patients stop taking their medication once they start feeling better,” says Dr. Plotz. “But gout is not just about managing flares — it’s about preventing them entirely. If you keep uric acid levels below a certain threshold, the disease essentially becomes inactive.”
Education is and will remain a cornerstone of the clinic’s strategy – for patients and referring physicians.
“We need to change the narrative around gout," says Dr. Plotz. “This isn’t just a painful arthritis that affects your big toe — it’s a systemic metabolic disease that increases the risk of heart attack, stroke, kidney disease, and even mortality.”2
The Link Between Gout and Cardiovascular Disease
Emerging research has reinforced that there is a connection between gout and cardiovascular disease.
“After a gout flare, a person’s risk of heart attack and stroke increases significantly for the next three months3, particularly if they have other risk factors like underlying cardiovascular disease, diabetes, hyperlipidemia and obesity," says Dr. Plotz. “Yet, many physicians and patients fail to recognize the potential systemic implications of gout.”
Colchicine, a medication traditionally used to treat gout flares and often used in conjunction with other medications at the start of treatment has now been FDA-approved for cardiovascular disease prevention.
“Studies published in the New England Journal of Medicine4,5 have shown that colchicine reduces the risk of heart attacks in high-risk patients by about a third,” says Dr. Plotz. “This underscores the fact that gout is not just a joint disease — it is a systemic inflammatory condition with metabolic syndrome underpinnings.”
What Does the Future of Gout Treatment Look Like?
While current treatments for gout are effective, there is, of course, always room for improvement.
“We have two primary urate-lowering medications: allopurinol and febuxostat. While they work well for many patients, they do not get everyone to target levels,” says Dr. Plotz. “And with febuxostat, we can run into issues with insurance providers not covering the medication.” There is also a medication that is given intravenously, pegloticase, in severe cases.New therapies are in development to address this gap.
“The field and its researchers are exploring new uric acid-lowering agents that work faster and more reliably than current options,” says Dr. Plotz. “Additionally, there’s interest in repurposing medications originally developed for other conditions, like the SGLT2 inhibitors for diabetes, which have been shown to help lower uric acid levels.”
But, as noted before, even if new therapies come on-line that work faster and work in refractory cases, there is still the need to address the underlying understanding of gout – the myths that have developed around it, and the fact that many patients and clinicians alike don’t view it as a serious medical condition. Dr. Plotz hopes improving gout management at UPMC he will not only improve long-term patient outcomes but also prevent more gout flares which lead to emergency department visits, hospitalizations, and missed work, in addition to a lot of pain and suffering.
Clinical Trials and Expanding Access to Care
Dr. Plotz is actively working to bring clinical trials for gout treatments to UPMC as part of the clinic and program he is building.
“Right now, we don’t have active trials at our center for patients, but that’s something I’m focused on changing,” says Dr. Plotz. “By increasing the volume of gout patients seen at our clinic, we will be better positioned to enroll in future studies and contribute to advancing treatment options.” The clinic also seeks to improve accessibility for patients.
“Many gout patients are managed in primary care, and only a small percentage are referred to rheumatologists like me that specialize in the disease,” says Dr. Plotz. “We want to build stronger referral pathways so that more patients receive specialized care when they need it.”
On the Horizon
Though still in its early stages, Dr. Plotz’s gout clinic represents a new step forward at UPMC in improving care for those suffering from gout.
“We have the tools to manage gout effectively, but we need to change the way it is perceived and treated,” says Dr. Plotz. “By focusing on education, accessibility, and long-term disease prevention, we can improve outcomes and enhance the quality of life for many patients.”
For referring physicians, the message is clear: gout management requires a proactive approach.
“We’re here to be a resource," says Dr. Plotz. “Whether it’s co-managing complex cases, providing guidance on urate-lowering therapy, or enrolling patients in future clinical trials, our goal is to ensure that every patient with gout receives optimal care.”
Gout may be an ancient disease – “the disease of kings” as it has been referred, but modern medicine offers effective therapeutic options. Initiatives like Dr. Plotz’s growing gout clinic at UPMC offer the chance for better management of this common but often overlooked and underappreciated inflammatory arthritis.
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