Clinical bias and gout: How stigma impacts patient care

The management of gout, a condition historically laden with stigma and misconceptions about its underlying causes, stands at a critical juncture. Despite significant advances in understanding its pathophysiology and treatment, gout management remains inconsistent and at odds with prevailing clinical guidelines and evidenced-based standards. This study investigates how inaccurate physician beliefs about gout can bias clinical judgment and contribute to compromised patient care. Across two independent samples (Pilot Study, N = 106; Main Study, N = 321), we examined how practicing rheumatologists evaluated patients with gout or rheumatoid arthritis, with or without stigma-related behavioral profiles (e.g., alcohol use, BMI). Participants completed a vignette experiment followed by a survey assessing causal attributions, treatment efficacy, and perceptions of patient responsibility. We find that gout-related stigma biases rheumatologists' causal beliefs, treatment recommendations, and expectations of patient compliance and adherence. Gout patients, compared to those with other forms of inflammatory arthritis, were misperceived as engaging in lifestyle choices that contribute to their disease severity and course. These misperceptions led to the attribution that gout patients were uniquely responsible for the cause and management of their condition, and were therefore assumed to be less compliant with or less likely to benefit from effective pharmacological and biological therapies. Importantly, these biases were observed in judgments of realistic patients whose behavioral profiles reflected gout-related stereotypes, even when disease severity and symptomology were otherwise identical. These findings underscore the urgent need to address gout-related stigma among healthcare providers as a critical step to improving patient outcomes and care.