10/11/2023    Keith L. Gurnick, DPM

Krystexxa and Gout (Allen Jacobs, DPM)

With all due respect to Dr. Allen Jacobs,
podiatrists are often the first to diagnose acute
gout, and we are often the doctors who treat acute
flare-ups and chronic gout as well. I have come in
to my office many times after regular office hours
and on a Saturday or a Sunday for a gout
emergency, and it is one of the most helpful and
thankful things we can do when a patient is having
an acute gout attack or flare up to help reduce or
alleviate their severe acute pain disability and
suffering.

Yes, it is true that we as podiatrists also make
appropriate referrals to other specialists for
systemic long-term management. However, we are
often the first and best educators to our patients
about the causes of gout, the short term and the
long term affects as well, including localized
effects in the foot and ankle and the long-term
effects of poorly or uncontrolled gout to other
body parts and organs, and treatment options. Just
ask any podiatrist who treats patients with gout
how much extra time he or she has spent explaining
this condition.

Whether a podiatrist chooses to prescribe this
medication or any other medication or to make a
referral to another healthcare provider, is
irrelevant. Our profession was excluded from their
magazine advertisement, which they sent to me,
unsolicited, however, they asked me to display the
magazines in my reception room for my podiatry
patients and any other visitors who might also be
there.

They also omitted our profession or any reference
to podiatry in the full page section marked "Your
healthcare team", and our profession is also
invisible as a referral source on their product
website. They included orthopedists. Do
orthopedists treat more patients gout than we do
and do, and also do they manage gout patients by
prescribing I.V. infusion medications?

By omitting us from their "team" they are snubbing
podiatric medicine as a profession but also doing
a disservice to the public. If Horizon feels it
is appropriate to educate the podiatry patient
about their medication then why are we not
included as part to the "gout team." ?

PS: Dr. Jacobs’ reference to our use of Jublia is
a weak argument. I do prescribe Jublia, when
indicated. I have done so for many years. The
parent company has provided my office with Jublia.
product representatives who come to my office with
samples, and updated information in support of the
product.

Jublia has sponsored Podiatry meetings, and
exhibited at our conferences, and they have used
Podiatrists in the past to lecture at dinner
meetings and to educate Podiatrists and to support
their product. In addition, the Jublia, in
December, 2021, was given the APMA seal of
approval. In paid advertisements we are mentioned
often.

One example of their support: "We are pleased to
receive this distinguished honor by the APMA, the
leading professional organization for the more
than 12,500 podiatrists in the United States,"
said Joseph C. Papa, chairman and CEO, Bausch
Health. "They recognize that podiatry is
important.

Yes, they also market to dermatologists and family
practitioners, but they highlight and include our
profession and consider us not only relevant but
important in the toenail fungus arena. I did not
see this with Horizon and their infusion gout
medication.

Keith L. Gurnick, DPM, Los Angeles, CA

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