Background The first ACR guidelines for gout treatment published in 20121,2.
Objectives To record and analyze gout treatment by rheumatologists in Brazil, according to the 2012 guidelines.
Methods Our study population were practicing rheumatologists (n=1436) registered in the Brazilian Society of Rheumatology (BSR). The sample size was calculated using PEPI as 304, aiming at a sample error of 5% and an expected proportion of 50% of concordance. Foreseeing a possible failure to contact 30% of the sample, 395 members were randomly selected using “True Random Number Generator” and e-mailed questionnaires. Proportions and their 95% confidence intervals (95% CI) were estimated for nominal variables. Means and standard deviations were calculated for continuous variables. Stata software v12.0 was used for statistical analysis.
Results 309 rheumatologists replied (78.2%), 58% females; mean age 46 years old (±12); 87% board certified by the BSR. Mean years of practice: 17 years; 53% were solely in private practice; 45% in combined private practice and academia. The first set of questions was regarding treatment of acute gout based on 8 different scenarios thought to impact care including: mono vs. polyarticular involvement, duration of attack (<36h vs. >36h) and creatinine clearance (CrCl) ≥60 vs. <60 ml/min. A combination of an NSAID plus colchicine was the preferred treatment in an otherwise healthy patient, while the combination of a corticosteroid with colchicine was the preferred treatment in patients with CKD. In contrary to ACR guidelines, use of high dose colchicine and initiating colchicine >36h after the onset of the attack were selected, > once, by 10% (95% CI, 6.7 – 13.4) and 20.1% (95% CI, 15.6 – 24.6) of rheumatologists respectively. The main results of the second set of questions are shown in table 1.
Conclusions In this large survey study of Brazilian rheumatologists, we found great compliance with the 2012 ACR gout guidelines; however, there are knowledge gaps to be filled in some areas including: acute gout treatment, duration of prophylaxis, allopurinol treatment and target SUA level achievement. Based on these data, we are developing a physician practice improvement program aimed at advancing gout education and thus the quality of care in gout patients in Brazil.
Khanna D et al. Arthritis Care Res 2012; 64:1431-46.
Khanna D et al. Arthritis Care Res 2012; 64:1447-61.
Disclosure of Interest None declared