Background Gout is the most common inflammatory arthritis in men. Suboptimal treatment of gout has been reported1. To improve quality of care, it is essential to identify problems.
Objectives To assess management of gout among physicians in Thailand.
Methods A cross-sectional survey was conducted among physicians in Thailand. A questionnaire designed to evaluate knowledge regarding management of hyperuricemia and gout was sent to 3,916 doctors between December 1, 2011 and January 1, 2012. Only doctors having experience in taking care patients with hyperuricemia and gout were included in this study.
Results A total of 742 (19.1%) questionnaires were returned. Six hundreds and seven (81.8%) participants had experience of hyperuricemia and gout management. Of total, 271 (44.6%) advised patients on non-pharmacologic management of hyperuricemia, as follows: stop alcohol drinking, 262 (43.2%); weight reduction, 223 (36.7%); stop entrails and gut, 216 (35.6%); stop purine rich vegetables, 198 (32.6%); and stop poultry, 196 (32.3%).
Regarding treating acute gout, colchicine was the most frequently used, 582 (95.9%) and 157 (27.0%) managed with high dose regimen, followed by non-steroidal anti-inflammatory drugs (NSAIDs) (88.8%), corticosteroid (47.1%), physiotherapy (33.9%), and topical NSAIDs (25.3%). Five hundreds and ten (84.0%) physicians used colchicine as the first medication for arthritis prophylaxis while only 36 (5.9%) doctors chose NSAIDs.
Three hundred and sixty nine (67%) of 575 respondents set the target of SUA of urate lowering therapy (ULT) less than 6 mg/dl. Among uric lowering agent, allopurinol was the most well-known, 592 (97.5%), followed by probenecid, 426 (70.2%), benzbromarone 244 (40.3%), and sulfinpyrazone, 140 (23.1%). Four hundred and eighty eight (80.4%) of respondents would hold or stop allopurinol sometimes along the course of allopurinol treatment. Ninety five (15.7%) and 58 (9.6%) held allopurinol when having gouty attack and acute illness, respectively. Reasons for stopping allopurinol were, as follows: normal serum uric acid for 5 years, 324 (53.4%); no tophi for 5 years, 206 (33.9%); no symptoms for 5 years, 224 (36.9%); no arthritis, no tophi, and normal serum uric acid for 5 years, 86 (14.2%); and no arthritis and normal serum uric acid for 5 years, 55 (9.1%).
Conclusions In Thailand, physicians gave patient education less than 50%, and some of advice was not correct as evidence-based studies. Colchicine was commonly used to control acute gout; however, some of doctors still used a high dose regimen which may result in more toxicity. Approximately 30% of physicians did not keep the target of SUA when treating with ULR as the general accepted target. To improve overall quality of care for gout and hyperuricemia patients, education should focus on specific problems.
Singh JA. Quality of life and quality of care for patients with gout. Curr Rheumatol Rep. 2009;11(2):154–60.
Acknowledgement The authors gratefully acknowledge the physicians of Thailand who generously participated in this study.
Disclosure of Interest None declared