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Doherty et al recently published results of an international survey on the diagnosis and management of gout conducted among delegates attending EULAR 2006.1 In addition, we would like to present the results of a survey conducted among 242 Dutch rheumatologists in 2005.
We sent a survey to all Dutch rheumatologists and those in training, all of whom were member of the Dutch Society for Rheumatology. We presented a case of tophaceous gout and recurrent gouty arthritis where the serum urate level was 0.69 mmol/l and urate excretion in urine was 1.0 mmol/day; renal function was normal. Nine multiple choice questions and two open questions were asked about urate-lowering treatment, dosage and target goal of serum urate-lowering treatment. The response rate was 50.4%.
In the presented case, the first choice treatment of respondents was allopurinol (87%), 13% preferred benzbromarone. The type of patient (underexcretor or overproducer) was not considered relevant for the choice of treatment (82%). Initial allopurinol dose was 100 mg/day (59%). Maximum dosage of allopurinol that would be described in general, differed widely: 300 mg (19%), 600 mg (40%) and 900 mg (25%). When treatment with allopurinol in this patient was insufficient, the majority of respondents would prescribe combination therapy with benzbromarone or probenecid (55%), 42% would switch to benzbromarone or probenecid. Eighty-nine per cent of rheumatologists use a target goal of serum urate to evaluate treatment; target values most frequently reported were 0.30 mmol/l (33%), 0.35–0.36 mmol/l (32%); 20% of respondents reported target values 0.38–0.45 mmol/l. There was no clear consensus about the maximum dosage allopurinol to be prescribed or which target urate level should be used.
Other surveys on the management of gout also showed considerable diversity.1 2 Since 1999, a Dutch guideline for gout has been made available by the Dutch society of general practitioners, but not by rheumatologists. Presumably, availability of guidelines for rheumatologists, like the EULAR recommendations, will improve uniformity and quality of management of gout.3 However, good evidence in this field is scarce,3 4 availability of urate-lowering drugs in countries is dissimilar and published recommendations are not consistent which each other.3 5
This survey shows that a large variety still exists in the management of gout by Dutch rheumatologists. Uniformity in treatment should be given a higher priority,6 starting with formulating (national) guidelines/recommendations and defining quality indicators, and subsequently, by assessing adherence to these guidelines and self-assessment or perhaps even measuring aforementioned indicators.
Competing interests: None declared.
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