AB1266 REVIEW OF THE MANAGEMENT OF GOUT BY THE GENERAL PRACTITIONER

Background

Gout is the most common microcrystalline arthritis. It is a life-threatening disease due to joint damage, but also due to renal complications, which depends on adequate management of the disease. Unlike other inflammatory arthritides, gout is largely managed in primary care.

Objectives

The objective of this study is to compare the general practitioners management with international recommendations.

Methods

For this we conducted a survey among 117 general practitioners during 1 month. The questionnaire was established in the form of 7 clinical cases.

Results

Oral colchicine is prescribed as first-line therapy in acute access by 85.3% of physicians. In 69% of the physicians, colchicine is combined with analgesics, prednisone or allopurinol. Allopurinol was prescribed alone by 31.9% of physicians. In case of side effects of colchicine, 49.6% of general practitioners recommend reducing the dose of colchicine, 35% of doctors proposed to stop it, 13.7% and 11.1% proposed to replace it by allopurinol and an analgesic respectively. For the initial assessment to be requested before starting allopurinol, 69.8% of the doctors indicated that the renal assessment is systematic before starting the treatment, while no assessment is necessary is noted by 23.3% of the doctors. Thirty-one physicians have a therapeutic goal of lowering uricemia below 50mg/l in case of tophaceous gout versus 45.7% recommending a level below 60mg/l and 4.3% suggesting a level below 70mg/l. The maximum dose of allopurinol not to be exceeded was 900mg noted by 47% of general practitioners, 300mg, 600mg and 1200mg by 21.4%, 17.1% and 15.4% respectively. Hypo-uricemic treatment is indicated in patients with recurrent attacks, arthropathies, tophus or radiological signs of gout. Thus, 8.5% of the physicians recommend disease-modifying therapy for the recommended indications. Among other things, 36.8% of patients recommend starting hypouricemic treatment in the event of asymptomatic hyperuricemia. Regarding patient education, the majority of doctors advise for weight loss (77.6%) and a low purine diet by (75%).

Conclusion

This work has objectified that gout is often poorly managed by general practitioners suggesting the need for continuing medical education of general practitioners which will certainly help improve practices.

Reference

[1]Roddy E, Zhang W, Doherty M.Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations,Ann Rheum Dis 2007 66: 1311-1315.

Acknowledgements:

NIL.

Disclosure of Interests

None Declared.