Background/Purpose:

Gout is a treatable arthritis and while the rate of gout in Australia has been steadily rising, drugs used to treat acute gouty arthritis have a variety of toxicities. A South Australian coroner’s case in 2014 drew attention to the fact that there are differences in approach to the treatment of gout that medical professional should be aware off.

We conducted a survey to help understand how South Australian healthcare providers manage Gout.

1. To identify which treatment approaches are favoured for management of acute gouty arthritis
2. To determine whether there are misconceptions in the management of gout according to current recommendations.
3. Whether healthcare providers are familiar with the “treat to target” approach when it comes to management of chronic hyperuricemia.

Methods:

An anonymous voluntary survey was conducted from 1^st of May till the 31^st of July 2015. The targeted population consisted of general practitioners working in the South Australian Health Care System. A random sample size of 326 was determined with 95% confidence level and confidence interval of 5. The population total was based on 2012 figures of practicing general practitioners which is 2138.

The questionnaire was based on published guidelines for management of gout:

1) Acute symptomatic management: (NSAIDs, colchicine, and prednisolone)

2) Knowledge regarding use of urate lowering therapy

3) Familiarity with different published treatment recommendations.

Ethics and site-specific approval was obtained before the start of the survey.

Results:

A total of 146 responses (response rate 48.6%) were received from general practitioners from both rural and metropolitan areas. At least half of whom see more than one patient with gout per week.

Most responders (63%) managed acute gouty arthritis with non-steroidal anti-inflammatory drugs while 24% uses Colchicine. For those who used colchicine, greater than 50% used a greater than 1.5mg per 24-hour dosing, 2.2% prescribed colchicine 500mcg 2-3 hourly until the patient has diarrhea.

Although, 66% commenced allopurinol and up titrate it, only 17% increased the dose more than 300 mg per day if serum urate remains elevated.

Out of the 146 responders only 27 knew of febuxostat as an alternative therapy for allopurinol, while 83% of responders were not aware of the “Treat to Target” approach.

Conclusion:

Gout is primarily managed by GPs in Australia. In recent years there has been a paradigm shift in terms of management. In published guidelines for acute attack of gouty arthritis the recommended options have been oral NSAIDs, systemic corticosteroid or colchicine. However, there remains to be ambiguity in the published dosing guidelines of colchicine.

Our study is the first to examine gout knowledge, belief and treatment approaches in the South Australian Health care system. Despite the recent coroner’s report and updates in the management of gout there continues to be a gap in our responder’s approach to its management.

We identified that suboptimal management of gout is due to poor dosage adjustment of urate lowering therapy to aim for the target urate level and lack of education with alternative to allopurinol as a urate lowering therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/management-of-gout-a-survey-for-healthcare-providers-in-south-australia/