Background/Purpose: The American College of Rheumatology (ACR) developed an updated guideline in 2020 for the management of gout.¹ This study evaluates US rheumatologists’ stated adherence to and agreement with the 2020 ACR guideline for the management of gout.

Methods: A 57-item questionnaire was administered to US rheumatologists, surveying their adherence to and agreement with the 2020 ACR guideline for the management of gout. Stated adherence scores were based on the number of specific recommendations reported to be followed by rheumatologists in practice. In contrast, stated agreement scores were based on the degree of agreement with these recommendations.

Results: All of the 201 rheumatologists approached completed the questionnaire. The mean age of participants was 50 years; 54% had >15 years of practice experience, and ~70% were in private practice (Table). The mean overall stated adherence score was 11.5 (of 15), and the mean overall stated agreement score was 7.7 (of 14). Rheumatologists with less experience (up to 8 years; n=49) were likely to claim greater adherence than those with more experience ( >8 years; n=152) (mean stated adherence score: 12.3 vs 11.3; p=0.05), whereas rheumatologists who claimed to see ≤75 patients with gout in 6 months (n=66) had a mean stated adherence score of ~12.1 versus ~11.2 (p=0.05) for those who claimed to have seen >75 patients. Approximately, 78% of rheumatologists reported initiating urate-lowering therapy (ULT) for patients who had ≥2 gout flares per year or ≥1 subcutaneous tophi or evidence of radiographic damage attributable to gout; 89% were likely to prescribe allopurinol as a first-line ULT for all patient types (Figure). Adherence to recommendations for dosing was lower than for other areas of recommendations: 43% and 39% of rheumatologists claimed to adhere to the recommended starting doses for febuxostat and allopurinol, respectively (Figure). Approximately, 92% of the rheumatologists claimed to adhere to the recommendations on using colchicine, non-steroidal anti-inflammatory drugs, or steroids as first-line therapy for gout flares (Figure). Rheumatologists from academic settings were more likely to prescribe an interleukin-1 inhibitor for gout flares than those working in other settings. In general, stated agreement with the guideline components was significantly less than stated compliance.

Conclusion: The self-reported practice of the surveyed US rheumatologists was generally concordant with the 2020 ACR guideline for the management of gout, even when there was stated disagreement with the guideline. However, there were gaps in guidelines knowledge and stated adherence among rheumatologists, mainly concerning the dosing of treatment regimens. Rheumatologists with less experience were likely to claim greater adherence to ACR guideline.

Reference

1. Fitzgerald JD, et al. Arthritis Care Res Hoboken). 2020;72(6):744-760.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-adherence-to-and-agreement-with-the-2020-american-college-of-rheumatology-guideline-for-the-management-of-gout-by-us-rheumatologists/