A survey of current evaluation and treatment of gout.
OBJECTIVE
To record diagnostic and treatment approaches to gouty arthritis among US rheumatologists.


METHODS
Questionnaires were faxed to 2500 US rheumatologists.


RESULTS
Responses were received from 518 rheumatologists. Respondents reported performing crystal analysis 80% of the time for new suspected gout; 64% use combination therapy for acute gout; nonsteroidal antiinflammatory drugs alone are used in only 27%. Urate-lowering drugs (ULD) are given to most patients. ULD treatment is given occasionally to patients with asymptomatic hyperuricemia (4%) but most frequently to patients after 2 (59%) or 3 (34%) attacks. ULD are given with the aim of achieving a serum urate (SU) level of 6 mg/dl.


CONCLUSIONS
Combination antiinflammatory agents are used frequently for acute gout despite absence of evidence in the literature to support this practice. There seems to be consensus regarding the necessity of lowering SU to < 6 mg/dl. Approaches vary widely, supporting the need for longterm prospective, placebo controlled studies to provide more evidence-based guidance.
Schlesinger
Naomi
N
Department of Medicine, The School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08903-0019, USA. schlesna@umdnj.edu
Moore
Dirk F
DF
Sun
Jennifer D
JD
Schumacher
H Ralph
HR
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003078:Colchicine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006073:Gout / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012219:Rheumatology / Q000639:trends; D014481:United States; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014528:Uricosuric Agents; D014527:Uric Acid; D000324:Adrenocorticotropic Hormone; D003078:Colchicine