Adherence to the 2012 American College of Rheumatology (ACR) Guidelines for Management of Gout: A Survey of Brazilian Rheumatologists.
OBJECTIVE
To describe the current pharmacological approach to gout treatment reported by rheumatologists in Brazil.


METHODS
We performed a cross-sectional survey study using an online questionnaire e-mailed to 395 rheumatologists, randomly selected, from among the members of the Brazilian Society of Rheumatology.


RESULTS
Three hundred and nine rheumatologists (78.2%) responded to the survey. For acute gout attacks, combination therapy (NSAIDs or steroid + colchicine) was often used, even in monoarticular involvement, and colchicine was commonly started as monotherapy after 36 hours or more from onset of attack. During an acute attack, urate-lowering therapy (ULT) was withdrawn by approximately a third of rheumatologists. Anti-inflammatory prophylaxis (98% colchicine) was initiated when ULT was started in most cases (92.4%), but its duration was varied. Most (70%) respondents considered the target serum uric acid level to be less than 6 mg/dl. Approximately 50% of rheumatologists reported starting allopurinol at doses of 100 mg daily or less and 42% reported the initial dose to be 300 mg daily in patients with normal renal function. ULT was maintained indefinitely in 76% of gout patients with tophi whereas in gout patients without tophi its use was kept indefinitely in 39.6%.


CONCLUSIONS
This is the first study evaluating gout treatment in a representative, random sample of Brazilian rheumatologists describing common treatment practices among these specialists. We identified several gaps in reported gout management, mainly concerning the use of colchicine and ULT and the duration of anti-inflammatory prophylaxis and ULT. Since rheumatologists are considered as opinion leaders in this disease, a program for improving quality of care for gout patients should focus on increasing their knowledge in this common disease.
Division of Rheumatology, Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Ana Beatriz
AB
Vargas-Santos
Division of Rheumatology, Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Geraldo da Rocha
Gda R
Castelar-Pinheiro
Epidemiology Department, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil.
Evandro Silva Freire
ES
Coutinho
Division of Rheumatology, University of Pennsylvania School of Medicine and Veterans Affairs Medical Center, Philadelphia, Pennsylvania, United States of America.
H Ralph
HR
Schumacher
Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America; Department of Medicine at the School of Medicine, and the Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, United States of America; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
Jasvinder A
JA
Singh
Division of Rheumatology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America.
Naomi
N
Schlesinger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001938:Brazil; D003078:Colchicine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006073:Gout / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D012219:Rheumatology; D012955:Societies, Medical
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000493:Allopurinol; D003078:Colchicine