A survey on the diagnosis and management of gout among general practitioners
Objective: To determine the knowledge and practices of general practitioners in the diagnosis and management of gout and compare to clinical guidelines and quality of care indicators to ascertain shortcomings in care. Methods: An email-based questionnaire survey of South African general practitioners relating a clinical case vignette of an acute inflammatory arthritis; specifically, gouty arthritis; with respect to diagnosis, management of acute gout, prophylaxis, indications and dosage of urate lowering therapy allopurinol, dietary modification and co-morbidity screening. Results: Of the 2891 email invitations, 221 questionnaire surveys were included in the study (7.6%). There was near equal representation of general practitioners in solo (54.3%) and group practice (45.7%). The majority of general practitioners (94.6%) participating in the survey appropriately diagnosed gouty arthritis. The evaluation of gout with arthrocentesis was however, considered by only 4.1% participants and 12.7% co-prescribed prophylaxis when initiating urate lowering therapy. Urate lowering therapy was always initiated in gout patients by 14.9% of participating general practitioners and by 31.2% in those patients presenting with tophi and other characteristic features. In patients presenting with more than 2 attacks a year, 70% would initiate ULT. Titration of urate lowering therapy with serum urate levels were performed by 29% of participants. Gout was disagreed upon as a risk factor for ischaemic heart disease by 26.2% of participants. General practitioners who consulted 5 or more gout patients in a month were more likely to attempt joint aspiration (p=0.004), prescribe prophylaxis (p=0.025) and to have updated their knowledge in gout management in the last 2 years (p=0.003). Conclusion: In this study, gout management, particularly chronic management is poorly implemented and is currently of a sub-optimal standard compared to guideline recommendations and quality of care indicators. Gout management in South Africa needs to be addressed as it remains a curable inflammatory arthritis despite its increased prevalence around the world.
A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of: Master of Medicine in Internal Medicine 2019