A survey on the diagnosis and management of gout among general practitioners
Date
2019
Authors
Ahmed, Anees
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Abstract
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.
Description
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