Diagnosis and treatment of gout in real clinical practice (according to a survey of primary care physicians)

Introduction. Gout is a chronic auto-inflammatory disease associated with the deposition of sodium monaurate crystals on the background of hyperuricemia. Despite clear international and national clinical guidelines, diagnosis is delayed by an average of 4–5 years from the first attack. The effectiveness of treatment directly depends on the timely diagnosis of the disease, as well as on the correct appointment of urate-lowering therapy.

Aim. The purpose of this study was to evaluate approaches to the diagnosis and treatment of gout among primary care physicians based on anonymous questionnaires.

Materials and methods. An anonymous survey of 190 district internists and general practitioners working in state medical institutions of the Chuvash Republic was conducted.

Results. The survey results showed a lack of awareness among respondents about diagnostic issues. Only 53.7% of the doctors’ responses met modern requirements for the diagnosis of gout. Many doctors (46.3%) mistakenly consider the presence of only one sign (for example, hyperuricemia) sufficient for diagnosis, underestimate the importance of conducting polarization microscopy of synovial fluid (75.8%), and are practically unfamiliar with alternative instrumental methods such as ultrasound and dual-energy computed tomography. Significant disadvantages have also been identified in the treatment of gout. 78.4% of doctors used only nonsteroidal anti-inflammatory drugs to treat an acute attack of arthritis, while only 5.3% of respondents used colchicine. The appointment of urate-lowering therapy was accompanied by errors: more than half of the doctors (52.6%) limited the maximum dose of allopurinol to 300 mg/day (with an acceptable 900 mg/day), 36.8% did not focus on the target uric acid level (<360 mcmol/l), and 53.2% did not carry out therapy on an ongoing basis. Only 11.6% of the respondents prescribed preventive anti-inflammatory therapy at the start of urate-lowering therapy.

Conclusions. Thus, the study demonstrates certain shortcomings in the diagnosis and treatment of gout at the primary health care level. According to the survey, despite the existence of clearly regulated and accessible clinical recommendations, their provisions are not fully implemented by primary care physicians, which underscores the need for additional education of outpatient doctors to improve the quality of care for patients with gout.

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