Primary Care Providers' Knowledge, Beliefs and Treatment Practices for Gout

Results of a Physician Questionnaire

Leslie R. Harrold; Kathleen M. Mazor; Amarie Negron; Jessica Ogarek; Cassandra Firneno; Robert A. Yood


Rheumatology. 2013;52(9):1623-1629. 

In This Article

Abstract and Introduction


Objective. We sought to examine primary care providers' gout knowledge and reported treatment patterns in comparison with current treatment recommendations.

Methods. We conducted a national survey of a random sample of US primary care physicians to assess their treatment of acute, intercritical and tophaceous gout using published European and American gout treatment recommendations and guidelines as a gold standard.

Results. There were 838 respondents (response rate of 41%), most of whom worked in private practice (63%) with >16 years experience (52%). Inappropriate dosing of medications in the setting of renal disease and lack of prophylaxis when initiating urate-lowering therapy (ULT) accounted for much of the lack of compliance with treatment recommendations. Specifically for acute podagra, 53% reported avoidance of anti-inflammatory drugs in the setting of renal insufficiency, use of colchicine at a dose of ≤2.4 mg/day and no initiation of a ULT during an acute attack. For intercritical gout in the setting of renal disease, 3% would provide care consistent with the recommendations, including initiating a ULT at the appropriate dose with dosing titration to a serum urate level of ≤6 mg/dl and providing prophylaxis. For tophaceous gout, 17% reported care consistent with the recommendations, including ULT use with dosing titration to a serum urate level of ≤6 mg/dl and prophylaxis.

Conclusion. Only half of primary care providers reported optimal treatment practices for the management of acute gout and <20% for intercritical or tophaceous gout, suggesting that care deficiencies are common.


Gout is a common form of inflammatory arthritis affecting at least 1% of the population in western countries.[1,2] Its prevalence over the past 20 years has risen, with higher rates in men and the elderly due in part to the rise in obesity and the ageing of the population.[3] Gout imposes a large economic burden. In the USA, new cases of gout cost $27.4 million annually.[4] Acute gout attacks usually present with swelling, redness and warmth of one or several joints, often occurring in the lower extremities. Medical treatments include colchicine, NSAIDs and glucocorticoids. When gout is progressive, it can result in joint destruction and tophaceous deposits. Urate-lowering therapies (ULTs) such as allopurinol, febuxostat and probenecid are first-line treatments for the management of chronic gout.

Deficits in the quality of care provided to gout patients have been well documented, in both the acute and chronic management of gout.[5,6] These deficits include medication errors with inappropriate dosing of allopurinol and colchicine[5] and initiation of a ULT during an acute gout attack.[6] In addition, there is inadequate patient education on gout, including lifestyle recommendations and the role of medications,[7,8] In recognition that gout is often poorly managed and misdiagnosed or diagnosed late in its course, both European rheumatology societies and American researchers have published evidence-based recommendations for the diagnosis and medical management of gout and quality care indictors.[9–12] These publications include a combination of pharmacological and non-pharmacological treatments, taking into account specific clinical factors such as clinical phase (acute, intercritical and tophaceous gout), serum urate level and associated comorbidities. Patient education and lifestyle advice as well as management of hyperlipidaemia, hypertension, hyperglycaemia and obesity are strongly encouraged.[12] Given that primary care physicians manage >90% of gout patients, we sought to examine the gout knowledge, beliefs and self-reported treatment patterns in a national sample of internists and family practitioners in the USA to better understand why deficits in gout treatment occur.[13]