Julia Goossens1, Sylvie Lancrenon2, Sabine Lanz3, Hang-Korng Ea4, Charles Lambert5, Pascal Guggenbuhl6, Alain Saraux7, Catherine Delva8, Samy Sahbane8, Frédéric Lioté9. 1. Service de rhumatologie, hôpital Lariboisière, AP-HP, centre Viggo-Petersen, 75010 Paris, France. 2. Sylia-Stat, 92340 Bourg-La-Reine, France. 3. Laboratoires Mayoly-Spindler, 78401 Chatou, France. 4. Service de rhumatologie, hôpital Lariboisière, AP-HP, centre Viggo-Petersen, 75010 Paris, France; University Paris Diderot, Sorbonne Paris cité, 75205 Paris, France; Inserm, UMR 1132, centre Viggo-Petersen, 75010 Paris, France. 5. Laboratoires Ipsen Pharma, 92100 Boulogne-Billancourt, France. 6. Service de rhumatologie, CHU de Rennes, 35203 Rennes, France; Inserm UMR 991, 35000 Rennes, France; Faculté de médecine, université Rennes 1, 35043 Rennes, France. 7. Service de rhumatologie, CHU de la Cavale-Blanche, université de Bretagne occidentale, 29000 Brest, France. 8. Vivactis études cliniques, 92400 Courbevoie, France. 9. Service de rhumatologie, hôpital Lariboisière, AP-HP, centre Viggo-Petersen, 75010 Paris, France; University Paris Diderot, Sorbonne Paris cité, 75205 Paris, France; Inserm, UMR 1132, centre Viggo-Petersen, 75010 Paris, France. Electronic address: frederic.liote@aphp.fr.
Abstract
INTRODUCTION: In 2006, recommendations about the management of gout were issued by the European League Against Rheumatism (EULAR). The objective of this work was to compare these recommendations to practice patterns of physicians working in private practices in France. METHOD: In a prospective multicenter nationwide study conducted in France, a random sample of primary-care physicians (PCPs) and private-practice rheumatologists (PPRs) was taken in 2009. Each physician included 2 consecutive patients with gout. Each patient was evaluated twice at an interval of 3-6months. Information on EULAR 2006 management modalities were collected in a standardized manner. RESULTS: Of 1003 patients, 771 were evaluated twice. Allopurinol was prescribed to 75.1% of patients in all and was initiated at the first study visit in 44 patients, among whom 19 (43.2%) 19 patients received the recommended starting dosage of 100mg/day. Colchicine therapy to prevent flares was prescribed to 74.3% of patients. Of the 522 patients on allopurinol therapy at the first visit, only 34.5% had serum uric acid levels≤360μmoL/L (mean dosage, 173 mg/day). Excessive dietary intake by patients who were overweight or obese was recorded in 31.5% of patients seen by PCPs and in 19.7% of those seen by OBRs. This finding prompted the delivery of nutritional advice to 45.8% of patients. Discontinuation of excessive alcohol intake was recommended to only 10% of patients. Diuretic therapy discontinuation was feasible in 175 patients but was recommended in only 7 patients. CONCLUSION: Differences between practice patterns and 2006 EULAR recommendations were identified. Simplifying the recommendations and teaching them during medical training and continued medical education may deserve consideration.
INTRODUCTION: In 2006, recommendations about the management of gout were issued by the European League Against Rheumatism (EULAR). The objective of this work was to compare these recommendations to practice patterns of physicians working in private practices in France. METHOD: In a prospective multicenter nationwide study conducted in France, a random sample of primary-care physicians (PCPs) and private-practice rheumatologists (PPRs) was taken in 2009. Each physician included 2 consecutive patients with gout. Each patient was evaluated twice at an interval of 3-6months. Information on EULAR 2006 management modalities were collected in a standardized manner. RESULTS: Of 1003 patients, 771 were evaluated twice. Allopurinol was prescribed to 75.1% of patients in all and was initiated at the first study visit in 44 patients, among whom 19 (43.2%) 19 patients received the recommended starting dosage of 100mg/day. Colchicine therapy to prevent flares was prescribed to 74.3% of patients. Of the 522 patients on allopurinol therapy at the first visit, only 34.5% had serum uric acid levels≤360μmoL/L (mean dosage, 173 mg/day). Excessive dietary intake by patients who were overweight or obese was recorded in 31.5% of patients seen by PCPs and in 19.7% of those seen by OBRs. This finding prompted the delivery of nutritional advice to 45.8% of patients. Discontinuation of excessive alcohol intake was recommended to only 10% of patients. Diuretic therapy discontinuation was feasible in 175 patients but was recommended in only 7 patients. CONCLUSION: Differences between practice patterns and 2006 EULAR recommendations were identified. Simplifying the recommendations and teaching them during medical training and continued medical education may deserve consideration.