Fernando Perez Ruiz1,2, Carlos A Sanchez-Piedra3, Jesus T Sanchez-Costa3, Mariano Andrés4,5, Cesar Diaz-Torne6, Mercedes Jimenez-Palop7, Eugenio De Miguel8, Carmen Moragues9, Francisca Sivera10. 1. Hospital Universitario Cruces e Instituto de Investigación Biomédica Biocruces, Vizcaya, Spain. fperezruiz@telefonica.net. 2. Universidad del País Vasco, Vizcaya, Spain. fperezruiz@telefonica.net. 3. Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain. 4. Hospital General Universitario de Alicante, Alicante, Spain. 5. Universidad Miguel Hernández, Alicante, Spain. 6. Hospital de la Santa Cruz y San Pablo, Barcelona, Spain. 7. Hospital Universitario Puerta de Hierro, Madrid, Spain. 8. Hospital Universitario La Paz, Madrid, Spain. 9. Hospital Universitario Bellvitge, Barcelona, Spain. 10. Hospital Universitario de Elda, Alicante, Spain.
Abstract
INTRODUCTION: The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. METHODS: The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. RESULTS: Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. CONCLUSION: Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. FUNDING: Menarini España.
INTRODUCTION: The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. METHODS: The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. RESULTS: Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. CONCLUSION: Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. FUNDING: Menarini España.
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Authors: Michael A Becker; H Ralph Schumacher; Robert L Wortmann; Patricia A MacDonald; Denise Eustace; William A Palo; Janet Streit; Nancy Joseph-Ridge Journal: N Engl J Med Date: 2005-12-08 Impact factor: 91.245
Authors: W Zhang; M Doherty; E Pascual; T Bardin; V Barskova; P Conaghan; J Gerster; J Jacobs; B Leeb; F Lioté; G McCarthy; P Netter; G Nuki; F Perez-Ruiz; A Pignone; J Pimentão; L Punzi; E Roddy; T Uhlig; I Zimmermann-Gòrska Journal: Ann Rheum Dis Date: 2006-05-17 Impact factor: 19.103
Authors: W Zhang; M Doherty; T Bardin; E Pascual; V Barskova; P Conaghan; J Gerster; J Jacobs; B Leeb; F Lioté; G McCarthy; P Netter; G Nuki; F Perez-Ruiz; A Pignone; J Pimentão; L Punzi; E Roddy; T Uhlig; I Zimmermann-Gòrska Journal: Ann Rheum Dis Date: 2006-05-17 Impact factor: 19.103
Authors: Fernando Pérez Ruiz; Pascal Richette; Austin G Stack; Ravichandra Karra Gurunath; Ma Jesus García de Yébenes; Loreto Carmona Journal: RMD Open Date: 2019-10-13
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