Survey of hyperuricemia and gout management among Thai physicians

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Objective: To survey the management of hyperuricemia and gout among Thai physicians. Materials and Methods: The present study was a cross-sectional questionnaire survey sent to 3,916 Thai physicians working in Thailand. Participants with no experience managing hyperuricemia and gout were excluded. Results: Of the 742 (18.9%) physician respondents, 607 (81.8%) reported having experience managing hyperuricemia and gout. Regarding acute gouty arthritis management, oral colchicine (98%) and non-steroidal anti-inflammatory drugs (91%) were the two most commonly prescribed medications to control acute gouty arthritis. High-dose regimen of colchicine (1.2 mg followed by 0.6 mg every two hours until symptom relief or marked toxicity) would be ordered by 28% of physicians. Regarding urate-lowering therapy (ULT), 33% of participants would start ULT in a patient with asymptomatic hyperuricemia, and 59% would start ULT if serum uric acid (sUA) was more than 11 mg/dl. Approximately 70% of physicians would start allopurinol at no more than 100 mg/day, 63% set the sUA target at less than 6 mg/dl, and, 80% would limit the maximal dosage of allopurinol according to renal function. Only 14% of respondents would continue ULT lifelong. Most physicians (95%) would prevent gout flare when starting ULT, and most (95%) used colchicine to prevent gout flare. Conclusion: The results of the present study revealed suboptimal management of hyperuricemia and gout, especially high-dose regimen of colchicine for acute gout, the sUA target and ULT duration, among Thai physicians. Improved condition-specific training and updated management guidelines are needed to improve the care and outcomes of hyperuricemia and gout patients in Thailand.