AB1240 PERCEPTIONS OF GOUT AND ITS MANAGEMENT PATTERNS: FINDINGS FROM SURVEY AND STRUCTURED INTERVIEWS WITH PRIMARY CARE PHYSICIANS AND RHEUMATOLOGISTS

Abstract

BackgroundDespite the high prevalence of gout worldwide,[1]there is widespread undertreatment of this painful, debilitating inflammatory arthritis.[2,3]Gout patients who maintain serum urate (SU) <6 mg/dL have fewer flares, less joint involvement, and overall better quality of life.[3]However, gout management guidelines differ substantially between the American College of Physicians (ACP)[4]and the American College of Rheumatology (ACR),[5]most notably with ACP recommending oral urate-lowering therapy (ULT; allopurinol, febuxostat, probenicid) use only in patients with frequent gout attacks with no clear SU-target and ACR recommending oral urate-lowering therapy use in all gout patients with tophi, flares, or gout-related bone damage with a treat-to-target approach to an SU <6 mg/dL. Because primary care physicians (PCPs) are often a first point-of-contact for patients suffering from gout, understanding their perceptions and management strategies of gout is of importance.ObjectivesTo better understand how PCPs perceive and manage gout.MethodsAn online survey was administered to PCPs regarding perceptions of gout patients, gout severity grading, gout treatment strategies, and gout patient referral patterns. A 5-point Likert scale was used to gauge perceptions and patterns. Additionally, structured 30-60 minute interviews of similar focus were conducted with PCPs and rheumatologists (all interviews conducted by a single interviewer [RL]). These interviews provided further insight into PCP perceptions of gout and allowed similarities and differences between physician types to be examined. A 10-point Likert scale was used to quantify select interview responses.ResultsA total of 56 PCPs completed the online survey, with most practicing in a metropolitan area (84%) and seeing >50 patients/week (66%). 98% of participating PCPs reported seeing <10 known gout cases/week, with 82% having high or very high confidence in their ability to manage gout. Anti-inflammatory treatments (89%), oral ULTs (88%), diet (70%), and biologic therapies (59%) were viewed by most as being highly effective or very highly effective. Further, 63% of PCPs viewed gout patients as always or almost always compliant with medication and 66% of PCPs reported that gout patients never or almost never ask for referral to a gout specialist. However, when PCPs did make a referral, it was most often for severe gout. The low referral rate coincided with the observation that the majority of PCPs (79%) reported most-commonly seeing gout of “medium” severity. Further insight was gained from 5 PCP and 5 rheumatologist interviews conducted. PCPs and rheumatologists viewed gout patient compliance differently, with PCPs perceiving a higher rate of compliance (7.3 vs. 5.7). Both PCPs and specialists expressed that gout flare data collection and gout severity determinant tools would be useful for patient management, including therapy efficacy evaluation.ConclusionThese findings suggest that, despite widespread undertreatment of gout outside of specialty care,[2]PCPs reported high comfort in managing gout, high compliance of gout patients, and little need for specialty referral except when gout is severe and refractory. Both PCPs and rheumatologists expressed that tools for determining gout severity and tracking gout flares would be helpful. We suggest that such tools could serve as guides for PCPs when monitoring for success of therapy and when to make a rheumatology referral.