AB1714 GOUT TREATMENT: ARE TUNISIAN INTERNS FOLLOWING INTERNATIONAL RECOMMENDATIONS?

Abstract

BackgroundGout is a common metabolic disease affecting at least 1% of the population. Its therapeutic management was recently redefined by the recommendations of the French society of rheumatology (SFR) 2020 [1,2].ObjectivesWe aimed to determine the level of adherence of Tunisian rheumatology interns to these recommendations.MethodsWe conducted a 26-item online questionnaire via Google Drive Forms destined to rheumatology interns. The questionnaire intended to assess the degree of application of the French recommendations for the treatment of gout.ResultsThe online questionnaire was sent to 50 rheumatology interns, 19 of whom (38%) responded. Thirty-one percent of participants were in first year, 15.7% in second year, 16% in third year and 31.5% in fourth year. The mean age was 28.3 ±8.7 years [26-33]. All participants were female. The average number of rheumatology internships performed was 3.9 ±0,2 [1-6]. All of the participants declared informing their patients of their pathology. The information given concerned the disease (94.7%), the aim of treatment (78.9%), the need for long-term adherence to treatment (94.7%), the risk of onset of gout symptoms at initiation of treatment (84.7%) and necessary adaptations to lifestyle (94.7%). Eighteen interns (94.7%) advised their patients to avoid certain foods: soda (84.2%), beer (89.4%), wine (36.8%), red meat (84.2%), fish (63.1%), chicken (26.3%) and seafood (73.6%). Almost all physicians screened for comorbidities (94.7%): hypertension (73.6%), dyslipidemia (78.9%), obesity (63.1%) and renal failure (78.9%). The therapeutic means that can be used in gout flares according to the doctors questioned were the following: non-steroidal anti-inflammatory drugs (NSAIDs) (94.7%), colchicine (100%), corticosteroid therapy (94.7%) and anti-interleukin1 (36.8%). Faced with a gout flare, 17 interns (89.4%) prescribed colchicine within 12 hours after the symptoms’ onset. Eleven interns (57.8%) followed the therapeutic regimen recommended by the SFR for flare treatment with colchicine. In the event of the onset of diarrhoea under colchicine, 8 interns (42.1%) stopped the treatment. Regarding corticosteroid therapy, the recommended dose of 30 to 35 mg/day was prescribed in 42.1% of cases. In case of kidney failure, doctors avoided prescribing NSAIDs in 89.4% of cases and colchicine in 63.1% of cases. Eighteen physicians (94.7%) prescribed allopurinol from the first gout flare. Colchicine was prescribed simultaneously with allopurinol in 47.3% of cases. Sixteen interns prescribed colchicine for six months in combination with urate-lowering treatment. Interns were aiming for a therapeutic uricemia target of 50mg/L in 15.7% of cases and 60mg/L in 73.6% of cases. The urate-lowering treatment was maintained for life by 57.8% of the interns, while it was stopped as soon as the therapeutic target was reached in 26.3% with retreatment if recurrence in 21% of the cases. Faced with a decrease in renal clearance, no intern stopped allopurinol and 78.9% of doctors prescribed it subject to monitoring. Once the therapeutic target had been reached, 84.2% of participants recommended monitoring uricemia every 6 to 12 months.ConclusionTunisian rheumatology interns do not fully follow the new French recommendations for the treatment of gout. Thus, medical training on the subject seems necessary in order to optimize the treatment of this pathology in Tunisian hospitals.