Rheumatologists are Not Always Aligned with 2012 ACR Gout Guidelines Save

A cross-sectional survey of 309 Brazilan rheumatologists was performed to assess their compliance with the 2012 ACR guidelines on gout. Specifically, they assess their use of colchicine, prophylaxis with urate-lowering therapy (ULT), not interrupting ULT during acute gout, targetting SUA < 6.0 mg/dl, and allopurinol dosing regiment (e.g., starting at 100 mg qd).

During acute attacks, combination therapy (NSAIDs or steroid + colchicine) was used by nearly half, followed by NSAIDs and colchicine monotherapy.  During an acute attack, ULT was withdrawn by one-third of rheumatologists. 90% always or almost always prescribe a prophylactic treatment when initiating ULT.  Only 70% considered the target serum uric acid level to be less than 6 mg/dl. Approximately 50% of rheumatologists reported starting allopurinol at doses of 100 mg daily or less and 42% reported the initial dose to be 300 mg daily in patients with normal renal function. 

Despite being "experts in gout", rheumatologist practices may not be aligned with ACR guidelines.  Gaps in education and variability of approaches to gout management suggests more education and consensus is needed.