Do Rheumatologists Follow 2020 ACR Guidelines on Gout? Save

Schlessinger and colleagues report that US Rheumatologists generally adhere to and agree with the 2020 American College of Rheumatology (ACR) Guideline for the Management of Gout, although knowledge gaps and practice variance exists.

A total of 201 US Rheumatologists responded to a 57-item questionnaire testing their views and practices regarding guideline recommendations and whether they followed the recommendations.

On a scale of 0-15 (maximum), respondents had an adherence score of 11.5, and stated agreement score of 7.7 (maximum 14). 

Younger, less experienced rheumatologists (≤ 8 yrs; n = 49) were more adherent, than those with more experience (> 8 yrs) with mean stated adherence scores of 12.3 vs 11.3; P ≤ 0.05).  Similarly, rheumatologists who see ≤ 75 patients with gout in 6 months (n = 66) had a mean stated adherence score of 12.1 vs 11.2 for those who claimed to have seen > 75 patients (P ≤ 0.05). 

Nearly three-quarters (78%) of rheumatologists follow the guideline for initiating urate-lowering therapy (ULT), with 89% using allopurinol as a first-line ULT. Adherence to dosing recommendations was lower for febuxostat (43%) and allopurinol (39%). 

Rheumatologists from academic settings were more likely to prescribe an interleukin-1 inhibitor for gout flares.

Despite being aware of and generally following 2020 ACR guidelines on gout, rheumatologists vary in guideline knowledge and stated adherence, especially with ULT dosing regimens.