Variability of treatment for gouty arthritis between rheumatologists and primary care physicians

Michelle V. Medellin, Alan R. Erickson, Raymond J. Enzenauer

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Wide variability exists in the treatment of gout. We compared the treatment practices of rheumatologists with those of primary care physicians (PCPs) in the management of gout. Pharmacy records were reviewed to identify patients treated with colchicine, allopurinol, probenecid, or sulfinpyrazone. Forty PCP patients were compared with 33 patients followed by rheumatologists. Rheumatologists were three times more likely to confirm the diagnosis with joint aspiration and guide therapy with 24-h urine uric acid collections than were PCPs. Rheumatologists were more likely to use prophylaxis in acute gout before initiating uric acid-lowering therapy than were PCPs. All PCP patients were treated with allopurinol compared with 65% of rheumatology patients. Mean posttreatment uric acid levels were lower for rheumatology patients (5.0 mg/dL) compared with PCP patients (6.0 mg/dL). Previous studies have reported poor symptom control and increased toxicity in gouty patients with suboptimal treatment. With the vast majority of patients being treated by PCPs in a managed care setting, further studies will be necessary to determine whether treatment variability affects outcome between the two groups.

Original languageEnglish (US)
Pages (from-to)24-27
Number of pages4
JournalJournal of Clinical Rheumatology
Volume3
Issue number1
DOIs
StatePublished - Feb 1997

Keywords

  • Allopurinol
  • Gouty arthritis
  • Joint aspiration
  • Uric acid
  • Uricosurics

ASJC Scopus subject areas

  • Rheumatology

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