An Audit of the Variability of Diagnosis and Management of Gout in the Rheumatology Setting

Abstract

Overall, implementation of clinical care in gout should be put on further attention to diagnosis, time-consuming evaluation of comorbidities, and long-term control of serum urate levels.

Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice

“…However, crystal-proven diagnosis was obtained in only 162/506 (32.0%) patients. As the rate of crystal-proven diagnosis attained in the GEMA audit was 26.0% (209/ 803) [5], the improvement in crystal-proven diagnosis was just 31%. For patients with noncrystal-proved diagnosis, it was based on just clinical findings in 35 patients (6.9%), on clinical findings plus hyperuricemia in 273 (54.0%), on clinical plus radiographic findings in 32 (6.3%), and on specific ultrasonographic findings in 4 (0.8%).…”

“…The cases were randomly selected using the same methodology as in GEMA, as previously described [5]. All 41 centers that participated in GEMA were invited to participate in GEMA-2.…”

“…Study variables included in the CRF, identical to those evaluated in GEMA, encompassed demographic and lifestyle data, associated comorbidities, diagnosis of gout, and evaluation of disease burden, clinical characteristics, and treatments for gout (medications for flares, prophylaxis, and urate-lowering drugs) prescribed both prior to and ongoing at the last visit [5]. Additional variables characterizing each unit were obtained from the local principal investigator or head of unit as applicable; specifically, the availability of a specific gout-dedicated clinic, a polarizing microscope, an ultrasonography machine, a specific protocol for gout, implementation of EULAR recommendations at any time since their publication, and a perception of achieving gold standard diagnoses and sUA targets in at least 50% of patients.…”

“…The GEMA (Gout Evaluation and MAnagement) study assessed rheumatology practice in Spain in comparison to the European League Against Rheumatism (EULAR) 2006 recommendations for gout and found that, even in a theoretical gold-standard setting, optimal diagnosis was achieved only in approximately one in four patients and target sUA in less than one in two [5]. The GEMA-2 study was conceived and developed as a commitment, within the design of GEMA, to evaluate changes in rheumatology practice over time.…”

Criteria for Gout Diagnosis?

“…However, adherence to crystal-proven diagnosis, for both gout and CPP crystal arthritis, has remained low among rheumatologists 11,12 , maybe contributing to the persistent interest in the construction of diagnostic and classification criteria. Several such criteria have been published 13,14,15,16,17 ; although developed for classification, criteria are often used for diagnosis, which can be problematic when applied for the diagnosis of individual patients 18 .…”