Rheumatologists' understanding of Refractory Gout: A questionnaire survey in China

Abstract

Background Refractory gout is a common problem faced by experienced rheumatologists, relevant research on the difficulties of gout treatment and the understanding of "refractory gout" by rheumatologists is lacking. Methods A total of 910 Chinese rheumatologists attending the annual academic conference on rheumatism completed the electronic questionnaires. The differences in the judgment of refractory gout were analyzed between the senior experience (SE) group and the general experience (GE) group. Results A total of 751 (82.5%) respondents with relevant continuing medical education (CME) were included in our study, including 175 (23.3%) SE rheumatologists and 576 (76.7%) GE rheumatologists. Most of the rheumatologists (715, 95.2%) considered renal function insufficiency as a common complication making gout challenging to treat, while rheumatologists with different experiences had different attitudes towards obesity. For the chronic gouty arthritis patients with one or more tophi, 476 (63.9%) Chinese rheumatologists preferred febuxostat as the first-line treatment option, while 582 (78.3%) chose the maximum daily dose of 80mg for febuxostat, with a higher proportion in SE group than GE group. Meanwhile, the proportion of doctors who chose the dosage of all three uric-lowering drugs consistently with the guidelines was higher in the SE group. Moreover, 123 (70.3%) people in the SE group thought that regardless of the use of drugs for prevention of attack during ULT, the recurrence of symptoms was symptomatic of refractory gout, while fewer in GE group agreed. Similarly, 119 (68.0%) in the SE group thought that failure to achieve the targeted serum uric acid level within 6 months of standardized urate-lowering therapy could be assigned to refractory gout, while fewer in GE group agreed. In terms of personal and social factors, the SE group had a higher percentage of physicians concerned about poor compliance leading to irregular treatment and drug abuse. Conclusions Most of the rheumatologists selected uric-lowering drugs and the maximum dosage of medicines consistently with guidelines. Uncontrolled symptoms, unattainable therapeutic targets, and unimproved lifestyle and compliance of patients are difficulties that Chinese rheumatologists have to face with during gout treatment.