Variability of Treatment for Gouty Arthritis Between Rheumatologists and Primary Care Physicians
作者:
Michelle Medellin,
Alan Erickson,
Raymond Enzenauer,
期刊:
JCR: Journal of Clinical Rheumatology
(OVID Available online 1997)
卷期:
Volume 3,
issue 1
页码: 24-27
ISSN:1076-1608
年代: 1997
出版商: OVID
关键词: Gouty arthritis;Uricosurics;Allopurinol;Joint aspiration;Uric acid
数据来源: OVID
摘要:
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 man-aged care setting, further studies will be necessary to determine whether treatment variability affects outcome between the two groups.
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