OBJECTIVE: To determine the practice of Filipino physicians in the management of gout

METHODS: A random survey was done at the rheumatology round-table discussions (RTD) and lecture symposia in Metro Manila and key cities in the Philippines, from March to August 2007. A set of questionnaires directed along clinical management of gout was asked to the physicians/trainees attending the rheumatology symposia or RTD.

RESULT: Of the 412 questionnaires distributed, 287 (69.7 percent) were available for evaluation. There were 112 (39.0 percent) internists/family physicians, 18 (6.3 percent) allied specialties, 117 (40.7 percent) general practitioners, 22 (7.7 percent) medical students/interns, and 18 (6.3% ) who did not indicate their fields of practice. Mean age of respondents was 44.3 +_ 12.6 years. Mean duration of practice was 14.6 +_ 11.6 years.

Generally, 150 (52.3 percent) respondents would prescribe urate lowering drug (ULD) during asymptomatic hyperuricemia, 94 (32.7 percent) after the first gouty attack, while 18 (6.3 percent) after at least 2-4 episodes of gout flares. For confirmatory diagnosis of gout, 173 (60.3 percent) respondents would want synovial fluid be examined in patients suspected for gout, 160 (55.7 percent) of them agreed to examine it once. For the management of acute gouty arthritis in an otherwise healthy patient, 136 (47.4 percent) chose colchicine, 57 (19.8 percent) non-steroidal anti-inflammatory drugs (NSAIDs), and 80 (27.9 percent) allopurinol. While for acute gout patients with renal impairment, 35 (12.2 percent) chose corticosteroid, 57 (19.9 percent) allopurinol, 44 (15.3 percent) NSAIDs.

For the dosage and frequency of colchicine during acute gout flare, 45 (15.7 percent) would give it t.i.d. daily for 3 days, one tablet hourly until pain relief in 44 (15.3 percent), one tablet hourly until abdominal toxicity occurs in 46 (16 percent), one tablet until maximum of 6 tablets/day in 72 (25 percent).

Ninety six (33.4 percent) preferred to initiate ULD 1-2 weeks after acute gouty flare, while 85 (29.6 percent) during acute flare of gout. In chronic gouty arthritis, 95 (33.1 percent) chose to use colchicine for prophylaxis while NSAIDs in 124 (43.2 percent). Ninety eight (34.1 percent) would discontinue prophylaxis soon after achieving a normal serum uric acid in a patient without evident tophi, while 90 (31.4 percent) would discontinue in 1-3 weeks, 51 (17.8 percent) in 1-6 months. Thirteen (4.5 percent) respondents would give ULD for life, while majority [148 (51.6 percent)] would discontinue it when serum uric acid normalizes.

Eighty-six respondents (30%) would request follow up SUA level once a month, 33 (11.5 percent) every 2 months, 120 (41.8 percent) every 3-6 months. One hundred forty seven (51.2 percent) would set < 5mg/dl while 95 (33.1 percent) chose < 6.0 mg/dl as the target SUA level in gout management.

CONCLUSION: This survey evidently shows the various inconsistent practices among physicians in the clinical management of gout. An efficient educational program should be designed in order to improve physicians' skills in the survey, hyperuricemia diagnosis and clinical management of gout.