Gaps in Practice Appear in Primary Healthcare Physicians Treating Gout

Ibrahim Tawhari, MD, MSc

Credit: LinkedIn

Results of a recent survey indicate despite a moderate level of knowledge and practice among primary healthcare physicians regarding asymptomatic hyperuricemia and gout, there was a gap in implementing this knowledge into personal practice, according to a study published in Cureus.¹ Investigators believe data underscore the need for continuing medical education as well as specialized training programs.

Gout, the most common form of inflammatory arthritis, stems from hyperuricemia, defined as elevated serum urate levels >7.0 mg/dL in men and 6.0 mg/dL in women. Asymptomatic hyperuricemia is characterized by the absence of the clinical monosodium urate crystal deposition disease and is considered a significant medical concern as it is linked to cardiovascular disease, hypertension, chronic kidney disease, and insulin resistance.²

A cross sectional study performed in the Asir region of Saudi Arabia recruited primary healthcare physicians specializing in family medicine and general practice. Participants were invited to complete a modified electronic questionnaire to evaluate their knowledge and practices related to asymptomatic hyperuricemia and gout. The questionnaire also collected demographic data.

Knowledge was evaluated using 5 questions with a total possible score of 7, in which clinicians who scored <50% had poor knowledge on the subject and >75% had good knowledge. Similarly, practices were assessed using an 8-item questionnaire in which patients could receive a total of 12 points. Like the first section, <50% was categorized as poor practice and >75% was considered good practice.

“The urgency of this endeavor is underscored by the looming risk of gout's painful and disabling consequences, which can significantly impair the quality of life and heighten the burden of associated health complications,” wrote Ibrahim Tawhari, MD, MSc, Department of Internal Medicine, College of Medicine, King Khalid University, SAU, and colleagues.

A total of 201 healthcare professionals participated in the study, of which the majority were male (68.2%), 73.1% were aged 25 — 34 years, and 61.2% were practicing as general practitioners. Most (63.7%) had <5 years of experience and 36.8% received continuing medical education on asymptomatic hyperuricemia or gout. Most participants (66.7%) were aware of related management guidelines.

The study showed respondents had a moderate level of knowledge of asymptomatic hyperuricemia and gout, with an average score of 5.18 out of 7. Twenty-two clinicians had poor knowledge (10.9%), 92 had moderate knowledge (45.8%), and 87 had good knowledge (43.3%). The practice level was also deemed moderate, with a mean practice score of 6.75 out of 12. Key practices were measured serum urate levels (51.7%), joint aspiration (31.3%), and initiating urate-lowering therapy during flare (17.9%). Acute management strategies included nonsteroidal anti-inflammatory drugs (85.6%), colchicine (51.7%), and steroids (34.8%). A total of 29.4% of respondents were rated as poor, 61.7% were moderate, and only 9% of respondents were rated as good.

Further, although there were no significant differences in knowledge scores based on age, gender, or years of experience, significant differences were observed based on medical specialty. Female respondents rated slightly higher in both knowledge (5.27) and practice (6.83) scores when compared with men (5.15 and 6.71, respectively). Additionally, family medicine practitioners scored higher in both knowledge (5.54) and practice (7.37) when compared with general practitioners (4.96 and 6.35, respectively).

A significantly positive correlation was observed between knowledge and practice scores (P <.001).

Investigators noted limitations such as the cross-sectional design and only analyzing physicians from the Asir region. Additionally, there is a possibility of self-reporting bias, and the study did not include an exploration of potential reasons behind gaps in knowledge and practice.

“Future research should focus on understanding the barriers to optimal management of asymptomatic hyperuricemia and gout and developing strategies to overcome them,” investigators concluded. “This will ultimately contribute to improved health outcomes for individuals with asymptomatic hyperuricemia and gout, in line with the study's aim.”

References

1. ^{Tawhari I, AlQahtani O A, Alqahtani M S, et al. (January 06, 2024) Assessment of Primary Healthcare Providers’ Knowledge and Practices in Addressing Asymptomatic Hyperuricemia and Gout in the Asir Region of Saudi Arabia. Cureus 16(1): e51745. doi:10.7759/cureus.51745}
2. ^{Waheed Y, Yang F, Sun D: Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease. Korean J Intern Med. 2021, 36:1281-93. 10.3904/kjim.2020.340}