Main Article Content

Abstract

Backgrounds: The global prevalence of gout and hyperuricemia is increasing in recent years. As the most visited health care service, it is thus become more important that general practitioners have proper approach in the diagnosis and treatment of patients with
gout, in order to prevent complications of the disease as well as adverse effects of inappropriate and improper use of medications.

Objective: To determine whether the practice of general practitioners on the clinical diagnosis and management of gout in Bandung have been appropriate, with the implementation of evidence-based medicine.

Methods: This was a descriptive cross-sectional qualitative study, done by survey using a questionnaire, conducted among general practitioners who attended medical symposia in Bandung from January to March 2011.

Result: There were 173 respondents participating in this survey. Median age of respondents was 33 years (range 23–73 years), with median duration of practice of 7 years (range 0–45 years). The largest proportion of the respondents often suggested measurement of serum uric acid to patients with any joint pain (45.7%), did not recommend synovial fluid examination to patients suspected of having gout (80.8%), usually prescribed
allopurinol to patients with asymptomatic hyperuricemia (52.6%), initiated allopurinol therapy during acute gout attack (35.8%), discontinued allopurinol therapy when serum uric acid normalizes (61.8%), and only very rarely gave prophylactic treatment to patients who started allopurinol therapy (43.4%).

Conclusion: The majority of general practitioners had not applied or aware about evidence-based medicine in the diagnosis and management of gouty arthritis.

Article Details

How to Cite
Hidayat, I., Hamijoyo, L., & Moeliono, M. A. (2018). A survey on the clinical diagnosis and management of gout among general practitioners in Bandung. Indonesian Journal of Rheumatology, 4(1). https://doi.org/10.37275/ijr.v4i1.86

References

  1. McLean L. The pathogenesis of gout. In: Hochberg M, Silman A, Smolen J, Weinblatt M, Weisman M, editors. Rheumatology. 3rd ed. London: Mosby; 2003. p. 1903–18.
  2. Terkeltaub R, Zelman D, Scavulli J, Perez-Ruiz F, Liote F. Gout Study Group: update on hyperuricemia and gout. Joint Bone Spine 2009;76:444–6.
  3. Hensen, Putra TR. Association between purine consumption and hyperuricemia in Balinese people living in tourist village [Hubungan konsumsi purin dengan hiperurisemia pada suku bali di daerahpariwisata pedesaan]. J Peny Dalam 2007; 8(1):37–43.
  4. Indrawan I. Association between high purine consumption and hyperuricemia: a cross-sectional analysis of Balinese people in Denpasar [Hubungan konsumsi purin tinggi dengan hiperurisemia studi potong lintang analitik pada penduduk suku Bali di kota Denpasar] [Thesis]: Universitas Udayana; 2005.
  5. Putra TR. Prevalensi hiperurisemia pada suku Bali di Desa Sembiran. [Thesis]. 2000.
  6. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD. The epidemiology of gout and hyperuricemia in a rural population of Java. J Rheumatol 1992;19(10):1595–9.
  7. Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician 2003;68:83–90.
  8. Indonesian Medical Council [Konsil Kedokteran Indonesia].
  9. Competency standards for doctors in primary health care in Indonesia [Standar kompetensi dokter Indonesia]. Jakarta: Indonesian Medical Council; 2006.
  10. Wortmann R. Gout and hyperuricemia. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, Sergent JS, editors. Kelley’s textbook of rheumatology. 8th ed. Philadelphia: WB Saunders; 2008. p. 1481–504.
  11. Dabu P. Penyebaran dokter belum merata, pemerintah usulkan asas afirmasi. [Online]. 2011 [cited 2011 June 10]; Available from: URL:http://nasional.kontan.co.id/v2 /read/1306741136/68878/ Penyebaran-dokter-belum-merata-pemerintah-usulkan-asas-afirmasi.
  12. BPS-Statistics Indonesia. Result of the 2000 population census [Hasil sensus penduduk 2000]. Jakarta: BPS-Statistics Indonesia; 2002.
  13. Jumlah dokter praktik di Bandung berlebih. Harian Pikiran Rakyat (Bandung) 2009 May 5.
  14. Fang W, Zeng X, Li M, Chen LX, Schumacher HR, Jr., Zhang F. The management of gout at an academic healthcare center in Beijing: a physician survey. J Rheumatol 2006;33:2041–9.
  15. Hamijoyo L, Yu J, Torralba T. A survey on clinical management of gout among Filipino physicians. Philippines Journal of Internal Medicine 2008;46:51–5.
  16. Data from the rheumatology clinic in 2010. Division of Rheumatology, Department of Internal Medicine, Hasan Sadikin Hospital; 2011.
  17. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977;20: 895–900.
  18. Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence-based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1301–11.
  19. Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology 2007;46:1372–4.
  20. Schumacher HR, Chen LX. Gout and other crystal-associated arthropathies. In: Fauci AS, Kasper DL, Longo DL, Braunwald E,Hauser SL, Jameson JL, et al, editors. Harrison’s principles of internal medicine. 17th ed. New York: Mc Graw-Hill’s; 2008. p. 2165–9.
  21. Cronstein BN, Terkeltaub R. The inflammatory process of gout and its treatment. Arthritis Res Ther 2006;8 Suppl 1:S3.
  22. Choudhury D, Ahmed Z. Drug-associated renal dysfunction and injury. Nat Clin Pract Nephrol 2006;2(2):80–91.
  23. Wortmann R. Disorders of Purine and Pyrimidine Metabolism. In: Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al, editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw-Hill’s; 2008. p. 2444–9.
  24. Perez-Ruiz F. Treating to target: a strategy to cure gout. Rheumatology.2009;48 Suppl 2:ii9–ii14.
  25. Gaffo AL, Saag KG. Febuxostat: the evidence for its use in the treatment of hyperuricemia and gout. Core Evid 2010;4:25–36.
  26. Sachs L, Batra KL, Zimmermann B. Medical implications of hyperuricemia. Med Health R I 2009;92:353–5.
  27. Rho YH, Choi SJ, Lee YH, Ji JD, Choi KM, Baik SH, et al. The prevalence of metabolic syndrome in patients with gout: a multicenter study. J Korean Med Sci 2005;20:1029–33.
  28. Feig DI, Kang D-H, Johnson RJ. Uric acid and cardiovascular risk. NEJM 2008;359: 1811–21.
  29. Navaneethan SD, Beddhu S. Associations of serum uric acid with cardiovascular events and mortality in moderate chronic kidney disease. Nephrol Dial Transplant 2009;24:1260–6.
  30. Ranu H, Jiang J, Ming PS. A case series of allopurinol-induced toxic epidermal necrolysis. Indian J Dermatol 2011;56(1):74–6.
  31. Furst DE, Ulrich R, Altamirano C. Nonstreroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, nonopioid analgesic, and drugs used in gout. In: Katzung B, Trevor A, Masters S, editors. Basic and clinical pharmacology. 11th ed. San Fransisco: McGraw-Hill;2009. p. 621–40.
  32. Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR evidence-based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). AnnRheum Dis 2006;65:1312–24.
  33. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM2004;350:1093–103.
  34. Dalbeth N, Collis J, Gregory K, Clark B, Robinson E, McQueen FM. Tophaceous joint disease strongly predicts hand function in patients with gout. Rheumatology 2007;46:1804–7.
  35. Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 2002;47:356–60.
  36. Lee SJ, Hirsch JD, Terkeltaub R, Khanna D, Singh JA, Sarkin A, et al. Perceptions of disease and health-related quality of life among patients with gout. Rheumatology 2009;48:582–6