Variations in the Management of Uncontrolled Gout Between Rheumatologists and Nephrologists: A Retrospective Medical Record Review

OBJECTIVE: To evaluate the management practices of rheumatologists and nephrologists in treating patients with uncontrolled gout. METHODS: US board-certified rheumatologists and nephrologists treating patients with uncontrolled gout participated in a web-based, retrospective medical record audit study, sharing their perceptions of uncontrolled gout management and treatment. Two-sample t-tests and chi-square tests were used to test the differences between specialties and the P values reported reflected statistically significant differences. RESULTS: A total of 75 nephrologists and 150 rheumatologists extracted medical records of 611 patients with uncontrolled gout. Common comorbidities included chronic kidney disease (CKD) (85%), hypertension (47%), obesity (36%), and diabetes (35%). Rheumatologists frequently prescribed higher doses of allopurinol (29% vs 17%; P = 0.002) and monitored serum urate (SU) levels at every visit (90% vs 75%; P < 0.001) compared with nephrologists. Patients managed by nephrologists had higher rates of emergency department visits (24% vs 13%; P = 0.001) and hospitalization for gout-related issues (6% vs 1%; P = 0.011) than patients managed by rheumatologists. Both specialties acknowledged a significant burden of current gout treatments among their patients and the need for improved treatment options for uncontrolled gout. CONCLUSION: Rheumatologists prescribed higher gout medication doses and monitored SU levels more frequently, whereas patients with uncontrolled gout managed by nephrologists had higher incidence of CKD and greater health care resource utilization. Both groups agreed on the need for improved gout treatments.