Pitfalls in management of acute gouty attack, a qualitative research conducted in Makah Region – Saudi Arabia

Abstract

Objective: To probe doctors’ attitudes and reveal wrong perception in the management
of acute gouty attacks.
Design: A descriptive study using a designed questionnaire that was completed through face to face interviews in hospitals, health units and polyclinics in the Makah Region.
Method: This is a qualitative study of treatment by 99 doctors conducted in the second half of 2012. The sample included orthopedists, rheumatologists, general practitioners and family physicians.
Results: 72 (72.7%) doctors started treatment of acute attacks with mono-therapy. 58 doctors (58.6%) started with NSAIDs. Indomethacin was the most frequent prescribed NSAIDs. 18 doctors (18.2%) prescribed Allopurinol as the first drug of choice. 42 doctors (43.8%) started Allopurinol ‘‘2 weeks after acute attack’’. 31 doctors (32.3%) mentioned that they used 100 mg daily dose. 41 doctors (42.7%) mentioned that the starting dose depends on the patient’s condition. Allopurinol was prescribed once daily by 37 doctors (38.9%). 53 doctors (55.8%) used Allopurinol as prophylaxis. The most frequent test requested was a 24-h urine test for uric acid. In case patients were already on Allopurinol and presented with an acute attack of gout; 33 doctors (34.7%) tended to ‘‘increase the dose’’. The most important factor in adjusting the Allopurinol dose is Serum Uric Acid Level. 37 doctors (39.4%) mentioned that they ask for Serum Uric Acid Level every 3–4 weeks. 
Conclusion: There were common pitfalls that need a training program to increase awareness of doctors with general guidelines and recommendations. The most critical pitfalls include prescribing Allopurinol in acute gouty attacks and ignoring the Renal Function Test.