A survey of current prescribing practices of antiinflammatory and urate-lowering drugs in gouty arthritis.
OBJECTIVE: to assess the prescribing habits in late 1988 of rheumatologists (NZR) and a random sample of general practitioners (NZGP) managing gout and hyperuricaemia. DESIGN: self administered questionnaires containing two demographic questions and 24 items probing the selection and prescription of antirheumatic drugs in patients with acute gout, chronic tophaceous gout and asymptomatic hyperuricaemia were sent to every rheumatologist and a 10% random sample of general practitioners in active practice. RESULTS: replies were received from 26 of 27 (96%) rheumatologists and 163 of 207 (79%) of general practitioners Rheumatologists were more likely to use indomethacin as the preferred drug for acute gout, and colchicine either alone or as adjunctive therapy for prophylaxis in chronic gout to prevent acute attacks occurring following the introduction of urate lowering agents, although nonsteroidal antiinflammatory drugs (NSAIDs) were more commonly used for this purpose by both groups. Prior to prescribing urate lowering therapy general practitioners were more likely to attempt control of alcohol intake, and rheumatologists more likely to avoid concomitant low dose salicylates. Allopurinol was the preferred hypouricaemic drug, with rheumatologists more likely to prescribe an initial dose of 100 mg daily, and gradually increase the dose according to the serum urate (SeUa). Although a minority of respondents prescribed allopurinol for asymptomatic hyperuricaemia, general practitioners were more likely to do so at a lower level of serum urate. CONCLUSION: there was a high level of adherence to what is considered optimal contemporary practice, with a number of differences in prescribing habits probably reflecting differences in case selection between patients attending rheumatologists and general practitioners. The data indicates a continuing need for education programmes for both specialists and general practitioners.