Avaliação do padrão de tratamento da artrite gotosa entre os médicos residentes de reumatologia no Brasil

Abstract

Gout is an inflammatory arthropathy caused by the deposition of monosodium urate crystals in joints and other tissues. It affects about 3.9% in the United States of America. Due to its high prevalence, most gout patients are followed up by general practitioners. It is expected, therefore, during the clinical residency that management of gout patients to be part of the programmatic content. On the other hand, with gout being a rheumatological disease, rheumatology residents should be exposed to an increasing number of patients with gout during the residency program. Therefore, it would be expected that physicians fresh out of rheumatology residency (TR) had more knowledge about the treatment of gout patients than those entering the second year of the program (R2). These, in turn, should be better trained in this subject than those entering the first year (R1), fresh out of the clinical residency. Recently the standard of gout treatment by Brazilian rheumatologists was evaluated by our group. As the rheumatology residents were not part of this previous study, but are the future professionals of this specialty, the standard of gout treatment by this group of physicians was evaluated. A cross - sectional study was carried out using a census, through a research site, with R1, R2 and TR in Brazil. The results of the research were compared with the rheumatologists (REU) of our previous study in Brazil and with the 2012 ACR (American College of Rheumatology) guidelines on gout management. To evaluate the treatment pattern of gout during the rheumatology residency the responses of R1 with TR were compared. In order to analyze the treatment standard of gout at the end of the residence and the clinical practice after the residence, the responses of the TR with REU were compared. A total of 224 responses (82%) were obtained from 271 participants. Among all responders, the first-choice treatment for gout flares in patients without comorbidities was the combination of anti-inflammatory drug and colchicine. In gout flares for patients with CrCl &#8804;60ml/min, the treatment of choice was the use of corticosteroids as monotherapy for R1, R2 and TR and colchicines associated corticoid for REU. Maintaining a serum uric acid level <6 mg/dL for patients without tophi was reported by 79% of R1, 88% R2, 78% TR and 70% of REU. responders. In patients without tophi 33 43% reported maintaining urate-lowering therapy indefinitely. The residency stage was the main predictor of agreement with the ACR guidelines. In general, a high degree of agreement with the ACR guidelines was observed by rheumatology residents, especially TRs. However, some important aspects of gout management need to be improved. These results will guide the development of a medical education program to improve the management of gout patients in Brazil.