Table 5. Urate-lowering therapy (ULT).
| Questions and respective options | Proportion (95% CI) |
|---|---|
| When would you initiate ULT? Check all that apply. | [N = 308] |
| After their first gouty attack | 45.8 (40.2–51.4) |
| After two or more gouty attacks a year 1 | 64.0 (58.6–69.4) |
| When a patient has tophi 1 | 46.8 (41.1–52.4) |
| When a gout patient has CKD 1 | 24.7 (19.8–29.5) |
| None of the above | 3.6 (1.5–5.7) |
| Choose the SUA level you consider the goal for ULT for a patient WITH TOPHI: 2 | [N = 308] |
| <5.0 mg/dl 1 | 38.0 (32.5–43.4) |
| <6.0 mg/dl 1 | 40.9 (35.4–46.4) |
| <6.8 mg/dl | 5.5 (3.0–8.1) |
| <upper limit provided by the lab | 7.8 (4.8–10.8) |
| I don’t adjust the ULT based on a specific level of serum uric acid. | 7.8 (4.8–10.8) |
| Choose the SUA level you consider the goal for ULT for a patient WITHOUT TOPHI: | [N = 283] |
| <5.0 mg/dl 1 | 15.5 (11.3–19.8) |
| <6.0 mg/dl 1 | 54.4 (48.6–60.3) |
| <6.8 mg/dl | 18.4 (13.8–22.9) |
| <upper limit provided by the lab | 9.5 (6.1–13.0) |
| I don’t adjust the ULT based on a specific level of serum uric acid. | 2.1 (0.4–3.8) |
| If you were to initiate ULT in a patient, would you wait for the resolution of the acute gouty attack? | [N = 302] |
| Yes | 96.7 (94.7–98.7) |
| How long after resolution of the acute gouty attack would you wait to initiate ULT? 3 | [N = 292] |
| 1–3 weeks | 76.7 (71.8–81.6) |
| 4–6 weeks | 21.6 (16.8–26.3) |
| 7–9 weeks | 0.7 (0.0–1.6) |
| 10–12 weeks | 1.0 (0.0–2.2) |
| In general, when you initiate allopurinol, what is the initial dose you prescribe for a patient with normal renal function? | [N = 302] |
| 50 mg/day 1 | 2.3 (0.6–4.0) |
| 100 mg/day 1 | 49.0 (43.3–54.7) |
| 200 mg/day | 6.0 (3.3–8.6) |
| 300 mg/day | 42.7 (37.1–48.3) |
| In general, when you initiate allopurinol, what is the initial dose you prescribe for a patient with CrCl ≤60 ml/min? | [N = 299] |
| 50 mg/day 1 | 28.4 (23.3–33.6) |
| 100 mg/day 1 | 62.5 (57.0–68.1) |
| 200 mg/day | 5.0 (2.5–7.5) |
| 300 mg/day | 4.0 (1.8–6.3) |
| Do you prescribe benzbromarone for patients with CrCl >60 ml/min? | [N = 302] |
| Always | 7.9 (4.9–11.0) |
| Almost always | 16.6 (12.3–20.8) |
| Sometimes | 47.0 (41.4–52.7) |
| Almost never | 14.2 (10.3–18.2) |
| Never | 14.2 (10.3–18.2) |
| Do you prescribe benzbromarone for patients with CrCl between 30 and 60 ml/min? | [N = 302] |
| Always | 3.3 (1.3–5.3) |
| Almost always | 7.6 (4.6–10.6) |
| Sometimes | 22.2 (17.5–26.9) |
| Almost never | 35.4 (30.0–40.9) |
| Never | 31.5 (26.2–36.7) |
| Do you prescribe benzbromarone for patients with CrCl <30 ml/min? | [N = 302] |
| Always | 2.0 (0.4–3.6) |
| Almost always | 2.6 (0.8–4.5) |
| Sometimes | 9.3 (6.0–12.6) |
| Almost never | 15.6 (11.5–19.7) |
| Never | 70.5 (65.4–75.7) |
| Do you prescribe benzbromarone for patients with current renal underexcretion of uric acid and a history of kidney stones in the past? | [N = 302] |
| Always | 3.6 (1.5–5.8) |
| Almost always | 5.0 (2.5–7.4) |
| Sometimes | 12.9 (9.1–16.7) |
| Almost never | 20.9 (16.3–25.5) |
| Never | 57.6 (52.0–63.2) |
| Do you prescribe benzbromarone for patients also using allopurinol? | [N = 302] |
| Always | 1.7 (0.2–3.1) |
| Almost always | 6.3 (3.5–9.0) |
| Sometimes | 42.1 (36.5–47.7) |
| Almost never | 21.5 (16.9–26.2) |
| Never | 28.5 (23.4–33.6) |
| For how long after achieving the target SUA level do you prescribe ULT for a patient with gout WITHOUT tophi? | [N = 283] |
| Withdraw the medication | 2.1 (0.4–3.8) |
| Maintain for 1–6 months | 21.6 (16.7–26.4) |
| Maintain for 7–11 months | 11.7 (7.9–15.4) |
| Maintain for 1–3 years | 17.3 (12.9–21.7) |
| Maintain for 4 or more years | 7.8 (4.6–10.9) |
| Maintain indefinitely 1 | 39.6 (33.8–45.3) |
| For how long after achieving the target SUA level do you prescribe ULT for a patient with gout WITH tophi? | [N = 283] |
| Withdraw the medication | 1.4 (0.0–2.8) |
| Maintain for 1–6 months | 2.8 (0.9–4.8) |
| Maintain for 7–11 months | 4.2 (1.9–6.6) |
| Maintain for 1–3 years | 6.4 (3.5–9.2) |
| Maintain for 4 or more years | 3.2 (1.1–5.2) |
| Maintain until tophi resolution | 5.7 (2.9–8.4) |
| Maintain indefinitely 1 | 76.3 (71.3–81.3) |
| How often do you check your patients SUA levels BEFORE achieving uric-acid levels goals? | [N = 283] |
| Every 1–3 months 1 | 80.6 (75.9–85.2) |
| Every 4–6 months | 19.1 (14.5–23.7) |
| Every 7–9 months | 0.4 (0.3–1.0) |
| Every 10–12 months | 0.0 (-) |
| How often do you check your patients SUA levels AFTER achieving uric-acid levels goals? | [N = 283] |
| Every 1–3 months | 5.7 (2.9–8.4) |
| Every 4–6 months 1 | 71.4 (66.1–76.7) |
| Every 7–9 months | 13.1 (9.1–17.0) |
| Every 10–12 months | 9.9 (6.4–13.4) |
1Answers in agreement with the 2012 American College of Rheumatology gout guidelines
2participants who reported not to adjust ULT for patients with tophaceous gout based on the SUA level were excluded from other questions that were based on the concept of a target SUA level
3this question was offered only to those who answered that they would wait for the resolution of the acute gouty attack to initiate ULT.
CI: confidence interval; CKD: chronic kidney disease; SUA: serum uric acid; CrCl: creatinine clearance.