Evaluation of the knowledge of internal medicine physicians, final-year medical students and rheumatologists regarding the diagnosis and management of gout in Switzerland

Background Gout is the most common inflammatory rheumatism in adults [1] . Its prevalence and incidence have doubled in the last two decades. However, it is commonly undertreated despite numerous therapeutic options and the availability of international recommendations. Objectives To explore the reasons why gout is undertreated, we aimed to assess and compare the knowledge of primary care physicians (internists), rheumatologists, and final-year medical students regarding the diagnosis and management of gout in Switzerland with mandatory continuing education for physicians. Methods We conducted a multicenter cross-sectional study between December 2021 and August 2022. All primary care physicians and hospital internists practicing in academic hospitals in Switzerland, rheumatology specialists, and final-year medical students from all 6 Swiss faculties of medicine were invited to complete an online questionnaire based on the EULAR 2016, 2018, and ACR 2020 recommendations. This multiple choice questionnaire consisted of 28 questions including 68 positive answers (since more than one positive answer was possible for each question) on gout diagnosis, management of an acute attack, indication to start hypouricaemic treatment and management of patients with renal failure. Participants were considered as having responded successfully to the questionnaire with at least 2/3 (45) correct answers. Results In total, we received approval for participation from 16 academic hospitals, 4 faculties of medicine, and the Swiss Society of Rheumatology. We included a total of 378 participants: 97 medical students, 210 internists and 71 rheumatologists. Figure 1. Percentage of participants who responded successfully to the questionnaire Only 33% of final-year medical students demonstrated sufficient knowledge about how to manage gout, compared to 66% of internists and 93% of rheumatologists. 55%, 48% and 14% in the student, internist and rheumatologist groups respectively did not know what type of crystals were found during a gout attack. The majority of participants in the different groups were familiar with at least one of the treatments that should be used for the management of a first acute attack of gout. Most participants in all 3 groups did not know the indications for initiation of hypouricaemic therapy. 80% of students, 62% of internists and 18% of rheumatologists were unaware of the target urate serum level to aim for when introducing hypouricaemic therapy and more than three-quarters of the students and internists thought that 300 mg was the maximal possible dose of allopurinol. Conclusion These results suggest that knowledge about the diagnosis and management of gout is sub-optimal among final-year medical students and primary care physicians across Switzerland. Although most rheumatologists demonstrated good knowledge about the management of gout, a surprising proportion did not, despite being experts in this field. Knowledge about the diagnosis and management of gout needs to be improved. References [1] Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020 Jul;16(7):380-390. doi: 10.1038/s41584-020-0441-1. Epub 2020 Jun 15. PMID: 32541923. Acknowledgements We would like to thank all those who agreed to participate in this survey. Disclosure of Interests None Declared.