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ARTICLE IN PRESS Joint Bone Spine xxx (2014) xxx–xxx

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Letter to the Editor Gout in French Polynesia: A survey of common practices

a r t i c l e

Table 1 Comparison of the management of ULT between French Polynesia and Metropolitan France.

i n f o

Keywords: Gout Polynesia Questionnaire Survey Common practice

Gout has a higher prevalence in French Polynesia (FP) compared to metropolitan France (MF) due to genetic and environmental factors [1,2]. Though being a dramatic public health concern in the Pacific islands [3,4], the issue of gout remains poorly addressed in FP. The objective of this survey was to give an assessment of Polynesian common practice and treatment habits of gout compared to those in MF. From November 2011 to April 2012, 47 general practitioners (GPs) and 2 rheumatologists settled across the FP archipelagos were interviewed during 30 min by a single investigator using a standardized questionnaire. Data were compared to those of the metropolitan survey CACTUS of 977 GPs and rheumatologists from September 2010 to May 2011 [5]. Physicians were settled in FP for 13 (±10) years. They estimated that 92% (±10%) of their patients were of Polynesian origins, 10% (±9%) had gout and 44% (±30%) of patients had other cases of gout in the family. In flares, 22% of practitioners evaluated C-reactive protein levels, 13% performed synovial fluid aspiration, 29% controlled serum uric acid (SUA) level and 6% prescribed X-rays of the affected joints. For the treatment of flares, 62% of practitioners used colchicine as the first drug, 15% prescribed non-steroidal anti-inflammatory drugs (NSAIDs), 19% an initial combination of colchicine and NSAIDs, 2% used steroids and 2% used a combination of steroids and colchicine. Treatment of flare was prescribed for 11(±9) days. Intra-articular corticosteroid injection was considered an option for 14% of the practitioners. Physicians introduced urate-lowering therapies (ULT) during the flare for 50% of them and 34% as soon as the first attack occurred. Prophylaxis of flares at ULT introduction was proposed by 74% of physicians in FP compared to 95% in MF. It was prescribed for 26 (±30) days in FP versus 62 (±57) days in MF. SUA target was 6.69 mg/dL (±1.31 mg/dL) in FP compared to 5.98 mg/dL (±7.5 mg/dL) in MF. Average number of follow-up consultations for gout was 3.9 (±4.9) per year in FP and 3.2 (±1.6) in MF. All FP physicians (100%) agreed that the main obstacle for the management of gout was the patients’ poor compliance (Table 1). This survey provides a qualitative assessment of the impact of gout on everyday practice in FP. Local physicians confirm the high prevalence of gout (10% as a mean) and notably of family cases in common practice. Recent data showed that US physicians

Immediate ULT introduction at gout diagnosis ULT introduction during the flare Prescription of flare prophylaxis at ULT introduction Flare prophylaxis duration Serum uric acid target Number of follow-up consultations for gout Annual number of SUA concentration level measurements

French Polynesia (n = 49)

Metropolitan France (n = 977)

34%

N/A

50%

N/A

74%

95%

26 (30) days 6.69 (1.31) mg/dL 3.9 (4.9)

62 (57) days 5.98 (0.75) mg/dL 3.2 (1.6)

1.7 (1.4)

N/A

ULT: Urate-lowering therapy; N/A: data not available.

provided care inconsistent with international recommendations [6]. Similarly, although having been trained in MF, confronted daily to gouty patients, Polynesian practitioners adapted their treatment habits differently from those suggested by international guidelines [7–10]. Indeed, seemingly facing an even worse compliance than elsewhere, management of gout in FP relied essentially on clinical assessment with limited use of non-clinical testing, higher frequency of follow-up consultations, shorter prophylaxis of ULT and higher (but ineffective) SUA target. By contrast with European practice but in accordance with the latest American College of Rheumatology guidelines, half of the practitioners introduced ULT during gout flares, mainly due to the difficulty to get patients back for follow-up once the flare has resolved. Disclosure of interest This study was supported financially by Menarini France. Tristan Pascart has no disclosures. Erwan Oehler has no disclosures. René-Marc Flipo received honorary fees from Menarini France as a member of the scientific board. Acknowledgements Special acknowledgements to Dr Laure Perrissin for being involved in the project. References [1] Merriman TR, Dalbeth N. The genetic basis of hyperuricaemia and gout. Joint Bone Spine 2011;78:35–40.

1297-319X/$ – see front matter © 2013 Société franc¸aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved. doi:10.1016/j.jbspin.2013.12.007

Please cite this article in press as: Pascart T, et al. Gout in French Polynesia: A survey of common practices. Joint Bone Spine (2014), doi:10.1016/j.jbspin.2013.12.007

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[2] Hollis-Moffatt JE, Xu X, Dalbeth N, et al. Role of the urate transporter SLC2A9 ¯ Pacific Island, and Caugene in susceptibility to gout in New Zealand Maori, casian case-control sample sets. Arthritis Rheum 2009;60:3485–92. [3] Prior L. Epidemiology of rheumatic disorders in the Pacific with particular emphasis on hyperuricaemia and gout. Semin Arthritis Rheum 1981;11:213–29. [4] Dalbeth N, House ME, Horne A, et al. The experience and impact of gout in ¯ Maori and Pacific people: a prospective observational study. Clin Rheumatol 2013;32:247–51. [5] Pascart T, Flipo R-M. Gout: from international guidelines to current practice. Results from a physician questionnaire. Clin Rheumatol 2013;32:1693–4. [6] Harrold LR, Mazor KM, Negron A, et al. Primary care providers’ knowledge, beliefs and treatment practices for gout: results of a physician questionnaire. Rheumatology (Oxford) 2013;52:1623–9. [7] Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 2012;64:1431–46. [8] Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res 2012;64: 1447–61. [9] Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1301–11. [10] Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing

Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1312–24.

Tristan Pascart a,b,∗ Erwan Oehler c René-Marc Flipo a a Department of Rheumatology, Roger Salengro Hospital, Lille 2 University, 59037 Lille, France b Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, 59160 Lomme, France c Department of Internal Medicine, Taaone Hospital, Papeete, French Polynesia ∗ Corresponding

author. Hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France. Tel.: +33 610 793 665; fax: +33 320 445 462. E-mail address: [email protected] (T. Pascart) Accepted 12 December 2013 Available online xxx

Please cite this article in press as: Pascart T, et al. Gout in French Polynesia: A survey of common practices. Joint Bone Spine (2014), doi:10.1016/j.jbspin.2013.12.007

Gout in French Polynesia: a survey of common practices.

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