WCO IOF- ESCEO 2025: The Phenomenon of Clinical Inertia in Gout Therapy

Presenter: T. A. Fominykh

Insufficient patient compliance is one of the reasons for ineffective gout treatment. Patient education can increase medication adherence to achieve target uric acid levels in 8 out of 10 people. The phenomenon of "clinical inertia" - the inability to initiate or intensify therapy in accordance with evidence-based guidelines - seems to be a possible explanation for this situation. A two-stage survey, assessing gout management dynamics in real world practice, was conducted in 2017 (stage I) and 2021 (stage II) among physicians. The questions touched on the treatment of gout in the acute and interictal period, and the opinion of doctors regarding patient compliance.

Predominantly NSAIDs were used for managing flare-ups (stage I vs. II: 100% vs. 86.9%) and prophylactic colchicine was used exclusively by rheumatologists (stage I vs II: 38.9% vs. 100%), but rarely by therapists (stage I vs. II: 1.7% vs. 20%). Urate-lowering therapy (ULT) was widely prescribed (rheumatologists 100%; therapists 75% vs. 93.3%); allopurinol and febuxostat were used by 20% of therapists vs. 26.7% to stop an attack. Allopurinol dosing remained low (<300 mg/day), with few physicians considering >300 mg (38.9% vs. 33% of rheumatologists and 11.3% vs. 13.3% of therapists at stages I and II, respectively). UST therapy “survival” declined (stage I 63% vs. 55%; stage II 59.4% vs. 54.3%). The expectation of attacks dropped (36.5% 10% to  by rheumatologists and 49.1% to 28.75% by therapists at stage I and II, resp.). Findings highlighted persistent clinical inertia and suboptimal adherence to evidence-based gout treatment strategies.

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, April 10-13, 2025, Rome, Italy