# Changes in Practitioners’ Attitudes toward the Recommendations for Clinical Questions of the Japanese Guideline for Management of Hyperuricemia and Gout, Third Edition between 2018 and 2020 in the Questionnaire’s Surveys: Involving Their Attitude toward the New Questionnaires in 2020

## TL;DR

This study examines how Japanese medical practitioners' attitudes toward gout management guidelines changed between 2018 and 2020.

## Contribution

It identifies a shift in practitioner agreement with specific recommendations on uric acid levels and colchicine use over two years.

## Key findings

- In 2020, more practitioners agreed to lower serum uric acid below 6 mg/dL in gout patients with tophi compared to 2018.
- Agreement with long-term colchicine use to prevent gout flares increased significantly in 2020 compared to 2018.
- There were no significant changes in attitudes toward overall guideline support or research themes between 2018 and 2020.

## Abstract

The Japanese Society of Gout, Uric, and Nucleic Acid developed the Japanese Guideline for Management of Hyperuricemia and Gout (JGMHG) third edition, which contains seven clinical questions (CQs) and corresponding recommendations. Questionnaire surveys were conducted to clarify how recommendations regarding CQs influence decision-making in clinical practice.

The surveillances were conducted twice in 2018, just after the publication of JGMHG, and in 2020, 2 years later. The participants were members of the Japanese Society of Gout, Uric, and Nucleic Acid. While the 2018 surveys contained questionnaires on the recommendations of seven CQs as well as three questionnaires on the status of their use, the 2020 surveys contained those regarding their recommendations of seven CQs and seven questionnaires on the status of their use. The answers from 74 (response rate: 16%) and 61 (response rate: 14%) participants in 2018 and 2020, respectively, were analyzed using the chi-square test or Fisher’s exact test.

The proportion of respondents in 2020 who agreed to reduce serum uric acid levels below 6 mg/dL in gout patients with tophi significantly increased compared to 2018. The agreement in 2020 with the long-term use of colchicine to reduce the recurrence of gout flares when initiating urate-lowering agents (ULAs) significantly increased compared to 2018. There were no significant differences between 2018 and 2020 in clinicians’ attitudes toward support for the third JGMHG in daily practice, support for the use of recommendations toward each CQ, or support for finding themes for research or important clinical issues.

The third JGMHG plays an important role in popularizing recommendations for serum uric acid levels in patients with tophi and the long-term use of colchicine for prophylaxis of gout flares when initiating ULA, although it did not influence the distribution of responses regarding clinicians’ attitudes toward its support.