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Introduction: A survey investigated physician reported use, prescribing practices and adverse renal events of topical NSAIDs. Method: This survey was sent to members of the Australian Rheumatology Association and the Australian and New Zealand Society of Nephrology. Results: Sixty physicians responded, 55% (n = 33) were nephrologists; 45% (n = 27) rheumatologists. Nearly all (n = 56, 93.3%) had managed at least one patient using topical NSAIDs, including those with an eGFR <45 mL/min (n = 55, 91.7%). Concern was expressed that patients may use topical NSAIDs without the physician's knowledge. The majority (n = 40, 66.6%) have prescribed (or recommended) a topical NSAID, slightly less in patients with a reduced eGFR <45 mL/min (n = 36, 60.0%). Participants would advise topical NSAIDs for osteoarthritis and musculoskeletal pain, though be mindful to monitor the renal function and blood pressure. There was a variance in comments in advising use in CKD (eGFR <45 mL/min) from avoidance in those with an eGFR <30 mL/min to minimal concern. Most respondents (n = 55, 91.7%) had not encountered an acute kidney injury (AKI) suspected from topical NSAID use. Of the five that did, three were thought to be an adverse renovascular event and two were uncertain. All patients had an eGFR <45 mL/min, all had recovery f their renal function with NSAID cessation. Discussion Patients commonly use topical NSAIDs, often without the physician's knowledge. Most respondents would recommend their use in osteoarthritis and musculoskeletal pain, though with caution in CKD. While an AKI is uncommon due to topical NSAIDs, it may occur, especially in those with CKD. [ABSTRACT FROM AUTHOR]

Abstract: Background: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher‐quality patient care through identifying and reducing low‐value practices. Aims: To determine the Australian Rheumatology Association’s (ARA) ‘top five’ list of low‐value practices. Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their ‘top five’ list from a list of 12‐items through SurveyMonkey in December 2015 (reminder February 2016). Results: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti‐nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark‐guided injection (50.3%) and Do not order anti‐double‐stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%). Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low‐value practices that should be questioned. [ABSTRACT FROM AUTHOR]

Background The international literature advocates for cancer screening in newly diagnosed patients with autoimmune myositis; however, there is no widely accepted consensus or guideline to outline the optimal cancer screening strategy and the evidence is currently insufficient to support any recommendation. Aim Our study aimed to establish the current trends in practice in malignancy screening in autoimmune myositis among Australian rheumatologists. Methods All rheumatologists who were full members of the Australian Rheumatology Association in 2016 (386) were invited to complete an online questionnaire. Respondent demographics and information on screening approach and concerns were collected using multiple choice and open-response questions. There were 60 respondents (16% response rate). All available quantitative data were analysed and reported using statistical software. Qualitative data were analysed and grouped according to themes. Results Most respondents (93%) performed cancer screening. Significant variation was found in terms of approach to patient selection, choice of screening test, delegation of screening and repeat screening. A lack of clinical practice consensus and guideline (77%), test selection knowledge (37%), knowledge on repeated screening (53%) and the potential for harm (62%) were identified challenges in this area. Conclusion Malignancy screening in autoimmune myositis was variable among this small cohort of Australian rheumatologists. The observed differences were driven by patient factors and clinician preferences. The group identified several challenges in the cancer screening process. Further research is warranted to address these challenges, close the evidence gap and develop workable guidelines. [ABSTRACT FROM AUTHOR]

To examine the management of gout in general practice in Townsville, Australia, and to explore comorbid conditions in patients with gout. Study will also explore how closely guidelines are being followed in managing gout. Retrospective chart review was conducted from May to November 2014 in three general practices in Townsville. Registers for patients were established by searching 'gout' and 'gouty arthritis'. Three hundred and twenty-one patients were included in the study after excluding inactive patients, patients below age of 18 and patients with cancer. Main outcome measures were prevalence of comorbidities in gout patients, gout medications and adequate serum urate control (≤0.36 mmol/l). Multivariate logistic regression was used to study the relationship between serum urate level, comorbid conditions and lifestyle factors. Hypertension was the most common comorbid condition with 60.8 % of patients followed by obesity and dyslipidaemia. In terms of medication, 46.7 % of patients were on allopurinol, 12.8 % on indomethacin and 13.4 % on diuretics. Eighty-six percentage of patients had serum urate level (sUA) recorded in the previous year. Of these, 32.2 % had a serum urate level below or equal to 0.36 mmol/l. Moreover, 17.4 % of patients had lifestyle advice documented in chart. Male gender was the most influential factor in having poor uric acid control ( p < 0.01), followed by not being on allopurinol ( p < 0.01) and patients older than 50 years ( p = 0.02). Management of gout in this study sample was not entirely concordant with guidelines. The study also suggests a need for possible tighter monitoring and allopurinol dosing regime in older, male patients. [ABSTRACT FROM AUTHOR]

Background: Many quantitative studies globally have identified suboptimal management of gout.Purpose: To explore management of gout from the perspective of general practitioners (GPs), while identifying the barriers and possible strategies for improvement.Study Design: This descriptive qualitative study used semistructured interviews with 14 purposely selected GPs from four separate general practices in Townsville. The questions focused on management strategies, practicalities in managing gout, barriers and possible strategies to improve management.Results: Indomethacin was commonly reported to be used in acute gout with progression to allopurinol after the acute stage had subsided. There were differences with the initial allopurinol dose and follow-up periods. GPs reported lack of patient adherence to allopurinol and lifestyle modifications, mainly due to lack of education. Most suggested the need for allied health input and improved patient education.Conclusions: Tailor-made plan in terms of education and lifestyle advice could help adherence to gout management. [ABSTRACT FROM AUTHOR]

This systematic review aims to summarise published evidence that assessed the management of gout in regard to the following: prescription of urate lowering therapy (ULT), monitoring of serum urate levels (sUA) and allopurinol dosing in patients with renal impairment, lifestyle advice and acute management of gout. Studies investigating the management of gout in general practice (GP) were identified by searching PubMed and Scopus databases. To be eligible for inclusion, studies had to be focused on the GP setting alone. Studies were also excluded if they examined diagnosis without exploring management of gout. Editorials and reviews were excluded. A total of nine studies were identified. Eight studies explored the proportion of gout patients currently on ULT. Six out of the eight studies revealed that ULT was prescribed in less than 50 % of gout patients. Four studies considered the monitoring of sUA levels in gout patients. The results were generally similar throughout studies indicating sub-optimal management. Only two studies examined the monitoring of sUA levels specifically in patients who were prescribed ULT. The two studies showed 28 and 38 % of patients on ULT had their sUA levels monitored. Two studies examined the dosing of allopurinol in renally impaired patients and revealed that 74-78 % of renally impaired patients had an appropriate allopurinol dose of less than 300 mg. This systematic review suggests that gout is sub-optimally managed in general practice. However, more studies with a larger sample size focusing on active patients are required to provide more definitive evidence. [ABSTRACT FROM AUTHOR]