Gout in Mindanao (PRA 2015)
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Transcript of Gout in Mindanao (PRA 2015)
TEDx TALKS
• To present great and well-‐formed ideas under 18 minutes.
• novel and surprising • Basic but compelling • New arguments that challenge beliefs and perspec@ves.
EBM
METHOD
OUTCOME
INTERVENTION
POPULATION
!
! SSurvey Inconvenience Sampling I.T.T.
! ! Rheumatologists
T > 3yrs in Mindanao
EBM
METHOD
OUTCOME
INTERVENTION
POPULATION
!
!
!
!
3 ques@ons 1. As a rheumatologist prac@cing in Mindanao, what aspects of your situa@on (e.g. environment, locality, city, or province) makes gout challenging in terms of its diagnosis or management? Where appropriate please indicate if the iden@fied aspect occurs Always, OTen, Some@mes, or Rarely.
2. What factors are related to pa@ents in your area (ie pa@ent’s Knowledge, AXtudes, Prac@ces)? Indicate if these occur Always, OTen, Some@mes, or Rarely.
3. What factors are related to physicians in your area (ie local physican’s Knowledge, AXtudes, Prac@ces)? Indicate if these occur Always, OTen, Some@mes, or Rarely.
1. Locality: ALWAYS + OFTEN
• Financial problems/low income • Herbals/Supplements: rampantly promoted on TV-‐Radio 2A
• Peace and Order hindering ffup • Distance/transporta@on: bus, boat, plane schedules
!
Physicians: Always + OT
• Rx: Low Purine diet for all • Febuxostat is preferred even when allopurinol is not contraindicated
• Late referrals: Misdiagnosis, Added cost, • Use of Steroids • Inadequate management issues: drug dose/choice, lack of pa@ent educa@on, pain management only
! !
Pa@ent: Always + OTen • Diet Non-‐Pharmacologic Issues
– All joint pains is related to uric acid 3 – Diet restric@on alone is sufficient 2 – Non-‐adherence to diet and lifestyle 2
• Drug Issues – Discon@nua@on of meds for fear of S/E (renal, hepa@c etc) 3 – Discon@nuing treatment once Asx – Maintain colchicine alone and not urate lowering therapy – Supplements: MX, Usana, Sehat Badan 3 – Self-‐medica@on: NSAID misuse, Dexamethasone/steroids 3
• Unaware of Rheumatologist
!!
Compliance: Discon@nue meds fears of adverse effects on bones, kidneys, Liver 3 Pa@ents think all arthri@s is related to uric acid 3 Supplements in place of meds: MX, Usana, Sehat Badan 3 Drug discon@nua@on once Asx 2 Maintain Colchicine alone; px stop urate lowering agents 2 NonAdherence to Diet-‐Lifestyle 2 Pa@ents believe that dietary restric@on alone iDietDs sufficient 2 Self medica@ng: Dexamethasone 2 Compliance: NonAdherence to Therapy 1 Compliance: Discon@nua@on of meds because Asx 1 • NSAID misuse 1 Pa@ent themselves seek rheuma consult. Pa@ent referrals 1 Self medica@ng: General 1
Recurring Issues
Supplements
Safety
MisInforma@on
MisAlloca@on of Php
All Natural, No Drugs No Chemicals, Organic
!
Recurring Issues
Supplements
Late Referrals Varying Presenta@ons
Diagnos@c Issue Elderly-‐onset-‐gout
Co-‐morbidi@es
Terkeltaub, R. The Rheumatologist, July 2007. Difficult Goutby hjp://www.the-‐rheumatologist.org/details/ar@cle/1304639/Difficult_Gout.html
Neogi T. Gout. N Engl J Med 2011;364:443-‐452 Marwah RK. ComorbidiMes in gouty arthriMs. J Inves@g Med. 2011 Dec;59(8):1211-‐20. Schlesinger N. Difficult-‐to-‐treat gouty arthri@s: a disease warran@ng bejer management. Drugs. 2011 Jul 30;71(11):1413-‐39 De Leonardis F1, Govoni M, Colina M, Bruschi M, Troja F. Elderly-‐onset gout: a review. Rheumatol Int. 2007 Nov;28(1):1-‐6. Epub 2007 Jul 26.
Drug-‐drug interac@on
Hoskison KT1, Wortmann RL. Management of gout in older adults: barriers to opMmal control. Drugs Aging. 2007;24(1):21-‐36.