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Singh JA, Herbey I, Bharat A, Dinnella JE, Pullman-Mooar S, Eisen S, Ivankova N. Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives. Arthritis Care Res (Hoboken) 2017; 69:1724-1732. [PMID: 28118526 DOI: 10.1002/acr.23202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore gout self-management and associated challenges and solutions in African Americans. METHODS We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. RESULTS Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. CONCLUSION Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout.
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Affiliation(s)
- Jasvinder A Singh
- VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | | - Janet E Dinnella
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sally Pullman-Mooar
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth Eisen
- Washington University School of Medicine and St. Louis VA Medical Center, St. Louis, Missouri
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Serlachius A, Gamble G, House M, Vincent ZL, Knight J, Horne A, Taylor WJ, Petrie KJ, Dalbeth N. Illness Perceptions and Mortality in Patients With Gout: A Prospective Observational Study. Arthritis Care Res (Hoboken) 2017; 69:1444-1448. [PMID: 27813363 DOI: 10.1002/acr.23147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/27/2016] [Accepted: 11/01/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine whether illness perceptions independently predict mortality in early-onset gout. METHODS Between December 2006 and January 2014, a total of 295 participants with early-onset gout (<10 years) were recruited in Auckland and Wellington, New Zealand. The participants were followed up until February 2015, and mortality information was collected. Participants with complete data were included in the current study (n = 242). Cox proportional hazards models were used to examine the association between illness perceptions and mortality risk, after adjustment for covariates associated with disease severity and mortality in gout. RESULTS In a Cox proportional hazards model adjusted for predictors of disease severity and mortality in gout (number of tophi, serum urate level, and frequency of flares), consequence beliefs, identity beliefs, concern beliefs, and emotional response to gout were associated with all-cause mortality (hazard ratios [HRs] 1.29, 1.15, 1.18, and 1.19, respectively; P < 0.05 for all). In the fully saturated model, the association between consequence beliefs and mortality remained robust after additional adjustment for ethnicity, disease duration, diuretic use, serum creatinine, and pain score (HR 1.18 [95% confidence interval 1.02-1.37]; P = 0.029). CONCLUSION Negative beliefs about the impact of gout and severity of symptoms, as well as concerns about gout and the emotional response to gout, were independently associated with all-cause mortality. Illness perceptions are important and potentially modifiable risk factors to target in future interventions.
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Affiliation(s)
| | - Greg Gamble
- University of Auckland, Auckland, New Zealand
| | | | | | | | - Anne Horne
- University of Auckland, Auckland, New Zealand
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Wright S, Chapman PT, Frampton C, O'Donnell JL, Raja R, Stamp LK. Management of Gout in a Hospital Setting: A Lost Opportunity. J Rheumatol 2017; 44:1493-1498. [PMID: 28765252 DOI: 10.3899/jrheum.170387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations. METHODS A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected. RESULTS A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (< 0.36 mmol/l). At 60 of the 235 admissions, urate-lowering therapy was already being prescribed. Nine out of 175 patients (5.1%) not treated with urate-lowering therapy at admission commenced allopurinol and 32/174 (18.4%) had commencement of urate-lowering therapy recommended in the discharge plan. CONCLUSION Rates of admission for gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.
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Affiliation(s)
- Sarah Wright
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch
| | - Peter T Chapman
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch
| | - Christopher Frampton
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch
| | - John L O'Donnell
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch
| | - Rafi Raja
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch
| | - Lisa K Stamp
- From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. .,S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch.
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Goh H, Kwan YH, Seah Y, Low LL, Fong W, Thumboo J. A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases. Rheumatol Int 2017; 37:1619-1628. [PMID: 28681249 DOI: 10.1007/s00296-017-3763-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
Medication adherence is a crucial part in the management of rheumatic diseases, especially with many such patients requiring long-term medications. In this paper, we aim to systematically review the literature for the factors associated with medication adherence in the rheumatic patient population. We carried out a systematic literature search using PubMed®, PsychInfo® and Embase ® with relevant keywords and employed the PRISMA® criteria. We included English peer-reviewed articles that studied the factors affecting medication adherence in patients with rheumatic diseases, which were assessed by two independent reviewers. Hand searches were conducted and relevant factors were extracted and classified using the World Health Organization (WHO)'s five dimensions of medication adherence. A simple diagram was drawn to summarise the factors extracted. 1977 articles were identified and reviewed and 90 articles were found to be relevant. A total of 17 factors and 38 sub-factors were identified and categorized based on the WHO's five dimensions of medication adherence. A hand model for medication adherence was developed to succinctly summarise these dimension to remind clinicians the importance of medication adherence in daily practice. We conducted a systematic review on the various factors including patient, therapy, condition, health system and socioeconomic-related factors that affected medication adherence in rheumatic patients. We found 17 factors and 38 sub-factors that affected medication adherence in this population. This systematic review can facilitate future focused research in unexplored dimensions.
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Affiliation(s)
- Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, Singapore.
- Singapore Heart Foundation, Singapore, Singapore.
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, Jenkins W, Jordan KM, Mallen CD, McDonald TM, Nuki G, Pywell A, Zhang W, Roddy E. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford) 2017; 56:e1-e20. [DOI: 10.1093/rheumatology/kex156] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Indexed: 12/13/2022] Open
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Duyck SD, Petrie KJ, Dalbeth N. “You Don't Have to Be a Drinker to Get Gout, But It Helps”: A Content Analysis of the Depiction of Gout in Popular Newspapers. Arthritis Care Res (Hoboken) 2016; 68:1721-1725. [DOI: 10.1002/acr.22879] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/22/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Stefanie D. Duyck
- Stefanie D. Duyck, BPsych: University of Leuven, Leuven, Belgium; and University of Auckland; Auckland New Zealand
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Walsh CP, Prior JA, Chandratre P, Belcher J, Mallen CD, Roddy E. Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. BMC Musculoskelet Disord 2016; 17:394. [PMID: 27639692 PMCID: PMC5027094 DOI: 10.1186/s12891-016-1252-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients' perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use. METHODS A health questionnaire was sent to 1805 people with gout aged ≥18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics. RESULTS One thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively). CONCLUSIONS Patients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of ULT.
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Affiliation(s)
- Ciaran P Walsh
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - James A Prior
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - Priyanka Chandratre
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - John Belcher
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
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Nguyen AD, Baysari MT, Kannangara DRW, Tariq A, Lau AYS, Westbrook JI, Day RO. Mobile applications to enhance self-management of gout. Int J Med Inform 2016; 94:67-74. [PMID: 27573313 DOI: 10.1016/j.ijmedinf.2016.06.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gout is an arthritic condition that is characterised by extremely painful, debilitating acute attacks and eventual joint and organ damage if not controlled. Despite the availability of very effective therapies that, if adhered to, will prevent acute attacks and long-term damage, the disorder is increasingly prevalent. There is an urgent need to improve self-management of gout. OBJECTIVES Mobile health (mHealth) applications ('apps'), designed to facilitate management of chronic conditions, present novel opportunities for supporting patient self-management of gout. The aim of this review was to assess features of available gout management apps designed to assist consumers in managing their gout and their consistency with guidelines for gout management. METHODS English-language, smart-device apps designed to assist self-management of gout were identified using search term "gout" and downloaded from Apple and Google Play app stores. To be included in the review, apps had to allow users to monitor their gout disease (e.g. serum uric acid (sUA) tracking, record acute attacks) and/or educate patients about gout. Investigators derived patient-focused recommendations for gout management from contemporary guidelines. Features of reviewed apps were independently assessed by two reviewers for their facilitation of these recommendations. RESULTS The search identified 57 apps possibly relevant to gout management, of which six met the inclusion criteria. One app incorporated all recommendations for patient-focused gout management from guidelines including monitoring sUA, recording attacks and lifestyle advice. However, the majority of these elements were not functional within the app, and instead required users to manually complete printouts. CONCLUSIONS Currently, only one app exists that includes all recommendations to facilitate patient self-management of gout, however some features can only be actioned manually. Given the lack of progress in achieving better patient outcomes and the promise of mHealth interventions to deliver significant gains, new or updated gout management apps are required to promote successful self-management of this chronic disease.
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Affiliation(s)
- Amy D Nguyen
- Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia; Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Diluk R W Kannangara
- Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Amina Tariq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Richard O Day
- Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, St. Vincent's Hospital, University of New South Wales, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia.
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Richardson JC, Liddle J, Mallen CD, Roddy E, Hider S, Prinjha S, Ziebland S. A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout. BMC Musculoskelet Disord 2016; 17:249. [PMID: 27267878 PMCID: PMC4895958 DOI: 10.1186/s12891-016-1117-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 06/02/2016] [Indexed: 12/31/2022] Open
Abstract
Background Although international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout. Methods A qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used. Results Participants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring. Conclusion Patients’ understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients’ perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through “a joint effort over a period of time”.
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Affiliation(s)
- Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
| | - Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Samantha Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Poratt D, Rome K. Surgical Management of Gout in the Foot and Ankle A Systematic Review. J Am Podiatr Med Assoc 2016; 106:182-8. [PMID: 27269973 DOI: 10.7547/14-128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The surgical management of tophaceous gout has been well documented in the literature, including its effect on foot pain and disability. To date, there have been no systematic reviews assessing the quality of the literature relating to the operative management of tophaceous gout and the outcomes in the foot and ankle. METHODS The following electronic databases were searched (1980-2014): Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Scopus, and the Cochrane Library. The articles identified were published in English and included adult participants (age ≥18 years) with diagnosed gout and surgical intervention to the foot and ankle. The Downs and Black Quality Index was modified to assess the quality of the articles being reviewed. RESULTS Six articles were reviewed and were of moderate quality (mean quality score of 71%). Surgical management was conducted on men (88%) with a mean age of 52 years. There was wide variation in the types of surgical procedures performed, with 28% of studies reporting surgery to the first metatarsophalangeal joint. Most studies were retrospective. A wide range of outcome measures were reported: foot pain, function, preoperative and postoperative activity levels, monitoring of uric acid levels, and patient satisfaction after surgery. CONCLUSIONS The review demonstrated a limited number of good-quality studies. Several surgical procedures for the foot and ankle in people with chronic tophaceous gout were reported. Future studies should include prospective observational studies using validated and reliable patient-reported outcome measures.
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Affiliation(s)
- Daniel Poratt
- Department of Podiatry, Auckland University of Technology, Northcote, New Zealand
| | - Keith Rome
- Department of Podiatry, Auckland University of Technology, Northcote, New Zealand
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Aujla N, Walker M, Sprigg N, Abrams K, Massey A, Vedhara K. Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis. Psychol Health 2016; 31:931-58. [PMID: 26911306 DOI: 10.1080/08870446.2016.1153640] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses. DESIGN AND MAIN OUTCOME MEASURES Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised. RESULTS The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up. CONCLUSION Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.
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Affiliation(s)
- N Aujla
- a Division of Primary Care, University of Nottingham , Nottingham , UK.,b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK.,d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - M Walker
- b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK
| | - N Sprigg
- d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - K Abrams
- e Department of Health Sciences , University of Leicester , Leicester , UK
| | - A Massey
- c School of Clinical Sciences , University of Nottingham , Nottingham , UK
| | - K Vedhara
- a Division of Primary Care, University of Nottingham , Nottingham , UK
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Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice. Clin Rheumatol 2016; 35:2053-2061. [PMID: 26898982 PMCID: PMC4960270 DOI: 10.1007/s10067-016-3212-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/03/2016] [Accepted: 02/06/2016] [Indexed: 01/31/2023]
Abstract
The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range 0–10; better) and Brief Illness Perceptions Questionnaire (BIPQ; nine items, range 0–10; stronger). Structured individual interviews obtained further qualitative insight into knowledge and perceptions, in the context of daily practice. Among 32 GPs, 18 (56.3 %) were male, mean age 44.4 years (SD 9.6) and mean working experience 17.1 years (SD 9.7). Median score [interquartile ranges (IQR)] on the GKQ was 7.8 [6.7–8.9] and 9.0 [8.0–10.0], when presented as open or multiple-choice questions, respectively. The BIPQ (median; [IQR]) revealed that gout was seen as a chronic disease (8.0; [7.0–9.0]), affecting life and emotions moderately (6.5; [5.0–7.0]), having many severe symptoms (8.0; [7.0–9.0]) and in which treatment could be very helpful (8.0; [7.0–9.0]). Further interviews revealed large variation in specific aspects of knowledge and about gaps concerning indications for uric acid-lowering therapy (UALT), duration of UALT, target serum uric acid (sUA) level or duration of prophylactic treatment. Finally, patients’ adherence was not checked systematically. Specific knowledge gaps and discrepancies between perceptions and stated practice behaviour were identified, which might hamper effective management of this well-treatable disease. Improving evidence on the rationale and effectiveness of treatment targets and adherence interventions, tailoring guidelines to general practice and intensification of implementation of guidelines in primary health care seem to be needed.
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Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, Santosa A. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. Patient Prefer Adherence 2016; 10:2449-2457. [PMID: 27980395 PMCID: PMC5144895 DOI: 10.2147/ppa.s119719] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand. OBJECTIVE We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT). METHODS This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88). CONCLUSION MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
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Affiliation(s)
- CSL Tan
- University Medicine Cluster, Division of Rheumatology, National University Health System
| | - GG Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - KJ Chong
- Department of Medicine, Yong Loo Lin School of Medicine
| | - PP Cheung
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - AYN Lim
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - HL Wee
- Department of Pharmacy, Faculty of Science
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
- Correspondence: A Santosa, University Medicine Cluster, Division of Rheumatology, National University Health System, Level 10 Tower Block, 1E Lower Kent Ridge Road, Singapore 119228, Singapore, Fax +65 6872 4130, Email
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Voigt A, Madrid E, Pacheco-Huergo V, Rastello A, Castro D, Navarro-Brito I, Oyaneder MJ. Association of glycaemia with perceived threat of illness in patients with type 2 diabetes. Prim Care Diabetes 2015; 9:426-431. [PMID: 25862461 DOI: 10.1016/j.pcd.2015.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is essential to reach glycaemic control in patients with diabetes mellitus to prevent reduced life expectancy and morbidity related to complications. The aim of this study was to determine whether glycaemic control is associated with the perception of illness in type II diabetes mellitus. METHODOLOGY Illness perception was assessed in a sample of 242 diabetics attending a Family Health Centre in Chile using the Brief Illness Perception Questionnaire (BIPQ). We considered well-controlled individuals to have glycated haemoglobin below 7%, and we assessed association with the BIPQ score. The data were analysed by logistic regression. RESULTS The total BIPQ score was significantly higher (more negative perception) in non-controlled individuals; the most significant differences were found in the following dimensions: consequences (p=0.0003), personal control (p=0.0392), identity (p=0.0006) and emotional affection (p=0.018). The dimensions of timeline, treatment control, concern and coherence showed no differences between the groups. The mean age of well-controlled subjects was significantly higher than the age of non-controlled diabetics. Well-controlled patients had been diagnosed with diabetes for significantly fewer years than had those that were not. CONCLUSIONS Perceiving illness as more negative (BIPQ score >37) is highly associated with being a non-controlled diabetic, with more consequences over their daily life, less control over the disease and a higher number of attributable symptoms. When control variables are considered, a negative perception of diabetes has an adjusted OR of 2.14 (CI 95% 1.17-3.92) to have glycated haemoglobin above 7%.
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Affiliation(s)
- Alejandra Voigt
- Department of Child and Adolescent Psychiatry, Hospital del Salvador, Valparaíso, Chile; Department of Pediatrics, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eva Madrid
- Biomedical Research Centre, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile; Department of Public Health, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
| | - Valeria Pacheco-Huergo
- Family Centre of Primary Care, ABS Turó, Catalan Institute of Health, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Rastello
- Family Centre of Primary Care, Corporación Municipal de Viña del Mar, Viña del Mar, Chile
| | - Daniela Castro
- Biomedical Research Centre, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Ignacio Navarro-Brito
- Biomedical Research Centre, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - María José Oyaneder
- Biomedical Research Centre, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile
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Shields GE, Beard SM. A Systematic Review of the Economic and Humanistic Burden of Gout. PHARMACOECONOMICS 2015; 33:1029-1047. [PMID: 25969152 DOI: 10.1007/s40273-015-0288-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Gout is a chronic and inflammatory form of arthritis that is often overlooked despite the associated pain caused by acute flares and associated joint damage caused by the development of debilitating tophi. The increasing burden of gout, due to an aging population and the increased prevalence of known risk factors for hyperuricaemia, means that there is a continued need for new and effective urate-lowering treatments. The evaluation of these treatments will require a comprehensive and comparative evidence base describing the economic and humanistic burden of gout, taken from the perspective of patients, the healthcare system, and wider society. OBJECTIVE The objective of this study is to review and summarise the current evidence of the disease burden related to chronic gout, assessed in terms of both cost and health-related quality of life (HRQL), and to identify key factors correlated with an increased burden. The overall aim is to support the economic evaluation of new treatments for gout, and to highlight key data gaps that may need further study and exploration. METHODS Relevant literature dating from January 2000 to July 2014 was sourced through searches of the MEDLINE database via PubMed and The Cochrane Library. Articles published in English and reporting either the economic burden (cost) or the humanistic burden (HRQL/utility) of gout were identified, and key data were extracted and summarised, with key themes and data gaps identified and discussed. RESULTS Of the 323 studies identified, 39 met the inclusion criteria, of which 17 and 26 were relevant to the economic and humanistic burden, respectively. The economic burden of gout varied according to numerous factors, most notably serum urate acid levels and number of flares and tophi, resulting in higher healthcare resource use most often attributed to hospitalisation and inpatient stay. The incremental direct cost of gout has been suggested in the range of US$3165 to US$5515 (2004 and 2005 values, respectively) climbing to US$10,222 to US$21,467 (2008 values) per annum where patients are experiencing regular acute flares and have tophi present. The humanistic burden of gout was largely due to physical disability and pain resulting from chronic clinical manifestations. Short Form 6 dimensions (SF-6D) assessed utility weights are estimated at 0.53 for a patient with severe gout (≥3 flares/year and tophi) compared with 0.73 for an asymptomatic gout patient with serum acid levels <6 mg/dl. CONCLUSIONS The evidence confirms that gout has a growing overall prevalence and represents a significant burden in terms of both direct healthcare cost and HRQL outcomes. In light of this, effective urate-lowering treatments are likely to be valued if they can be clearly demonstrated to be both clinically effective and cost effective. Published data to support healthcare decision making in non-US countries with regards to treatments for gout are currently limited, which is a key limitation of the current evidence base. More research is also required to extend our understanding of the impact of gout on indirect costs, and a need also exists to develop a more comprehensive set of comparative HRQL utility assessments.
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Affiliation(s)
- Gemma E Shields
- BresMed Health Solutions, North Church House, 84 Queen Street, Sheffield, S1 2DW, UK
| | - Stephen M Beard
- BresMed Health Solutions, North Church House, 84 Queen Street, Sheffield, S1 2DW, UK.
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Liddle J, Roddy E, Mallen CD, Hider SL, Prinjha S, Ziebland S, Richardson JC. Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration. BMJ Open 2015; 5:e008323. [PMID: 26369796 PMCID: PMC4577947 DOI: 10.1136/bmjopen-2015-008323] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. DESIGN Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. PARTICIPANTS AND SETTING A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. RESULTS Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. CONCLUSIONS This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences.
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Affiliation(s)
- Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 2015; 30:1361-85. [DOI: 10.1080/08870446.2015.1070851] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Flynn TJ, Cadzow M, Dalbeth N, Jones PB, Stamp LK, Hindmarsh JH, Todd AS, Walker RJ, Topless R, Merriman TR. Positive association of tomato consumption with serum urate: support for tomato consumption as an anecdotal trigger of gout flares. BMC Musculoskelet Disord 2015; 16:196. [PMID: 26286027 PMCID: PMC4541734 DOI: 10.1186/s12891-015-0661-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 08/04/2015] [Indexed: 01/01/2023] Open
Abstract
Background Gout is a consequence of an innate immune reaction to monosodium urate crystals deposited in joints. Acute gout attacks can be triggered by dietary factors that are themselves associated with serum urate levels. Tomato consumption is an anecdotal trigger of gout flares. This study aimed to measure the frequency of tomato consumption as a self-reported trigger of gout attacks in a large New Zealand sample set, and to test the hypothesis that tomato consumption is associated with serum urate levels. Methods Two thousand fifty one New Zealanders (of Māori, Pacific Island, European or other ancestry) with clinically-ascertained gout were asked about gout trigger foods. European individuals from the Atherosclerosis Risk In Communities (ARIC; n = 7517) Study, Cardiovascular Health Study (CHS; n = 2151) and Framingham Heart Study (FHS; n = 3052) were used to test, in multivariate-adjusted analyses, for association between serum urate and tomato intake. Results Seventy one percent of people with gout reported having ≥1 gout trigger food. Of these 20 % specifically mentioned tomatoes, the 4th most commonly reported trigger food. There was association between tomato intake and serum urate levels in the ARIC, CHS and FHS combined cohort (β = 0.66 μmolL−1 increase in serum urate per additional serve per week; P = 0.006) - evident in both sexes (men: β = 0.84 μmolL−1, P = 0.035; women: β = 0.59 μmolL −1, P = 0.041). Conclusions While our descriptive and observational data are unable to support the claim that tomato consumption is a trigger of gout attacks, the positive association between tomato consumption and serum urate levels suggests that the self-reporting of tomatoes as a dietary trigger by people with gout has a biological basis. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0661-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tanya J Flynn
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand.
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Peter B Jones
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand.
| | | | - Alwyn S Todd
- Mater Research Institute, Brisbane, Australia and School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
| | - Robert J Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand.
| | - Ruth Topless
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Box 56, Dunedin, New Zealand.
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Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. "You want to get on with the rest of your life": a qualitative study of health-related quality of life in gout. Clin Rheumatol 2015; 35:1197-205. [PMID: 26245722 PMCID: PMC4844632 DOI: 10.1007/s10067-015-3039-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/30/2022]
Abstract
The objective of the study is to examine the impact of gout and its treatments on health-related quality of life (HRQOL) using focus group interviews. From the baseline phase of a cohort study of HRQOL in gout, 17 participants (15 males, mean age 71 years) with varying attack frequency and treatment with and without allopurinol participated in one of four focus group interviews. All interviews were audio-recorded and transcribed verbatim. Data was analysed thematically. Physical and psychosocial HRQOL in gout was affected by characteristics of acute gout (particularly the unpredictable nature of attacks, location of joint involved in an attack, pain and modifications in lifestyle), lack of understanding of gout by others (association with unhealthy lifestyle, symptoms ridiculed as non-severe and non-serious) as well as participants (not considered a disease) and the lack of information provided by physicians (about causes and pharmacological as well as non-pharmacological treatments of gout). Participants emphasised the impact of acute attacks of gout and prioritised dietary modifications and treatment of acute attacks over long-term urate-lowering therapy. Characteristics of acute gout, lack of understanding and information about gout and its treatments perpetuate poor HRQOL. HRQOL (maintenance of usual diet and reduced frequency of attacks) was associated with urate-lowering treatment. Better patient, public and practitioner education about gout being a chronic condition associated with co-morbidities and poor HRQOL may improve understanding and long-term treatment of gout.
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Affiliation(s)
- Priyanka Chandratre
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Jennifer Liddle
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Jane Richardson
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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Grainger R, Harrison AA. Rules of engagement: turning recommendations into results in the diagnosis and management of gout. Int J Rheum Dis 2015; 18:261-3. [PMID: 25923604 DOI: 10.1111/1756-185x.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca Grainger
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
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Johnston ME, Treharne GJ, Chapman PT, Stamp LK. Patient Information about Gout: An International Review of Existing Educational Resources. J Rheumatol 2015; 42:975-8. [DOI: 10.3899/jrheum.141442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/22/2022]
Abstract
Objective.Inadequate patient information about gout may contribute to poor disease outcomes. We reviewed existing educational resources for gout to identify strengths and weaknesses and compare resources cross-nationally.Methods.Content, readability, and dietary recommendations were reviewed using a sample of 30 resources (print and Web-based) from 6 countries.Results.More than half of the resources were written at a highly complex level. Some content areas were lacking coverage, including comorbidity risks, uric acid target levels, and continuing allopurinol during acute attacks.Conclusion.Our findings suggest significant room for improvement in gout patient educational resources, particularly regarding self-management.
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De Vera MA, Marcotte G, Rai S, Galo JS, Bhole V. Medication adherence in gout: a systematic review. Arthritis Care Res (Hoboken) 2015; 66:1551-9. [PMID: 24692321 DOI: 10.1002/acr.22336] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent data suggesting the growing problem of medication nonadherence in gout have called for the need to synthesize the burden, determinants, and impacts of the problem. Our objective was to conduct a systematic review of the literature examining medication adherence among patients with gout in real-world settings. METHODS We conducted a search of Medline, Embase, International Pharmaceutical Abstracts, PsycINFO, and CINAHL databases and selected studies of gout patients and medication adherence in real-world settings. We extracted information on study design, sample size, length of followup, data source (e.g., prescription records versus electronic monitoring versus self-report), type of nonadherence problem evaluated, adherence measures and reported estimates, and determinants of adherence reported in multivariable analyses. RESULTS We included 16 studies that we categorized according to methods used to measure adherence, including electronic prescription records (n = 10), clinical records (n = 1), electronic monitoring devices (n = 1), and self-report (n = 4). The burden of nonadherence was reported in all studies, and among studies based on electronic prescription records, adherence rates were all below 0.80 and the proportion of adherent patients ranged from 10-46%. Six studies reported on determinants, with older age and having comorbid hypertension consistently shown to be positively associated with better adherence. One study showed the impact of adherence on achieving a serum uric acid target. CONCLUSION With less than half of gout patients in real-world settings adherent to their treatment, this systematic review highlights the importance of health care professionals discussing adherence to medications during encounters with patients.
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Affiliation(s)
- Mary A De Vera
- University of British Columbia Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Self-reported disability in patients with inflammatory bowel disease largely determined by disease activity and illness perceptions. Inflamm Bowel Dis 2015; 21:369-77. [PMID: 25569738 DOI: 10.1097/mib.0000000000000278] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The inflammatory bowel disease (IBD) disability index has recently been introduced to measure patients' physical, psychological, familial, and social limitations associated with IBD. We assessed factors related to self-reported disability and the relationship between disability and direct health care costs. METHODS A large cohort of patients with Crohn's disease (CD) and ulcerative colitis (UC) was prospectively followed for 2 years by 3 monthly web-based questionnaires. At 2 years, patients completed the IBD disability index, with lower score indicating more disability. Linear regression analysis was used to examine the impact of demographics, clinical characteristics, and illness perceptions on self-reported disability. Trends in direct health care costs across the disability severity groups minimal, mild, moderate, and severe, were tested. RESULTS A total of 554 patients with CD and 424 patients with UC completed the IBD disability index (response rate, 45%). Both clinical characteristics and illness perceptions significantly contributed to self-reported disability (45%-47%, P = 0.000 and 8%-12%, P = 0.000, respectively). Patients with CD scored lower on the self-reported IBD disability index than patients with UC (0.255 versus 3.890, P < 0.000), indicating more disability in patients with CD. Factors independently associated with higher self-reported disability rates were increased disease activity, illness identity (higher number of symptoms attributed to IBD), and stronger emotional response. Disease duration and disease phenotype were not associated with self-reported disability. Direct health care costs increased with the worsening of self-reported disability (P = 0.000). CONCLUSIONS More disability was reported by patients with CD than by UC. Self-reported disability in IBD was mainly determined by clinical disease activity and illness perceptions but not by disease duration or disease phenotype.
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The impact of gout on patient's lives: a study of African-American and Caucasian men and women with gout. Arthritis Res Ther 2014; 16:R132. [PMID: 24961941 PMCID: PMC4230273 DOI: 10.1186/ar4589] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/29/2014] [Indexed: 12/22/2022] Open
Abstract
Introduction The aim of this study was to examine the impact of gout on quality of life (QOL) and study differences by gender and race. Methods Ten race- and sex-stratified nominal groups were conducted, oversampling for African-Americans and women with gout. Patients presented, discussed, combined and rank-ordered their concerns. Results A total of 62 patients with mean age 65.1 years, 60% men, 64% African-American, participated in 10 nominal groups: African-American men (n = 23; 3 groups); African-American women (n = 18; 3 groups); Caucasian men (n = 15; 3 groups); and Caucasian women (n = 6; 1 group). The most frequently cited high-ranked concerns among the ten nominal groups were: (1) effect of gout flare on daily activities (n = 10 groups); (2) work disability (n = 8 groups); (3) severe pain (n = 8 groups); (4) joint swelling and tenderness (n = 6 groups); (5) food restrictions (n = 6 groups); (6) medication related issues (n = 6 groups); (7) dependency on family and others (n = 5 groups); (8) emotional Impact (n = 5 groups); (9) interference with sexual function (n = 4 groups); (10) difficulty with shoes (n = 4 groups); and (11) sleep disruption (n = 4 groups). Compared with men, women ranked the following concerns high more often: problems with shoes (n = 4 versus n = 0 groups); dependency (n = 3 versus n = 2 groups); and joint/limb deformity (n = 2 versus n = 0 group). Compared with Caucasians, African-Americans ranked the following concerns high more often: dietary restrictions (n = 6 versus n = 0 groups); severe pain (n = 6 versus n = 2 groups); gout bringing the day to a “halt” (n = 2 versus n = 0 group); effect on emotional health (n = 4 versus n = 1 groups); and the need for canes/crutches during flares (n = 2 versus n = 0 group). Conclusions Gout has a significant impact on a patient’s QOL. Important differences in the impact of gout by gender and race were noted.
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Grayson PC, Amudala NA, Mcalear CA, Leduc RL, Shereff D, Richesson R, Fraenkel L, Merkel PA. Illness perceptions and fatigue in systemic vasculitis. Arthritis Care Res (Hoboken) 2014; 65:1835-43. [PMID: 23861259 DOI: 10.1002/acr.22069] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/06/2013] [Accepted: 06/21/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare illness perceptions among patients with different forms of vasculitis, identify risk factors for negative illness perceptions, and determine the association between illness perceptions and fatigue. METHODS Participants were recruited from an online vasculitis registry to complete the revised Illness Perception Questionnaire (IPQ-R). The mean scores on each IPQ-R dimension were compared across different types of vasculitis. Cluster analysis and stepwise regression identified predictors of negative illness perception. Fatigue was measured using the general subscale of the Multidimensional Fatigue Inventory (MFI-20). Patient-reported measures of disease activity and IPQ-R dimensions were assessed in relation to MFI-20 scores using linear regression in sequential, additive models with model-fit comparisons. RESULTS In total, 692 participants with 9 types of vasculitis completed the IPQ-R. For 6 of the 8 IPQ-R dimensions, there were no significant differences in mean scores between the different vasculitides. Scores in the identity and cyclical dimensions were significantly higher in Behçet’s disease compared with other types of vasculitis (13.5 versus 10.7 for identity and 4.0 versus 3.2 for cyclical [P < 0.05]). Younger age (odds ratio [OR] 1.04, 95% confidence interval [95% CI]1.02–1.06), depression (OR 4.94, 95% CI 2.90–8.41), active disease status (OR 2.05, 95% CI 1.27–3.29), and poor overall health (OR 3.92, 95% CI 0.88–17.56) were associated with negative illness perceptions. The sequential models demonstrated that the IPQ-R dimensions explained an equivalent proportion of variability in fatigue scores compared with measures of disease activity. CONCLUSION Illness perceptions are similar across different types of vasculitis, and younger age is a risk factor for negative illness perceptions. Illness perceptions explain differences in fatigue scores beyond what can be explained by measures of disease activity.
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Gout: joints and beyond, epidemiology, clinical features, treatment and co-morbidities. Maturitas 2014; 78:245-51. [PMID: 24880206 DOI: 10.1016/j.maturitas.2014.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 02/07/2023]
Abstract
Gout is a common inflammatory arthritis precipitated by an inflammatory reaction to urate crystals in the joint. Gout is increasingly being recognised as a disease primarily of urate overload with arthritis being a consequence of this pathological accumulation. It is associated with a number of important co-morbidities including chronic kidney disease, obesity, diabetes and cardiovascular disease. The prevalence of gout is increasing around the world. Significant progress has been made in determining the genetic basis for both gout and hyperuricaemia. Environmental risk factors for gout have been identified as certain foods, alcohol and several medications. There is, however, little evidence that changing these environmental risks improves gout on an individual level. Treatment of gout encompasses two strategies: firstly treatment of inflammatory arthritis with non-steroidal anti-inflammatories, corticosteroids, colchicine or interleukin-1 inhibitors. The second and most important strategy is urate lowering, to a target of 0.36 mmol/L (6 mg/dL) or potentially lower in those with tophi (collections of crystalline urate subcutaneously). Along with urate lowering, adequate and prolonged gout flare prophylaxis is required to prevent the precipitation of acute attacks. Newer urate lowering agents are in development and have the potential to significantly expand the potential treatment options. Education of patients regarding the importance of life long urate lowering therapy and prophylaxis of acute attacks is critical to treatment success as adherence with medication is low in chronic diseases in general but especially in gout.
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Abstract
Gout is the most common inflammatory arthritis worldwide. Although effective treatments exist to eliminate sodium urate crystals and to 'cure' the disease, the management of gout is often suboptimal. This article reviews available treatments, recommended best practice and barriers to effective care, and how these barriers might be overcome. To optimize the management of gout, health professionals need to know not only how to treat acute attacks but also how to up-titrate urate-lowering therapy against a specific target level of serum uric acid that is below the saturation point for crystal formation. Current perspectives are changing towards much earlier use of urate-lowering therapy, even at the time of first diagnosis of gout. Holistic assessment and patient education are essential to address patient-specific risk factors and ensuring adherence to individualized therapy. Shared decision-making between a fully informed patient and practitioner greatly increases the likelihood of curing gout.
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Affiliation(s)
- Frances Rees
- Division of Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital Nottingham, Hucknall Road, Nottingham NG5 1PB, UK
| | - Michelle Hui
- Division of Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital Nottingham, Hucknall Road, Nottingham NG5 1PB, UK
| | - Michael Doherty
- Division of Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital Nottingham, Hucknall Road, Nottingham NG5 1PB, UK
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Segal BM, Pogatchnik B, Rhodus N, Sivils KM, McElvain G, Solid CA. Pain in primary Sjögren’s syndrome: the role of catastrophizing and negative illness perceptions. Scand J Rheumatol 2014; 43:234-41. [DOI: 10.3109/03009742.2013.846409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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79
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Allopurinol use in a New Zealand population: prevalence and adherence. Rheumatol Int 2014; 34:963-70. [DOI: 10.1007/s00296-013-2935-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/21/2013] [Indexed: 11/25/2022]
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Dalbeth N, House ME, Horne A, Taylor WJ. Reduced creatinine clearance is associated with early development of subcutaneous tophi in people with gout. BMC Musculoskelet Disord 2013; 14:363. [PMID: 24359261 PMCID: PMC3878111 DOI: 10.1186/1471-2474-14-363] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Although typically a late feature of gout, tophi may present early in the course of disease. The aim of this study was to identify factors associated with the presence of early tophaceous disease. Methods People with gout for <10 years were prospectively recruited, and had a comprehensive clinical assessment including examination for subcutaneous tophi. The clinical factors independently associated with the presence and number of tophi were analyzed using regression models. Results Of the 290 participants, there were 47 (16.2%) with clinically apparent tophi. In univariate analysis, those with tophi were older, were more frequently taking diuretics and colchicine prophylaxis, and had lower creatinine clearance. The association between the presence of tophi and creatinine clearance was strongest in those with creatinine clearance ≤30 ml/min. In logistic regression analysis, creatinine clearance ≤30 ml/min was associated with the presence of tophi, even after adjusting for ethnicity, corticosteroid use, colchicine use and diuretic use (multivariate adjusted odds ratio 7.0, p = 0.005). Participants with tophi reported higher frequency of gout flares, pain scores, patient global assessment scores, and HAQ scores. Conclusions The presence of tophi is associated with more symptomatic disease in people with gout for <10 years. Creatinine clearance is independently associated with early presentation of subcutaneous tophi.
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Affiliation(s)
- Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, New Zealand.
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Scire CA, Manara M, Cimmino MA, Govoni M, Salaffi F, Punzi L, Monti MC, Carrara G, Montecucco C, Matucci-Cerinic M, Minisola G. Gout impacts on function and health-related quality of life beyond associated risk factors and medical conditions: results from the KING observational study of the Italian Society for Rheumatology (SIR). Arthritis Res Ther 2013; 15:R101. [PMID: 24004577 PMCID: PMC3979095 DOI: 10.1186/ar4281] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/13/2013] [Accepted: 09/03/2013] [Indexed: 12/22/2022] Open
Abstract
Introduction Gout is the most prevalent arthritis and significantly impacts on function and quality of life. Given that gout associates with disabling comorbid conditions, it is not clear whether such a complex of diseases accounts for the increased disability or if gout may play a role by itself. This study aims to evaluate the specific influence of gout and disease-related features on functional disability and health-related quality of life (HRQoL) in patients with gout followed in rheumatology clinics. Methods A random sample of patients was drawn from clinical registries of 30 rheumatology clinics across Italy. Sociodemographic, general health and gout-specific variables were collected. Functional disability and HRQoL were assessed by the health assessment questionnaire (HAQ) and the Physical and Mental Component Summary scores (PCS and MCS) of the Short Form-36 (SF-36). Crude and adjusted ordinal logistic and linear regression models were applied to investigate the specific contribution of different variables on HAQ and SF-36 scores. Results are presented as odds ratio (OR) or mean difference (MD) and 95% confidence intervals. Results Out of 446 patients with gout, 90% were males with a mean age of 63.9 years and median disease duration of 3.8 years; the majority of patients were overweight or obese, and with several comorbidities; 21.1% showed at least moderate disability; the PCS score was significantly lower than expected age- and gender-matched samples in the general population, while MCS score was not. After adjusting for potential sociodemographic and general-health confounders, gout-specific variables significantly impacted on HAQ, including polyarticular involvement OR 3.82 (1.63, 8.95), presence of tophi OR 1.92 (1.07, 3.43) and recent attacks OR 2.20 (1.27, 3.81). Consistent results were found for PCS. The impairment of PCS compared to the general population was limited to patients with features of chronic gout. MCS was only affected by recent attacks (MD -2.72 [-4.58, -0.86]) and corticosteroid treatment (-3.39 [-5.30,-1.48]). Conclusions The data from the KING study confirm that gout impacts on disability and provide evidence for an independent association of gout and gout-related features with functional outcome and HRQoL. This result supports the need to improve specific treatment in gout.
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Chandratre P, Roddy E, Clarson L, Richardson J, Hider SL, Mallen CD. Health-related quality of life in gout: a systematic review. Rheumatology (Oxford) 2013; 52:2031-40. [PMID: 23934311 PMCID: PMC3798715 DOI: 10.1093/rheumatology/ket265] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives. To identify the instruments that have been used to measure health-related quality of life (HRQOL) in gout and assess their clinimetric properties, determine the distribution of HRQOL in gout and identify factors associated with poor HRQOL. Methods. Medline, CINAHL, EMBASE and PsycINFO were searched from inception to October 2012. Search terms pertained to gout, health or functional status, clinimetric properties and HRQOL. Study data extraction and quality assessment were performed by two independent reviewers. Results. From 474 identified studies, 22 met the inclusion criteria. Health Assessment Questionnaire Disability Index (HAQ-DI) and Short Form 36 (SF-36) were most frequently used and highest rated due to robust construct and concurrent validity, despite high floor and ceiling effects. The Gout Impact Scale had good content validity. Gout had a greater impact on physical HRQOL compared to other domains. Both gout-specific features (attack frequency and intensity, intercritical pain and number of joints involved) and comorbid disease were associated with poor HRQOL. Evidence for objective features such as tophi and serum uric acid was less robust. Limitations of existing studies include cross-sectional design, recruitment from specialist clinic settings and frequent use of generic instruments. Conclusion. Most studies have used the generic HAQ-DI and SF-36. Gout-specific characteristics and comorbidities contribute to poor HRQOL. There is a need for a cohort study in primary care (where most patients with gout are treated) to determine which factors predict changes in HRQOL over time. This will enable those at risk of deterioration to be identified and better targeted for treatment.
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Affiliation(s)
- Priyanka Chandratre
- Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK.
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Gergel TL. Illness perception, time perception and phenomenology - an extended response to Borrett. J Eval Clin Pract 2013; 19:501-8. [PMID: 23692235 DOI: 10.1111/jep.12047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 11/26/2022]
Abstract
Borrett joins other phenomenologists in using phenomenological ideas on temporality to explain how illness affects the individual's experience of time. Unlike others, he attempts to synthesize this use of phenomenology with a biomedical understanding of the relation between time and illness. My paper expands on Borrett's ideas by reviewing current medical scholarship on time and illness perception, including Heidegger's ideas on temporality. The first section considers questions and suggestions emerging from contemporary medicine. After a short review of theories of time perception, I describe and critique how Borrett and others use phenomenological temporality in a medical context. My conclusion suggests how Heideggerian temporality might help with the questions and recommendations emerging within diverse medical fields.
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Affiliation(s)
- Tania L Gergel
- Centre for Humanities and Health, King's College London, London, UK.
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Blair J, Angus NJ, Lauder WJ, Atherton I, Evans J, Leslie SJ. The influence of non-modifiable illness perceptions on attendance at cardiac rehabilitation. Eur J Cardiovasc Nurs 2013; 13:55-62. [DOI: 10.1177/1474515113477272] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julie Blair
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Neil J Angus
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - William J Lauder
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Iain Atherton
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
| | - Josie Evans
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Stephen J Leslie
- School of Nursing and Midwifery, University of Stirling, Inverness, UK
- Cardiac Unit, Raigmore Hospital, Inverness, UK
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The experience and impact of gout in Māori and Pacific people: a prospective observational study. Clin Rheumatol 2012; 32:247-51. [DOI: 10.1007/s10067-012-2110-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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Perez-Ruiz F, Herrero-Beites AM. Evaluation and treatment of gout as a chronic disease. Adv Ther 2012; 29:935-46. [PMID: 23104464 DOI: 10.1007/s12325-012-0059-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Indexed: 12/22/2022]
Abstract
Gout is a disease caused by deposition of monosodium urate crystals in tissues. One of the limitations for successful treatment of gout is to consider it as an intermittent disease rather than a chronic inflammatory disease which, if improperly treated, leads to chronic clinical manifestations. In addition, gout is linked to increased cardiovascular morbidity and mortality.Urate-lowering therapy comprises both nonpharmacologic and pharmacologic interventions, but most patients will need urate-lowering drugs to achieve target therapeutic serum urate levels. Reaching target serum urate levels is associated with improvement in clinical outcomes, including a reduction of acute inflammation episodes, resolution of tophi, and improvement in health-related quality of life perception.A number of urate-lowering drugs are available but a number of patients fail to achieve or maintain therapeutic serum urate levels and go on to develop refractory chronic gout. For such patients, efforts have been made to develop new treatments (e.g., febuxostat or pegloticase).This review intends to increase the awareness of gout as a chronic deposition disease, and show that efforts should be made to properly control serum urate levels in order to achieve complete disappearance of urate crystal deposition.
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Dalbeth N, House ME, Horne A, Petrie KJ, McQueen FM, Taylor WJ. Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout. BMC Musculoskelet Disord 2012; 13:174. [PMID: 22978848 PMCID: PMC3493372 DOI: 10.1186/1471-2474-13-174] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/12/2012] [Indexed: 04/01/2023] Open
Abstract
Background Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout. Methods Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed. Results Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Urate-lowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03). Conclusions ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
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