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Do H, Choi HJ, Choi B, Son CN, Kim SH, Choi SR, Kim JH, Kim MJ, Shin K, Kim HO, Song R, Lee SW, Ahn JK, Lee SG, Lee CH, Son KM, Moon KW. Factors for achieving target serum uric acid levels after initiating urate-lowering therapy in patients with gout: results from the ULTRA registry. Sci Rep 2023; 13:20511. [PMID: 37993515 PMCID: PMC10665459 DOI: 10.1038/s41598-023-47790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
Achieving target serum uric acid (SUA) levels is important in gout management. Guidelines recommend lowering SUA levels to < 6 mg/dL; however, many patients fail to reach this target, even with uric acid-lowering therapy (ULT). This study investigated clinical characteristics of target SUA achievers among Korean patients with gout. This study used data from the ULTRA registry, a nationwide inception cohort established in September 2021 that enrolls patients with gout who initiate ULT. Demographic, clinical, and laboratory data were collected at baseline; the 6-month follow-up. Patients were divided into two groups: target achievers (SUA level < 6 mg/dL at 6 months) and non-achievers. The mean participant (N = 117) age was 56.1 years, and 88.0% were male. At 6 months, 83 patients (70.9%) reached target SUA levels. Target achievers had better drug adherence (≥ 80%) to ULT (97.6% vs. 76.5%; p < 0.01) than non-achievers. Target non-achievers had a higher percentage of a family history of gout (32.4% vs. 10.8%; p < 0.01) and less antihypertensive agent use (38.2% vs. 59.0%; p = 0.03) than target achievers. Multivariate regression analysis revealed that good adherence to ULT, the absence of a family history of gout, and antihypertensive agent use were key factors associated with achieving target SUA levels at 6 months.
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Affiliation(s)
- Hyunsue Do
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon, 24341, South Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byoongyong Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Seoul Medical Center, Seoul, South Korea
| | - Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Se Rim Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Hyoun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Min Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun-Ok Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ran Song
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University, Seoul, South Korea
| | - Sung Won Lee
- Division of Rheumatology, Department of Internal Medicine, Soon Chun Hyang University Hospital, Cheonan, South Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Chang Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, South Korea
| | - Kyeong Min Son
- Division of Rheumatology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon, 24341, South Korea.
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Dasgupta E, Chong ZP, Ting MN, Mohd Tajuddin AA, Voon KX, Sasitharan T, Tai KS, Yeap SS. Relationship of medication adherence, serum uric acid level and diet to recurrent attacks of gout. THE EGYPTIAN RHEUMATOLOGIST 2022. [DOI: 10.1016/j.ejr.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Murdoch R, Jones P, Greenwell J, Dalbeth N. Quality of care in people requiring hospital admission for gout in Aotearoa New Zealand: a nationwide analysis. Intern Med J 2021; 52:2136-2142. [PMID: 34339089 DOI: 10.1111/imj.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
AIMS To understand national trends in hospital admission for a primary diagnosis of gout in Aotearoa New Zealand over the past 10 years and the quality of care for gout received by these patients before and after the admission. METHODS Data from the Aotearoa New Zealand National Collections from 1 January 2007 to 31 December 2019 were analysed to determine rates of hospital admission for a primary diagnosis of gout. Admission data including cost-weight analysis, as well as quality of care data including gout-specific medication dispensing in the year prior and year after admission. RESULTS There were 13,721 admissions with a primary diagnosis of gout over the analysis period, with an average cost per admission in 2019 of NZD 4,301. The rate of admission per 100,000 population was highest in Pacific peoples followed by MĀori. Although dispensing of any allopurinol increased in the year after admission, rates of regular allopurinol dispensing remained low; 38.1% for admissions in 2018. Patients who were younger (especially 20-44 years), not enrolled in a primary health organisation before admission, and female had lower rate of regular allopurinol after admission. CONCLUSION In this nationwide study, rates of admission for gout were highest in Pacific peoples and in MĀori. Rates of regular allopurinol dispensing was low even after admission for a primary diagnosis of gout. These findings highlight the need for improvements in gout management in Aotearoa New Zealand, including in post-discharge planning from secondary care inpatient services. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rachel Murdoch
- Clinical Research Fellow, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Rheumatologist and Clinical Lead - System Improvement, Ministry of Health, New Zealand
| | - James Greenwell
- Principal Advisor, Ministry of Health, New Zealand, and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Rheumatologist and Professor of Medicine, Department of Medicine, University of Auckland, Auckland, New Zealand
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Zhou W, Zhu J, Guo J, Chen H, Zhang X, Gu Z, Zhou F, Dong C. Health-related quality of life assessed by Gout Impact Scale (GIS) in Chinese patients with gout. Curr Med Res Opin 2020; 36:2071-2078. [PMID: 33085514 DOI: 10.1080/03007995.2020.1840341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The Gout Impact Scale (GIS) is a disease-specific health-related quality of life (HR-QoL) measurement for patients with gout. This study aimed to investigate the quality of life in Chinese patients with gout and potential risk factors for poorer HR-QoL by GIS. METHODS Adults with gout from February 2017 to February 2019 were invited to complete a questionnaire containing the GIS, social demographic characteristics, clinical information and gout-specific questions. Pearson/Spearman correlation and linear regression were used to analyze the data. RESULTS A total of 413 patients were included in the analysis (mean age, 51.85 years; 96.4% male). The mean (SD) score of GIS total was 56.79 ± 15.45. Worse gout-specific HR-QoL was associated with anxiety (p < .05), depression (p < .05) and fatigue (p < .05). The effectiveness and global satisfaction of Treatment Satisfaction Questionnaire for Medication (TSQM) were negatively related to each dimension of GIS. Age (B = -0.251, p = .013), fatigue (B = 1.850, p < .001) and depression (B = 9.068, p = .042) were independent predictors of GIS total score. CONCLUSION Gout-specific HR-QoL is impaired by social demographic and clinical characteristics, highlighting the importance of psychological factors (fatigue and depression) and patient-reported outcomes (patients' satisfaction and confidence in gout treatment). These findings suggest that more studies should focus on disease-specific HR-QoL.
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Affiliation(s)
- Wei Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Jinjin Zhu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiaxin Guo
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Huamao Chen
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaomei Zhang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Fengyan Zhou
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
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Quilisadio JEC, Salido EO, Penserga EG. Achievement of the target serum urate level among patients with gout treated with allopurinol or febuxostat in an arthritis clinic in the Philippines. Mod Rheumatol 2020; 31:755-761. [PMID: 32701037 DOI: 10.1080/14397595.2020.1800557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Gout is an important cause of disability among Filipinos, despite measures for effective management. This study aims to determine attainment of target serum uric acid level (SUA ≤ 6 mg/dl) among patients with gout given urate-lowering therapy (ULT) over 6-12 months. METHODS This is a single-center, prospective cohort study conducted in one adult Arthritis Clinic at the University of the Philippines-Philippine General Hospital which included 138 patients with gout (1977 ACR criteria), SUA ≥ 6 mg/dl prior to ULT, initiated on ULT (allopurinol or febuxostat), with six months minimum follow-up and with SUA determination post-treatment. RESULTS 37.7% (52/138) and 36.2% (50/138), achieved target SUA at 6 and 12 months. The factors associated with achieving target SUA in 6 months are BMI > 25 kg/m2 [OR 6.98, 95% confidence interval (CI) 1.44-33.88, p value = .016], allopurinol dose ≥ 300 mg (OR 15.76, 95% CI 2.24-111.06, p value = .006), and baseline SUA (OR 0.52, 95% CI 0.33-0.82, p value = .005). The factors associated with achieving target SUA in 12 months are employment (OR 5.51, 95% CI 1.00-30.33, p value = .050), baseline SUA (OR 0.45, 95% CI 0.28-0.74, p value = .002), and age at onset of gout (OR 1.08, 95% CI 1.01-1.15, p value = .026). CONCLUSION Target SUA level was not achieved at 6 and 12 months of ULT in most of this cohort. This mirrors the deficient control of gout and should urge health professionals to fully study and address the problem.
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Affiliation(s)
- John Elmer Cabang Quilisadio
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Evelyn Osio Salido
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Ester Gonzales Penserga
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
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Robinson PC. Adherence to allopurinol in patients with gout: further insights generate further questions. THE LANCET. RHEUMATOLOGY 2020; 2:e249-e250. [PMID: 38273472 DOI: 10.1016/s2665-9913(20)30060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/27/2024]
Affiliation(s)
- Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Brisbane, QLD 4006, Australia.
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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Serlachius A, Schache K, Kieser A, Arroll B, Petrie K, Dalbeth N. Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e15021. [PMID: 31411147 PMCID: PMC6711037 DOI: 10.2196/15021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. Objective Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. Methods Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. Results Participants rated the gout app as more engaging (mean difference –0.58, 95% CI –0.96 to –0.21) and more informative (mean difference –0.34, 95% CI –0.67 to –0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference –0.64, 95% CI –1.27 to –0.003) and higher knowledge/understanding of gout (mean difference –0.70, 95% CI –1.30 to –0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference –2.43, 95% CI –3.68 to –1.18), stronger beliefs regarding the severity of symptoms (mean difference –1.97, 95% CI –3.12 to –0.82), and a stronger emotional response to gout (mean difference –2.38, 95% CI –3.85 to –0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. Conclusions Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.
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Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anel Kieser
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bruce Arroll
- General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial. Am J Med 2019; 132:354-361. [PMID: 30503879 PMCID: PMC6399023 DOI: 10.1016/j.amjmed.2018.11.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes. METHODS We conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at 1 year. Outcomes were reassessed at year 2. RESULTS Patients who underwent intervention were more likely than patients of usual care to be adherent (50% vs 37%; odds ratio [OR] 1.68; 95% confidence interval [CI] 1.30, 2.17) and reach serum urate goal (30% vs 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (1 year after the intervention ended), differences were attenuated, remaining significant for urate goal but not for adherence. The intervention was associated with a 6%-16% lower gout flare rate during year 2, but the differences did not reach statistical significance. CONCLUSIONS A pharmacist-led intervention incorporating automated telephone technology improved adherence and serum urate goal in patients with gout initiating allopurinol. Although this light-touch, low-tech intervention was efficacious, additional efforts are needed to enhance patient engagement in gout management and ultimately to improve outcomes.
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Lee S, So MW, Ahn E. Long-term adherence and persistence with febuxostat among male patients with gout in a routine clinical setting. Mod Rheumatol 2018; 29:662-668. [PMID: 29856667 DOI: 10.1080/14397595.2018.1483293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: To assess long-term adherence and persistence to febuxostat (FBX) and factors that might contribute to non-adherence and non-persistence to FBX in male patients with gout during a 3-year period. Methods: Adherence to FBX was assessed by the clinic nurses through pill counts at the scheduled visits and non-adherence was defined as less than 80% of the prescribed dose taken. Non-persistence was defined as discontinuation of FBX longer than 60 days. Results: A total of 220 patients were recruited. The percentage of adherence and persistence was 71.8% and 80.9% at 1 year, 65.5% and 68.2% at 2 years and 58.2% and 56.4% at 3 years, respectively. The logistic regression analysis identified high income status, current smoking, absence of hypertension and previous history of non-persistence with urate-lowering therapy (ULT) as the independent factors associated with non-adherence, and the unmarried, absence of hypertension and previous history of non-persistence with ULT as the independent factors associated with non-persistence. Conclusion: Variable risk factors that are correlated with poor adherence or persistence and easily assessed can be used to identify patients at a particular risk of poor adherence or persistence.
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Affiliation(s)
- Sunggun Lee
- a Department of Internal Medicine, Division of Rheumatology, Haeundae Paik Hospital , Inje University College of Medicine , Busan , Korea
| | - Min Wook So
- b Department of Internal Medicine, Division of Rheumatology , Pusan National University Yangsan Hospital , Gyeongnam , Korea
| | - Eunyoung Ahn
- b Department of Internal Medicine, Division of Rheumatology , Pusan National University Yangsan Hospital , Gyeongnam , Korea
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Scheepers LE, van Onna M, Stehouwer CD, Singh JA, Arts IC, Boonen A. Medication adherence among patients with gout: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 47:689-702. [DOI: 10.1016/j.semarthrit.2017.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/29/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
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Latourte A, Bardin T, Clerson P, Ea HK, Flipo RM, Richette P. Dyslipidemia, Alcohol Consumption, and Obesity as Main Factors Associated With Poor Control of Urate Levels in Patients Receiving Urate-Lowering Therapy. Arthritis Care Res (Hoboken) 2018; 70:918-924. [DOI: 10.1002/acr.23347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Augustin Latourte
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | - Thomas Bardin
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | | | - Hang-Korng Ea
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | - René-Marc Flipo
- Hôpital Roger-Salengro; CHRU de Lille; and Université de Lille 2; Lille France
| | - Pascal Richette
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
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Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M. Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study. Rheumatology (Oxford) 2017; 56:529-533. [PMID: 28082620 DOI: 10.1093/rheumatology/kew395] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate the persistence and adherence on urate-lowering treatment (ULT) in primary care 5 years after an initial nurse-led treatment of gout. Methods One hundred gout patients initiated on up-titrated ULT between March and July 2010 were sent a questionnaire that elicited information on current ULT, reasons for discontinuation of ULT if applicable, medication adherence and generic and disease-specific quality-of-life measures in 2015. They were invited for one visit at which height and weight were measured and blood was collected for serum uric acid measurement. Results Seventy-five patients, mean age 68.13 years ( s . d . 10.07) and disease duration 19.44 years ( s . d . 13), returned completed questionnaires. The 5-year persistence on ULT was 90.7% (95% CI 81.4, 91.6) and 85.3% of responders self-reported taking ULT ⩾6 days/week. Of the 65 patients who attended the study visit, the mean serum uric acid was 292.8 μmol/l ( s . d . 97.2). Conclusion An initial treatment that includes individualized patient education and involvement in treatment decisions results in excellent adherence and persistence on ULT >4 years after the responsibility of treatment is taken over by the patient's general practitioner, suggesting that this model of gout management should be widely adopted.
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Affiliation(s)
- Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital
| | - Wendy Jenkins
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital
| | - Jonathan La-Crette
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital.,Department of Medicine, Nottingham University Hospitals NHS Trust
| | - Gwen Fernandes
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital
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The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study. Rheumatol Int 2017; 37:1187-1194. [DOI: 10.1007/s00296-017-3746-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/17/2017] [Indexed: 12/27/2022]
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Shiozawa A, Szabo SM, Bolzani A, Cheung A, Choi HK. Serum Uric Acid and the Risk of Incident and Recurrent Gout: A Systematic Review. J Rheumatol 2017; 44:388-396. [PMID: 28148699 DOI: 10.3899/jrheum.160452] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Lowering serum uric acid (SUA) levels can essentially cure gout; however, this is not widely practiced. To summarize epidemiologic evidence related to this causal link, we conducted a systematic review of the published literature reporting the association between SUA level and incident and recurrent gout (i.e., gout flares). METHODS We systematically searched Medline, EMBASE, and the Cochrane Database of Systematic Reviews using separate search strategies for incident gout and recurrent gout. We screened 646 abstracts to identify 8 eligible articles reporting gout incidence and 913 abstracts to identify 18 articles reporting recurrent gout. RESULTS For both gout incidence and recurrence, a graded trend was observed where the risk was increased with higher SUA levels. Gout incidence rates per 1000 person-years from population-based studies ranged from 0.8 (SUA ≤ 6 mg/dl) to 70.2 cases (SUA ≥ 10 mg/dl). Recurrent gout risk in clinical cohorts ranged from 12% (SUA ≤ 6 mg/dl) to 61% (SUA ≥ 9 mg/dl) among those receiving urate-lowering therapy (ULT), and 3.7% (SUA 6-7 mg/dl) to 61% (SUA > 9.3 mg/dl) after successful ULT. Retrospective database studies also showed a graded relationship, although the strength of the association was weaker. Studies reporting mean flares or time-to-flare according to SUA showed similar findings. CONCLUSION This systematic review confirms that higher SUA levels are associated with increased risk of incident and recurrent gout in a graded manner. Although few prospective cohorts have evaluated incident and recurrent gout according to SUA, the existing evidence underscores the need to treat to SUA targets, as recommended by the American College of Rheumatology and the European League Against Rheumatism.
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Affiliation(s)
- Aki Shiozawa
- From Takeda Pharmaceuticals International Inc., Deerfield, Illinois; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Redwood Outcomes, Vancouver, British Columbia, Canada.,A. Shiozawa, Associate Director, MPH, Takeda Pharmaceuticals International Inc.; S.M. Szabo, Principal, MSc, Redwood Outcomes; A. Bolzani, Research Associate, MSc, Redwood Outcomes; A. Cheung, Research Associate, MPH, Redwood Outcomes; H.K. Choi, Professor, Director, MD, DrPH, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School
| | - Shelagh M Szabo
- From Takeda Pharmaceuticals International Inc., Deerfield, Illinois; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Redwood Outcomes, Vancouver, British Columbia, Canada. .,A. Shiozawa, Associate Director, MPH, Takeda Pharmaceuticals International Inc.; S.M. Szabo, Principal, MSc, Redwood Outcomes; A. Bolzani, Research Associate, MSc, Redwood Outcomes; A. Cheung, Research Associate, MPH, Redwood Outcomes; H.K. Choi, Professor, Director, MD, DrPH, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School.
| | - Anna Bolzani
- From Takeda Pharmaceuticals International Inc., Deerfield, Illinois; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Redwood Outcomes, Vancouver, British Columbia, Canada.,A. Shiozawa, Associate Director, MPH, Takeda Pharmaceuticals International Inc.; S.M. Szabo, Principal, MSc, Redwood Outcomes; A. Bolzani, Research Associate, MSc, Redwood Outcomes; A. Cheung, Research Associate, MPH, Redwood Outcomes; H.K. Choi, Professor, Director, MD, DrPH, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School
| | - Antoinette Cheung
- From Takeda Pharmaceuticals International Inc., Deerfield, Illinois; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Redwood Outcomes, Vancouver, British Columbia, Canada.,A. Shiozawa, Associate Director, MPH, Takeda Pharmaceuticals International Inc.; S.M. Szabo, Principal, MSc, Redwood Outcomes; A. Bolzani, Research Associate, MSc, Redwood Outcomes; A. Cheung, Research Associate, MPH, Redwood Outcomes; H.K. Choi, Professor, Director, MD, DrPH, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School
| | - Hyon K Choi
- From Takeda Pharmaceuticals International Inc., Deerfield, Illinois; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Redwood Outcomes, Vancouver, British Columbia, Canada.,A. Shiozawa, Associate Director, MPH, Takeda Pharmaceuticals International Inc.; S.M. Szabo, Principal, MSc, Redwood Outcomes; A. Bolzani, Research Associate, MSc, Redwood Outcomes; A. Cheung, Research Associate, MPH, Redwood Outcomes; H.K. Choi, Professor, Director, MD, DrPH, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School
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Singh JA, Uhlig T. Chasing crystals out of the body: will treat to serum urate target for gout help us get there? Ann Rheum Dis 2016; 76:629-631. [PMID: 28031165 DOI: 10.1136/annrheumdis-2016-210436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/12/2016] [Accepted: 12/03/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center, Birmingham, Alabama, USA.,Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama, USA.,Division of Epidemiology at the School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Lee S, So MW. Adherence with urate-lowering therapies among male patients with gout in a routine clinical setting. Mod Rheumatol 2016; 26:950-955. [DOI: 10.3109/14397595.2016.1170914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sunggun Lee
- Division of Rheumatology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea and
| | - Min Wook So
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Gyeongnam, Korea
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19
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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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Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, Hider S. "Why me? I don't fit the mould … I am a freak of nature": a qualitative study of women's experience of gout. BMC WOMENS HEALTH 2015; 15:122. [PMID: 26710971 PMCID: PMC4693432 DOI: 10.1186/s12905-015-0277-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/11/2015] [Indexed: 01/21/2023]
Abstract
Background Gout is more common in men, and is often perceived by both patients and health practitioners to be a disorder of men, but its prevalence in women is increasing. Little is known about women’s experience of gout and the impact it has on their lives. It is important for practitioners to be aware of these areas, given the increasing numbers of women with gout they are likely to see in the future. This study aimed to explore women’s experiences of gout. Methods A qualitative research design was used. Semi-structured interviews were conducted with 43 people, of whom 14 were women. Interviews were video and/or tape recorded and transcribed verbatim. Data from the interviews was first grouped into broad categories, followed by a more detailed thematic analysis and interpretation. Results Participants’ ages ranged from 32 to 82. Nine participants were retired and five were in fulltime work. Four themes emerged: (1) experience of onset, help seeking and diagnosis (2) understanding and finding information about gout, (3) impact on identity, and (4) impact on roles and relationships. Conclusions The diagnostic process for women with gout can be uncertain due to lack of awareness of gout in women (by health care professionals and women themselves). Women do not have a good understanding of the condition and find it difficult to find information that feels relevant to them. Gout has a major impact on women’s identity and on their roles and relationships. These findings are of importance to health care professionals dealing with women with potential gout and those with an existing diagnosis.
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Affiliation(s)
- Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, 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.
| | - Samantha Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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Khanna P, Khanna D, Storgard C, Baumgartner S, Morlock R. A world of hurt: failure to achieve treatment goals in patients with gout requires a paradigm shift. Postgrad Med 2015; 128:34-40. [PMID: 26578028 DOI: 10.1080/00325481.2016.1113840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gout continues to be underdiagnosed and poorly managed despite the potential for cure. US and European management guidelines recommend treating to target serum urate (sUA) levels of <6 mg/dL (or <5 mg/dL to durably improve severe symptoms), with use of regular sUA monitoring, but studies suggest relatively poor adherence to these recommendations. This study investigates the real-world state of gout management in the United States by describing the characteristics of a large patient population treated in primary care and rheumatology settings. METHODS A retrospective chart audit, conducted among 124 primary care physicians and 125 rheumatologists, included 1245 patients with gout. Physicians completed structured case report forms capturing 12 months of sUA laboratory values, flare counts, comorbidities, types and doses of treatment, treatment duration, diagnosis date, physician specialty and socio-demographic factors. Focusing on the xanthine oxidase inhibitors (n = 858), descriptive statistics and multivariate models characterized relationships between patient characteristics, disease control, and treatment. RESULTS Only 83 (11%) patients achieved disease control, defined as a 12-month average sUA ≤6 mg/dL, no flares, and no tophi. Patients with greatest disease severity (defined as sUA >6 mg/dL, ≥2 flares per year, and tophi) were more likely to have kidney disease and other comorbidities. In a multivariate model, predictors of more severe gout were rheumatologist (vs primary care) management, febuxostat (vs allopurinol) use and presence of comorbid conditions. CONCLUSION Our findings confirm the inadequacy of gout management in the real-world setting. Regular monitoring, including sUA measurement as recommended in guidelines, is important to assess gout control. Our analyses also demonstrate that patients with more severe gout are more likely to have comorbid conditions, be treated by a specialist and use newer therapies.
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Affiliation(s)
- Puja Khanna
- a Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA
| | - Dinesh Khanna
- a Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA
| | - Chris Storgard
- b Research & Development, Ardea Biosciences, Inc. , San Diego , CA , USA
| | | | - Robert Morlock
- d Health Outcomes, Ardea Biosciences, Inc. , San Diego , CA , USA
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22
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Eliseev MS, Barskova VG, Denisov IS. [Time course of changes in the clinical manifestations of gout in men: data of a 7-year retrospective follow-up]. TERAPEVT ARKH 2015; 87:10-15. [PMID: 26155614 DOI: 10.17116/terarkh201587510-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To estimate the time course of changes in the clinical manifestations of gout and their risk factors during a long-term follow-up. SUBJECTS AND METHODS A total of 160 male patients with gout were examined and followed up for a mean of 6.9 ± 2.0 years. Their clinical assessment included determination of the type of arthritis over time, the frequency of arthritis attacks during one year prior to the examination, the presence and number of subcutaneous tophi, inflamed joints, comorbid or co-occurring diseases (CD), allopurinol adherence, dietary compliance, frequency of taking non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and alcohol. The serum levels of uric acid (UA), glucose, total cholesterol, and glomerular filtration rate were estimated. RESULTS The number of patients taking allopurinol increased from 19% to 64% (p < 0.0001), its average daily dose was 167.6 ± 94.6 mg. The serum level of UA decreased; 16% of the patients achieved its target level. The number of patients with chronic arthritis was not significantly changed. Their serum level of UA was unchanged; the detection rate of subcutaneous tophi and CD rose. During one year, arthritis attacks were absent in 13% of the patients; 90% of them took allopurinol. In these patients, serum UA levels and body mass index significantly declined and the rate of CD was unchanged. None of 18 patients who had their diet and no allopurinol achieved the target level of UA. CONCLUSION Among the gouty patients, 36% refrain from the use of allopurinol, only 23% out of them require that its dose be adjusted to achieve the target level of UA. Dietary compliance is insufficient to reach the target level of UA. Chronic arthritis is associated with the increased incidence of CD.
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Affiliation(s)
- M S Eliseev
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - V G Barskova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - I S Denisov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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24
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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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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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Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, Doherty M. Epidemiology and management of gout in Taiwan: a nationwide population study. Arthritis Res Ther 2015; 17:13. [PMID: 25612613 PMCID: PMC4342824 DOI: 10.1186/s13075-015-0522-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/08/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Gout is the most common inflammatory arthritis worldwide and is the only type of chronic arthritis that potentially can be 'cured'. However, data on gout incidence, prevalence and management, assessed at multiple time points in the same population, are sparse, particularly in Asian populations. The aim of this study was to describe trends in the epidemiology of gout in the general population of Taiwan. METHODS The National Health Insurance Research Database was used to identify patients with gout and to estimate the prevalence and incidence of gout for each calendar year from 2005 to 2010. The pattern of gout management was also examined. RESULTS Of 23,371,362 beneficiaries in 2010, there were 1,458,569 prevalent and 56,595 incident cases of gout, giving a prevalence of 6.24% (95% confidence interval (CI), 6.23% to 6.25%) and an incidence of 2.74 (95% CI, 2.72 to 2.76) per 1,000 person-years. The annual percentage change (APC) of the standardised prevalence was -0.7% (95% CI, -1.7% to 0.3%; P=0.14), suggesting that the prevalence of gout was essentially the same throughout the study period. However, The APC of incidence was -13.4 (95% CI, -16.1 to -10.6) between 2005 and 2007 and -2.1 (95% CI, -10.4 to 7.1) between 2007 and 2010. Regions with the highest prevalence and incidence were eastern coastal counties and offshore islets, where indigenous people are clustered. Among prevalent gout cases in 2010, only 22.93% (95% CI, 22.87% to 23.00%) were prescribed urate-lowering treatment (ULT), which remained unchanged between 2005 and 2010 at an APC of 0.0 (95% CI, -3.8 to 4.0). Uricosuric agents were more commonly prescribed than xanthine oxidase inhibitors in Taiwan. CONCLUSIONS In Taiwan, 1 in 16 people have gout. Whereas the incidence has decreased recently, the prevalence remains unchanged. Management of gout in Taiwan is poor, with only one in five affected people being treated with ULT.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. .,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, 259, Wenhua 1st road, Taoyuan, 333, Taiwan. .,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, 259, Wenhua 1st road, Taoyuan, 333, Taiwan.
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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McGowan B, Bennett K, Silke C, Whelan B. Adherence and persistence to urate-lowering therapies in the Irish setting. Clin Rheumatol 2014; 35:715-21. [PMID: 25409858 DOI: 10.1007/s10067-014-2823-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 10/20/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Abstract
To identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.
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Affiliation(s)
- Bernie McGowan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.
| | - Kath Bennett
- The Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Carmel Silke
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bryan Whelan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.,The Department of Medicine, National University of Ireland, Galway, Ireland
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Lopez AD, Williams TN, Levin A, Tonelli M, Singh JA, Burney PGJ, Rehm J, Volkow ND, Koob G, Ferri CP. Remembering the forgotten non-communicable diseases. BMC Med 2014; 12:200. [PMID: 25604462 PMCID: PMC4207624 DOI: 10.1186/s12916-014-0200-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 12/15/2022] Open
Abstract
The forthcoming post-Millennium Development Goals era will bring about new challenges in global health. Low- and middle-income countries will have to contend with a dual burden of infectious and non-communicable diseases (NCDs). Some of these NCDs, such as neoplasms, COPD, cardiovascular diseases and diabetes, cause much health loss worldwide and are already widely recognised as doing so. However, 55% of the global NCD burden arises from other NCDs, which tend to be ignored in terms of premature mortality and quality of life reduction. Here, experts in some of these 'forgotten NCDs' review the clinical impact of these diseases along with the consequences of their ignoring their medical importance, and discuss ways in which they can be given higher global health priority in order to decrease the growing burden of disease and disability.
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Affiliation(s)
- Alan D Lopez
- School of Population and Global Health, The University of Melbourne, Building 379, 207 Bouverie St, Carlton, Melbourne, VIC, 3053, Australia.
| | - Thomas N Williams
- Department of Medicine, Imperial College, St Mary's Hospital, London, W21NY, UK.
- KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya.
| | - Adeera Levin
- University of British Columbia, St Paul's Hospital, 1081 Burrard Street Rm 6010 A, Vancouver, BC, V6Z1Y8, Canada.
| | - Marcello Tonelli
- , 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions, VA Medical Center, 510, 20th street South, Birmingham, AL, FOT 805B, USA.
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College, London, UK.
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada.
- Clinical Psychology and Psychotherapy, Technical Universität Dresden, Dresden, Germany.
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Toronto, Canada.
- Department of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada.
- Institute of Medical Science, UofT, Toronto, Canada.
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA.
| | - George Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892-9304, USA.
| | - Cleusa P Ferri
- Institute of Education and Health Sciences, Hospital Alemao Oswaldo Cruz, Rua João Julião, 245 - Bloco D CEP 01323-903, São Paulo, SP, Brazil.
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 862- 1o andar, São Paulo, CEP, 04023-062, Brazil.
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Kerr GS, Richards JS, Nunziato CA, Patterson OV, DuVall SL, Aujero M, Maron D, Amdur R. Measuring physician adherence with gout quality indicators: a role for natural language processing. Arthritis Care Res (Hoboken) 2014; 67:273-9. [PMID: 25047509 DOI: 10.1002/acr.22406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/15/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate physician adherence with gout quality indicators (QIs) for medication use and monitoring, and behavioral modification (BM). METHODS Gout patients were assessed for the QIs as follows: QI 1: initial allopurinol dosage <300 mg/day for patients with chronic kidney disease (CKD); QI 2: uric acid within 6 months of allopurinol start; and QI 3: complete blood count and creatinine phosphokinase within 6 months of colchicine initiation. Natural language processing (NLP) was used to analyze clinical narrative data from electronic medical records (EMRs) of overweight (body mass index ≥28 kg/m(2) ) gout patients for BM counseling on gout-specific dietary restrictions, weight loss, and alcohol consumption (QI 4). Additional data included sociodemographics, comorbidities, and number of rheumatology and primary care visits. QI compliance versus noncompliance was compared using chi-square analyses and independent-groups t-test. RESULTS In 2,280 gout patients, compliance with QI was as follows: QI 1: 92.1%, QI 2: 44.8%, and QI 3: 7.7%. Patients compliant with QI 2 had more rheumatology visits at 3.5 versus 2.6 visits (P < 0.001), while those compliant with QI 3 had more CKD (P < 0.01). Of 1,576 eligible patients, BM counseling for weight loss occurred in 1,008 patients (64.0%), low purine diet in 390 (24.8%), alcohol abstention in 137 (8.7%), and all 3 elements in 51 patients (3.2%). Regular rheumatology clinic visits correlated with frequent advice on weight loss and gout-specific diet (P < 0.0001). CONCLUSION Rheumatology clinic attendance was associated with greater QI compliance. NLP proved a valuable tool for measuring BM as documented in the clinical narrative of EMRs.
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Affiliation(s)
- Gail S Kerr
- Veterans Affairs Medical Center, Georgetown University, and Howard University, Washington, DC
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Stamp LK, Merriman TR, Barclay ML, Singh JA, Roberts RL, Wright DFB, Dalbeth N. Impaired response or insufficient dosage? Examining the potential causes of "inadequate response" to allopurinol in the treatment of gout. Semin Arthritis Rheum 2014; 44:170-4. [PMID: 24925693 DOI: 10.1016/j.semarthrit.2014.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/06/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Gout is one of the most common forms of arthritis. It is well established that urate-lowering therapy that aims for a serum urate less than at least 0.36 mmol/l (6 mg/dl) is required for the successful management of gout. Allopurinol, a xanthine oxidase (XO) inhibitor, is the most commonly used urate-lowering therapy. However, many patients fail to achieve the target serum urate on allopurinol; these patients can be considered to have "inadequate response" to allopurinol. Herein, we examine the potential mechanisms and implications of inadequate response to allopurinol. METHODS The literature was reviewed for potential causes for failure to reach target serum urate in patients receiving allopurinol. RESULTS The two most common causes of inadequate response to allopurinol are poor adherence and under-dosing of allopurinol. Adherent patients who fail to achieve target serum urate on standard doses of allopurinol form a group that could be considered to be "partially resistant" to allopurinol. There are four potential mechanisms for partial allopurinol resistance: decreased conversion of allopurinol to oxypurinol; increased renal excretion of oxypurinol; abnormality in XO structure and/or function such that oxypurinol is rendered less effective and/or drug interactions. CONCLUSIONS It is important to determine the reasons for failure to achieve treatment targets with allopurinol, particularly as newer agents become available. The knowledge of the mechanisms for inadequate response may help guide the clinician towards making a therapeutic choice that is more likely to result in achieving the serum urate target.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch 8140, New Zealand.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Murray L Barclay
- Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand
| | - Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL; Rheumatology Division, University of Alabama, Birmingham, AL
| | - Rebecca L Roberts
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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