Problems of adherence to therapy in patients with gout in real clinical practice

Aim. To evaluate treatment adherence among patients with gout.

Materials and methods. One hundred and thirty-eight patients with gout were examined in the Dzhanelidze Saint Petersburg Research Institute of Emergency Care; 89.9% of them are men and 10.1% are women. The average age of the subjects was 58.1±1.1 years, the average duration of the disease was 8.4±0.7 years. All patients answered a questionnaire in which they indicated the prescription of the disease, the number of gout attacks over the past 12 months, adherence to a low-purine diet, taking urate-lowering drugs, dose and duration of therapy, as well as contacting a rheumatologist and the regularity of observation by a specialist. All the subjects were also examined to identify tofuses, and blood was taken from them to determine the level of uric acid. Results were statistically processed, considering the differences as significant at p<0.05.

Results. Tophi were detected in 31.9% of patients. The average uric acid level in all examined patients was 8.1±0.2 mg/dl, while the target level of less than 6.0 mg/dl was detected only in 10.1%. Of all the respondents, only 13.0% of patients had no arthritis attacks in the last 12 months, the remaining 87.0% of patients had at least one attack during this period; 36.2% of people had never taken urate-lowering therapy; 39.1% of patients regularly received urate-lowering drugs, most of them (20.3%) took allopurinol at a dose of 100 mg/day, while only two of them had a target uric acid level of less than 6.0 mg/dl; 13.7% of respondents took allopurinol at a different dosage (50 mg/day; 150–400 mg/day); 5.1% of patients took febuxostat; 13.8% of patients independently canceled the drug after a short course of administration, 8.0% received urate-lowering therapy sporadically, 2.9% do not tolerate urate-lowering drugs. The average uric acid level in the group receiving urate-lowering therapy was 7.5±0.2 mg/dl, and in the sample without therapy – 8.5±0.3 mg/dl (p<0.05); 70.3% of the surveyed patients reported that they did not follow a diet, only 13%, according to words, comply and 16.7% try to comply with the necessary restrictions in nutrition. 44.2% of patients from the group have never seen a rheumatologist, 33.3% have been treated once during the entire period of the disease, 19.6% are observed from time to time and only 2.9% of the entire group was regularly observed by a rheumatologist. When comparing groups of patients who have never seen a rheumatologist (group 1) and patients who have been examined at least once by a specialist (group 2), adherence to urate-lowering therapy and a low-purine diet is significantly higher in the second group.

Conclusion. The patients we examined showed low adherence to the treatment of gout: only 39.1% of them regularly took urate-lowering therapy, while 70.4% of those receiving therapy retained arthritis attacks and 75.9% of these patients did not reach the target uric acid level. Unsatisfactory control of gout is primarily associated with an insufficient dose of urate-lowering drugs taken, the lack of individual selection of therapy according to the level of uric acid. Ways to solve the problem, in our opinion, are to increase the level of knowledge of primary care physicians about the specifics of treatment and selection of anti-inflammatory drugs, increase awareness of people with gout about their disease, as well as more actively refer such patients to a rheumatologist.