AB1019 Patients compliance to chronic gout therapy when administered by different medical professionals
Authors: A. Sarapulova, O. Teplyakova, A. Popov, T. Popova, P. Palabugina
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> in everyday practice chronic gout patients are frequently consulted by general practitioners, surgeons, cardiologists and other specialists. In general, chronic gout patients have been reported to be quite incompliant, but it remains unclear whether low compliance depends on the specialty of the prescribing physician.<sup>1</sup> <h3>Objectives</h3> to compare the clinical course of gout in patients consulted by different specialists and to identify factors of low patients' compliance in Russia. <h3>Methods</h3> cross-sectional study included 56 chronic gout patients aged 31 to 82 (median 54 years). Average gout symptoms duration was 6.8 years, average attacks frequency was 6.4 per year. Tofi were present in 21.4% of patients. All subjects were divided into three groups: Group 1 consisted of treatment naive patients at primary rheumatologist visit, Group 2 and Group 3 included patients who had previously been treated. Group 2 subjects were visiting both non-rheumatologists and rheumatologists. Group 3 were managed by rheumatologists strictly according to the EULAR evidence-based recommendations.<sup>2</sup> <h3>Results</h3> Group 1 primary consulted rheumatologists at the age of 47.3±14.5, Group 2 patients were assessed at the age of 58.4±15.2, and Group 3 were aged 51.2±13.5. Disease symptoms duration was maximal in Group 2 (10.6±10.6 years) while 5 years in Groups 1 and Group 3. Flares frequency was the lowest in Group 3 (2.2±1.8 per year), while in Group 2 it was extremely high – (10,58±10,56 per year). The incidence of tofi and urolithiasis was lowest in the Group 3 whereas every third treatment naive patient had tophi or/and urolythiasis. To relieve gouty arthritis vast majority of patients used NSAIDs, though at 50% strength of the recommended dose. Only 9%–14% of flares were controlled by colchicine in Groups 2 and 3. Colchicine prevention of flares was prescribed only in 45% of cases by rheumatologists. The most frequent urate-lowering therapy (ULT) was allopurinol, it was taken only by 63% of patients of the third group and 35.7% in the second group. While patients in the third group took the drug daily, the other patients did not follow the administration scheme. Serum creatinine level was the lowest (87.5±16.8 μmol/L) in Group 3, being the highest in treatment of naïve patients (102.7±30.0 μmol/L). Serum uric acid target level was achieved only in the compliant Group 3 patients (343 μmol/L), while Group 2 levels varied between 462–546 μmol/L, being the highest (625 μmol/L) in treatment naïve Group 1. Low compliance risk factors were: age under 45, absence of comorbidity and long term multiple drugs consumption. <h3>Conclusions</h3> chronic gout patients' compliance and quality of patient management can be assessed as alarmingly low. Rheumatologists adhering to EULAR evidence-based approach to gout management can actually achieve recommended treatment targets. Both general practitioners and other specialists are in need of consistent educational program on gout management. Younger and comorbidity-free gout patients should be encouraged to follow attending physician's recommendations. <h3>Reference</h3> [1] Burrell A, Wong P, Ollendorf D, et al. Defining compliance/adherence and persistence: ISPOR Special Interest Working Group. Value Health2005; 8:A194–5. <h3>Disclosure of Interest</h3> None declared