POS1477-HPR GOUT PATIENTS IN REMISSION, AND THEIR PERSPECTIVES ON URATE LOWERING THERAPY TREATMENT STOP OR CONTINUATION STRATEGIES
Authors: I. R. Peeters, S. A. C. Wanten, L. M. Verhoef, A. Den Broeder, N. Van Herwaarden, M. Flendrie
Journal: Annals of the Rheumatic Diseases (2021)

Background: Urate lowering therapies (ULT) are used to reduce hyperuricemia in gout patients (1). When gout remission is reached, patients often ask if ULT should be continued lifelong (treat to target strategy, T2T), or if tapering or stopping (a treat to symptom approach, T2S) can be attempted. In fact, although current rheumatology guidelines (1,2) suggest continuation, conclusive evidence for this is absent. Since ULT therapy adherence also remains suboptimal, exploring gout patients’ beliefs on different long term ULT treatment strategies is of great value. Objectives: To identify cognitions and emotions on ULT treatment strategies (T2T continuation and T2S cessation) of gout patients in remission with current or previous ULT use. Methods: Purposive sampling (3) was used to recruit patients from a general practice and a rheumatology department (Nijmegen, the Netherlands), with a clinical diagnosis of gout, current or previous ULT use and remission according to adapted (without serum urate criterion) preliminary gout remission criteria(4). Semi-structured interviews were conducted by two interviewers and audio-records were fully transcribed. Inductive thematic analysis (5) was used to analyse and interpret our data using the ATLAS.ti. software. Results: From a total of 18 patients (16 male/2 female), 14 patients were treated by a rheumatologist (10 currently using ULT, 1 intermittent and 3 previously) and 4 were treated by a general practitioner (all currently using ULT). Patients were satisfied with a T2T strategy, due to the absence of flares, a feeling of certainty and the reassurance of serum urate monitoring. Reluctance towards medication was reported, the importance of indefinite ULT use was questioned and its chronic use was addressed as a drawback. Reducing medication use by a T2S strategy was assessed positively and this strategy was considered less burdensome. A wish for and the willingness to follow a T2S approach was expressed. Fear and concerns of flaring after ULT cessation were expressed and were deemed both acceptable and unacceptable. See Table 1 for a schematic overview of the results. Table 1. Overview of patients’ perspectives on ULT treatment strategies Motivation for a T2T strategy Drawbacks of a T2T strategy 1. Being free of flares 2. Acceptance of and contentment with chronic ULT use 3. Feels secure due to regular SU monitoring 4. No desire for change 1. Resistance to (any) medication use 2. Side effects of ULT 3. Possibly detrimental to healthcare costs Motivation for a T2S strategy Drawbacks of a T2S strategy 1. Doubt if chronic ULT use is necessary a. Possible restorative capacity of the body b. Curious to effects of ULT cessation 2. Being free of ULT side effects 3. Long term damage ULT unknown 4. Less burdensome for patient and body 5. Wish for minimization of (any) medication use 1. Fear and insecurities on a. Flaring and not being able to function b. Joint damage 2. Feels uncontrolled 3. Hassle with visits, blood tests and medication adjustments when a flare occurs. Conclusion: This study provides an overview of perspectives on ULT treatment strategies of gout patients in remission. These results must be considered in developing educational material for patients and in future research on gout management, particularly in designing randomised clinical trials on this subject. References: [1]Richette P et al. Ann Rheum Dis. 2017;76(1):29-42. [2]FitzGerald JD et al. Arthritis Care Res (Hoboken). 2020;72(6):744-60. [3]Pope C et al. Qual Saf Health Care. 2002;11(2):148-52. [4]de Lautour H et al. Arthritis Care Res (Hoboken). 2016;68(5):667-72. [5]Pope C et al. Bmj. 2000;320(7227):114-6. Acknowledgements: We would like to thank dr. Erik Bischoff for his cooperation and help in including primary care patients from his general practice UGC Heyendael, Nijmegen the Netherlands. Disclosure of Interests: None declared