Gout Clinical Update, July 22, 2011

Treatment adherence for gout is poor and patient education should be emphasized as a key tool in battling problems with adherence, according to the results of a recent study conducted by researchers in France and published in the journal Joint Bone Spine.

As the researchers note, the treatment objectives in gout are to promptly terminate the acute flares and to prevent the long-term complications via chronic pharmacotherapy, usually with urate-lowering drugs, combined with diet and lifestyle changes.

“Published data indicate that adherence with pharmacotherapy is particularly poor in gout patients,” the authors wrote. “In studies of pharmacy dispensing of gout medications, the percentage of patients with good adherence, defined as purchasing at least 80% of the prescribed amount of medication, ranged from 18 to 44%. In a comparative study showing a 36.8% adherence rate among gout patients, patients with hypertension or type 2 diabetes had considerably higher rates, 72.3 and 65.4%, respectively.”

The researchers added that data are lacking on adherence to recommended dietary and lifestyle changes, the importance of which has been emphasized in recent years. “Poor adherence has well-documented adverse consequences on the treatment success rate and on disease progression. These data identify treatment adherence in gout as a key target of patient education.”

Patient-Reported Outcomes in Chronic Gout From OMERACT 10

Delegates to the OMERACT (Outcome Measures in Rheumatology) 10 gout workshop have endorsed one measure each for pain, patient global, SF-36, and activity limitation, meaning that all 4 patient-related outcome (PRO) domains for chronic gout have been endorsed. The results were published in a recent issue of the Journal of Rheumatology.

Validation data were presented at OMERACT, which was held in May, for key PRO domains including pain [pain by visual analog scale (VAS)], patient global (patient global VAS), activity limitation [Health Assessment Questionnaire-Disability Index (HAQ-DI)], and a disease-specific measure, the Gout Assessment Questionnaire version 2.0 (GAQ v2.0).

According to the announcement, data were presented on all three aspects of the OMERACT filters of truth, discrimination, and feasibility. One PRO, health-related quality of life measurement with the Medical Outcomes Study Short-form 36 (SF-36), was previously endorsed at OMERACT 9.

“One measure for each of the three PRO of pain, patient global, and activity limitation was endorsed by > 70% of the OMERACT delegates to have appropriate validation data. Specifically, pain measurement by VAS was endorsed by 85%, patient global assessment by VAS by 73%, and activity limitation by HAQ-DI by 71%. GAQ v2.0 received 30% vote and was not endorsed due to several concerns including low internal consistency and lack of familiarity with the measure. More validation studies are needed for this measure,” the researchers wrote.

“Future validation studies are needed for the disease-specific measure, GAQ v2.0. Validation for PRO for acute gout will be the focus of the next validation exercise for the OMERACT gout group,” they added.

SourcesTreatment Adherence in Patients with Gout [Joint Bone Spine]

Patient-Reported Outcomes in Chronic Gout From OMERACT 10 [Journal of Rheumatology]