Gout Patients Prefer Drugs (and Cherry Extract)

The American College of Rheumatology (ACR) recommends that pharmacologic therapy for acute gout arthritis attacks be prescribed within 24 hours of onset, yet half of patients with gout are not prescribed urate-lowing therapy (ULT) by their physician and more than 50 percent turn to complementary and alternative therapies, according to a study published in the March 1 issue of BMC Complimentary and Alternative Medicine.

The study, a cross-sectional survey conducted by Jasvinder A. Singh, M.D., and colleagues from the University of Alabama, was designed to assess the prevalence of ULT use and adherence and patient preference for non-pharmacological interventions, such as cherry extract and diet modification.

Urate-lowering therapy (ULT) is the first line of defense for severe gout attacks and its use is associated with a decreased risk of repeated attacks, but its use in the initial phase can sometimes intensify the symptoms, which can contribute to a patient’s non-adherence to long-term treatment.

Because gout is associated with an increased risk of cardiovascular mortality, reducing serum urate levels is especially important. But patient adherence to medication has always been an issue and among patients with gout, medication adherence is among the lowest of all chronic conditions.

Brian Mandell, M.D., Ph.D., a rheumatologist with the Cleveland Clinic, points to a host of other reasons. In a continuing education course, Dr. Mandell agreed that urate-lowering therapy is too frequently prescribed, but allopurinol, is also often dosed too low to be effective.

There are other factors as well, but managing gout patients with comorbidities – such as diabetes, kidney and cardiovascular disease – makes treating gout even more difficult, Dr. Mandell writes.

The new study is based on the results of a survey of 499 gout patients, mean age 56.3 years with 74% being white males. Fifty seven percent (285) of the patients were prescribed urate-lowering therapy (allopurinol or febuxostat)  and of those currently taking a ULT for gout (88%), 78% reported they were taking their ULT more than 80% of the time. In terms of their willingness to take ULT long-term, 56% agreed, but 24% preferred cherry extract and 16% felt they could manage gout flares with diet modification.

A large proportion of the patients in the study expressed a preference for non-pharmacological treatments for gout regardless of whether they were prescribed a ULT, which the researchers say, is an important finding.

“It is possible that discussing these non-pharmacological options during a clinic visit in a patient-centric approach can lead to setting of common goals by a patient-physician team that may lead to higher patient satisfaction and possibly more success in achieving treatment goals,” the researchers wrote.

References:

Jasvinder A. Singh, Nipam Shah and N. Lawrence Edwards. “A cross-sectional internet-based patient survey of the management strategies for gout,” BMC Complementary and Alternative Medicine. March 1, 2016. DOI: 10.1186/s12906-016-1067-3.

"Biologics in the Treatment of Gout – Bringing High-Tech Therapies to an Ancient Disease," Brian F. Mandell, MD, PhD. Cleveland Clinic Center for Continuing Education

Dinesh Khanna, Puja P. Khanna, et al. “2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis,” Arthritis Care & Research. Vol. 64, No. 10, October 2012. DOI 10.1002/acr.21773