european crystal network workshop

    Assessment of treatment adherence and effectiveness in a hospital-based gout cohort: the role of ckd and comorbidities

    Background: Gout is an inflammatory disease secondary to hyperuricemia leading to uric acid deposition in tissues. Many studies have documented that treatment is sub-optimal: many patients are not receiving an effective treatment/dose and many continue to experience gout flares as well as disease progression to tophaceous gout.

    Objectives: We investigated treatment adherence and the possible causes of lack of adherence in a hospital-based cohort of gout patients. The relation of adherence to co-morbidities as well as clinical features of gout was studied.

    Methods: We sent a questionnaire to all patients seen at the gout clinic of the CHUV between January 2015 and November 2018 to solicit their participation in the study. Adherence to therapy was based on responses to the questionnaire. 50 of 197 contacted patients returned a completed questionnaire. Clinical, demographic and biochemical data were obtained from the hospital’s electronic clinical information system. Statistical analyses were performed using the c2 test. The study was approved by the institutional ethics committee.

    Results: Of the 50 patients, 78% have been on treatment for > 6 months. 44% had tophaceous gout. The most common ULT was allopurinol (67%). 86% of patients declared a good therapeutic adhesion (on medication > 90% of the time). However, 56% of patients continued to have flares (>1 in the last 6 months); no difference was observed between patients with or without tophaceous gout. Only 58% of patients reached the target sUA level (tophaceous 45%, non-tophaceous 68%; p = n.s.).  Patients who reached sUA targets were more likely to have no co-morbid conditions (79% vs 50%, p=0.07). Most patients with did not reach sUA targets had inadequate ULT dose compared to patients who reached ULT target (89% vs 11%, p=0.0001). Among co-morbidities, presence of CKD was associated with more flares. 

    Conclusions: Suboptimal care in gout is not only dependent on patients’ adherence but also on their general health and concomitant diseases. It would therefore be interesting to investigate in more detail the relation between comorbidities, in particular CKD, and the quality of care of the gout.