BackgroundGout is a poorly controlled disease despite the availability of effective treatment methods. One of the main reasons for its poor controll is patients’ low adherence to treatment, including due to insufficient knowledge of treatment principles.ObjectivesTo assess adherence to therapy and results of treatment in gout patients who attended schools for patients and in those who did not.MethodsAll patients with crystal-verified gout were interviewed and invited to attend School for gout pts. Totally 301 pts with gout were observed, 36 (10%) females and 264 (90%) males, mean age 54.5±12,7 y., mean disease duration 9.02±1,12 y., with the gout diagnosis verified at average 48.71[12;60 months after the onset, the target UA level <360 µmol/l initially was in 72 pts (24%).All patients were divided into 3 groups: Group 1 included 111 (36%) patients who refused to attend the school, Group 2 included 90 (30%) patients who consented but failed to come, Group 3 consisted of 100 (34%) patients who attended the School (- 100 (34%)).The data from the questionnaires were used for baseline and on-treatment assessments of the following: patient‘s attitude to the disease, patient’s compliance to treatment, satisfaction with quality of life, the fact of taking urate-lowering therapy, UA level control, achievement of the UA level of <360 µmol/l.ResultsIn all 3 groups, after the visit to the doctor, the number of the patients taking urate-lowering therapy who reached the target level of uric acid, significantly increased, the maximum values were noted in the group who attended the School for gout pts. The UA target level achievement results in Group 2, of those who agreed to attend the School but never did for various reasons, were better than in Group 1 and comparable to that in Group 3. Table 1 presents the results of questionnaire survey at baseline and after one year.Better adherence to treatment was noted in patients with poorer quality of life and a rational attitude toward their disease. The patients who report satisfaction with quality of life often decided to refuse to take their medications, visited the doctor less often and more seldom achieved the UA target level.Abstract FRI0226 – Table 1Parameters at baseline and after one yearparametersGroup 1 (patients who refused to attend the school), n=111Group 2 (patients who consented but failed to come), n=90Group 3 (patients who attended the school), n=100 baselineafter 1 yearbaselineafter 1 yearbaselineafter 1 year Did not take urate lowering therapy, n (%)86 (79%)38 * (35%)55 (62%)12 (12%)56 (56%)8 (8%)Monitored the level of UA, n (%)62 (56%)76 * (69%)68 (75%)72 (80%)62 (62%)90 (92%)Achieved the target UA level<360 µmol/l, n (%)8 (33%)56* (51%)14 (15%)62 (69%)13 (13%)87 (87%)Satisfied with the quality of life, n (%)84 (67%)85 (77%)42 (47%)75 (83%)62 (62%)95 (95%)Not satisfied with the quality of life, n (%)26 (33%)5 (5%)48 (53%)3 (4%)38 (38%)3 (3%)»*<0,05 between the baseline and one-yearConclusionsPatients’ attendance of the School for gout pts increases their adherence...
О р и г и н а л ь н ы е и с с л е д о в а н и я ФГБНУ «Научноисследовательский институт ревматологии им. В.А. Насоновой»,
The 2018 national guidelines for the management of gout provide a consistent scheme for urate-lowering drugs; however, the possibility of achieving uric acid (UA) targets in its use has not been studied.Objective: to evaluate the effectiveness and safety of the urate-lowering therapy algorithm presented in the national guidelines for the management of gout.Patients and methods. This investigation was a prospective single-center study. It has been currently included 54 patients (91% males) with gout. The follow-up period is not less than 12 weeks of continuous use of allopurinol or febuxostat (Azurix) at the final dose.After the initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to achieve the UA target that was defined as <360 or <300 μmol/L in patients with severe tophaceous gout. The maximum dose was 900 mg/day; it was 300 mg/day when the glomerular filtration rate was <60 ml/min/1.73 m2 . Patients with the inefficacy of allopurinol and/or the presence of its associated adverse reactions (ARs) were prescribed febuxostat 80 mg/day; the dose was increased to 120 mg/day as needed.For the prevention of acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at the minimum therapeutic doses or colchicine 0.5 mg/day, and if these drugs were contraindicated, a glucocorticoid (GC) 7.5 mg/day, as calculated with reference to prednisone, was taken.The probability of achieving the serum UA target (<360 or 300 μmol/L) was assessed in patients with chronic tophaceous gout.Results and discussion. 12 weeks after therapy initiation, the UA target could be achieved in 39/50 (79%) patients. The target levels <360 and 360 μmol/L were recorded in 15/21 (71%) and 24/33 (73%), respectively. The UA level <360 μmol/L was noted to decrease in a total of 92% of cases. Febuxostat was given to 41 patients: to 27 (66%) due to the inefficacy of allopurinol and to 14 (34%) due to its ARs. As a result, the UA target was achieved in 30 (73%) patients, and there was a decrease in the UA level <360 μmol/L in 35 (85%).ARs were seen only in 3 febuxostat-treated patients, including 2 patients with previous allopurinol-induced ARs.For the prevention of arthritis attacks, 10 (19%) patients took NSAIDs, 41 (75%) received colchicine, and 3 (6%) used GC. There were no refusals to receive urate-lowering and preventive anti-inflammatory therapies.Conclusion. The proposed treatment regimen allows for achieving the serum UA target in 79% of patients and its decrease <360 μmol/L in 92%. Treatment with febuxostat (Azurix) is associated with its good tolerance, including in the patients who could not use allopurinol because of AR. Preventive anti-inflammatory therapy is likely to improve adherence to urate-lowering therapy.
During the first months after the initiation of urate-lowering therapy in gout patients, the risk of exacerbation of arthritis considerably rises, which often results in discontinuation of the prescribed therapy by patients. The main way to avoid this risk is preventive prescription of colchicine, NSAIDs or glucocorticoids. Such prophylaxis of acute arthritis has been specified in a large number of the latest editions of various national and international guidelines; however, this tactics is rarely used in practice. The chapter includes the most significant studies on this problem.
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