Background Gout is a common cause of acute inflammatory arthritis. Recurrent gout attacks may eventually cause long-term consequences such as structural joint damage due to tophaceous complications. Because gout is a well treatable condition, it is important to identify barriers to effective management, in order to prevent long-term negative impact of gout on function and quality of life. One of the known barriers is non-adherence of patients to prescribed drug regimens.
Objectives (1) To explore the knowledge of patients about various aspects of gout. (2) To study negative perceptions about gout treatments that might account for non-adherence to uric-acid lowering therapy (UALT) and that might need attention in future educational programmes.
Methods Semi-structured interviews involving patients with gout were conducted. Each interview was audio-taped and fully transcribed afterwards. The transcripts were independently read and annotated by 2 readers, illustrative themes were identified and a coding system to categorize the data was developed.
Results Fourteen patients (13 men; mean age 62 years; mean disease duration 11 years) were interviewed. Nine were recruited from the rheumatology outpatient clinic; 5 were recruited from primary care. Six patients had gout tophi and 11 patients were on UALT. All patients had ≥1 cardiovascular risk factor and/or cardiovascular disorder. All patients described a gout attack as “unbearable pain” and most patients considered gout a chronic condition. Five patients mentioned that hyperuricemia can cause gout and 8 patients knew that “crystals” play an important role in the pathophysiology of gout. Three patients could explain the difference in mode of action between anti-inflammatory drugs and UALT. Most patients did not realize that inadequate control of gout can eventually result in chronic polyarticular disease and structural joint damage. Almost all patients expressed that medication intake is part of their daily routine and they considered themselves adherent to medication. However, 6 patients also admitted medication non-adherence at some point in time. Some patients discontinued UALT because they experienced a gout flare and concluded that the medication did not work. Other reasons for non-adherence were: (1) too many prescription pills a day, (2) physicians gave conflicting messages about medication, (3) insecurity due to generic substitution by pharmacists, (4) forgot to take medication (no further specification). Half of the patients expressed that they, especially at the time of diagnosis, wanted to know more about the aetiology of gout, treatment goals, long-term consequences and lifestyle modification.
Conclusions In this qualitative study, patients correctly recognised gout as a chronic condition. More than half of the patients are more or less aware of the pathophysiologic processes that cause inflammatory arthritis. Most patients described themselves as adherent to therapy but also revealed several barriers that can challenge compliance. Improving knowledge and addressing common misperceptions in educational programmes, may ultimately contribute to adherence to UALT.
Disclosure of Interest None declared