Background According to EULAR recommendations, long term management of gout encompasses pharmacological and non pharmacological treatments. Patient education and adherence to medication and lifestyle advices are key factors of management .
Objectives An observational and cross-sectional study was conducted by general practitioners (GP). The main objective was to determine factors associated with adherence to treatment of gout. Secondary objectives were to analyse adherence to lifestyle recommendations and achievement of therapeutic goal for uricaemia, and also to describe the perception of the disease and treatments.
Methods Adult patients with gout, taking a urate lowering therapy for more than 3 months, were included by 630 GP. Data were collected during a unique visit. Adherence to treatment was assessed through a 5-item self-questionnaire [2,3]. Factors associated with adherence were analysed using a multivariate logistic regression. Adherence to lifestyle recommendations were assessed via questions on alcohol, beer and soda intake. Patients also completed the Brief Illness Perception Questionnaire (B-IPQ)  and the Beliefs about Medicines Questionnaire (BMQ) .
Results 1441 patients with gout (85% male, age: 64.4 ± 11.4 years) were retained in the analysis. Main symptoms were pain and swelling (85%), podagra (60%) and erythema (49%). Mean serum uric acid level was 63.4 ± 16.4 mg/L (42% were below the therapeutic goal of 60 mg/L); 85% of patients were overweighted (including 38% obese); 70% had hypertension; 62% had dyslipidemia; 24% had type 2 diabetes; they took 4.9 ± 3.5 tablets daily in average. Overall, 80% of patients were assessed as adherent to medicines and 32% to lifestyle recommendations. Main factors associated with a good adherence to medicines were: being more than 70 years (OR=1.9; CI95%: [1.2–2.9]), having an uricaemia below the therapeutic goal (OR=1.8; CI95%: [1.3–2.5]), regularly checking uricaemia (OR=1.5; CI95%: [1.0–2.1]), and taking few tablets daily (OR/unit=0.9; CI95%: [0.9–1.0]). Besides, good adherence to medicines was associated with a better perception of the disease and treatments (lower impact on quality of life, better control of gout) and a better relationship with health care professionals.
Conclusions The ADAGIO study indicates that a good adherence to the pharmacological treatment of gout is associated with regular uricaemia controls and achievement of the recommended therapeutic goal, i.e. maintaining serum uric acid below 60 mg/L . The data suggests that patients under multiple medications would benefit from special attention to help improving gout management.
Zhang W et al. Ann Rheum Dis, 2006. 65(10): p. 1312–24.
Girerd X et al. Arch Mal Coeur Vaiss, 2001. 94(8): p. 839–42.
Reach G et al. Diabetes Metab, 2011. 37(6): p. 497–504.
Broadbent E et al. Journal of psychosomatic research, 2006. 60(6): p. 631–7.
Horne R et al. Psychology & Health, 1999. 14(1): p. 1–24.
Disclosure of Interest R.-M. FLIPO Grant/research support from: Menarini, L. Martinez Grant/research support from: Menarini, P. Maigret Employee of: Menarini, G. Reach Grant/research support from: Menarini