Background/Purpose The prevalence of gout appeared to be increasing in China as its economy developed rapidly in the past three decades. Though efficacious and affordable treatment of gout was widely available, the disease was not well controlled in many countries of the world including China. Poor adherence to treatment recommendations was one major reason leading to unsatisfactory management. Patients’ adherence to medical treatment of gout was reported to be 17-44% in developed countries, but the data were unknown in China.

Methods A structured survey was carried out by telephone interview in 349 patients recruited from Gout Clinic at Peking Union Medical College Hospital in 2014. They all satisfied the ACR classification criteria for gout, 1977, and had dietary education when their diagnosis was made or confirmed in our clinic as baseline. 271 patients with urate lowering therapy (ULT) indications were also provided with medication recommendations and/or prescriptions according to the ACR and EULAR guidelines. Demographic data and clinical characteristics were collected at baseline. Patients’ adherence to dietary and medication recommendations was measured by food frequency questionnaire and proportion of accumulative days of ULT medication consumption, respectively in the survey. Consumption of alcohol (beer, wine, spirit and yellow rice wine), seafood and internal organs less than once a month and limited intake of red meat was defined as dietary adherence, and ULT ≥80% of time since baseline was defined as medication adherence. Multivariable logistic regression models were used to estimate the independent association between patient characteristics and adherence. Patients’ explanations for medication non-adherence were also asked.

Results The dietary and medication adherence were 44.2% and 21.9%, respectively. Older patients (age ≥60), high serum urate levels (>642umol/L) and tophi at baseline were associated with dietary adherence independently. Tophi and chronic kidney disease at baseline were associated with medication adherence independently, but the longer the time between baseline and the survey was, the less proportion of patients were adherent to ULT medication (Table 1). The main reasons patients reported leading to their medication non-adherence included remission after treatment (35.1%), concern of side effects (22.7%), insufficient patient education (9.5%) and adverse events (8.1%).

Conclusion Patients’ adherence to treatment recommendations of gout was poor in China.Older age, high serum urate levels and comorbidity (tophi and chronic kidney disease) at baseline were associated with treatment adherence. As time elapsed, less patients were adherent to ULT medications.

Table 1. Characteristics associated with treatment adherence of gout

Characteristics	Adjusted OR(95%CI)	p
Dietary adherence
Age
<30	1(Ref.)
30-39	0.44(0.12-1.57)	0.20
40-49	0.86(0.26-2.99)	0.81
50-59	0.83(0.22-3.19)	0.79
≥60	4.67(1.07-20.36)	0.04
Serum urate levels
1st Quartile (0-498umol/L)	1
2nd Quartile (499-569 umol/L)	1.05(0.39-2.83)	0.92
3rd Quartile (570-642 umol/L)	0.97(0.37-2.52)	0.95
4th Quartile (>642 umol/L)	4.23(1.47-12.16)	<0.01
Tophi	2.39(1.06-5.37)	0.04
Medication adherence
Tophi	4.60(1.37-15.42)	0.01
Chronic kidney disease	8.39(2.02-34.84)	<0.001
Time interval between baseline and the survey
<1year	1(Ref.)
1-3year	0.09(0.03-0.30)	<0.001
≥3year	0.03(0.003-0.37)	<0.01

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-treatment-recommendations-of-gout-a-patient-survey-in-china/