Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
The interplay of use of dietary supplement, diet modification and ULT adherence in gout management is not known. Therefore, we aimed to begin to assess the ULT adherence and choice of non-pharmacological interventions by patients with gout, using a cross-sectional online survey.
Methods:
People visiting the Gout and Uric Acid Education Society’s website (http://gouteducation.org) were invited to participate in a brief anonymous Internet survey on a voluntary basis between 08/11/2014 to 04/14/2015. We collected each individual’s report of their age, gender, race, physician-diagnosed gout, receipt of physician prescription of urate-lowering medication (ULT; allopurinol or febuxostat; responses were yes/no), number of days the patient forgot to take ULT in the last month, the use of cherry extract vs. diet modification vs. ULT medication as what individuals thought might be the best life-long strategy for gout and patients’ likelihood of making a lifelong change to their diet (0=not at all likely to 10=extremely likely scale) for better gout management.
Results:
Of the 524 survey participants reporting a physician diagnosis of gout, 499 respondents were included in the final analysis (Table 1). Mean age of survey responders was 56.3 years (standard deviation, 12.6), 50% were 41-60 years old, 74% were males, and 74% were White and 9% Asians.
57% participants responded that they were prescribed a ULT for gout, allopurinol or febuxostat. Gender, age or race were not significantly associated with the likelihood of receiving a ULT prescription. Of those who were prescribed ULT, 251/285 (88.1%) were taking ULT, 20/285 (7%) quit taking ULT, 2/285 (0.4%) were taking ULT only when they had a gout flare and 13/285 (4.5%) did not respond to this question. 197/251 (78.5%) had ULT adherence >80% and 54/251(21.5%) had ULT adherence ≤80%. In univariate and multivariable-adjusted analyses (Table 1), gender, race and age were not significant predictors of ULT adherence.
56% of respondents said that they preferred ULT as a lifelong treatment for gout, 24% preferred cherry extract, 16% preferred diet modification and 4% preferred none of the treatments. In multivariable-adjusted analyses, men had significantly lower odds of preferring ULT as the lifelong treatment choice for gout vs. other therapies (p=0.03; Table 1).
54% of participants were highly motivated to make a lifelong dietary modification to improve their gout (likelihood score of 9-10; 72.7% had score of >5). In adjusted analyses, age was significantly associated with high level of willingness to modify diet (p=0.023; Table 1).
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Table 1. Multivariate-adjusted odds of the choice of ULT as gout treatment (ULT vs. others), adherence to ULT >80% and likelihood of lifelong diet change as treatment for gout by gender, race and age |
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|
Patient characteristics |
ULT prescribed*
|
Choice of ULT as the treatment for gout**
|
Urate-lowering medication adherence >80%*** |
Likelihood of diet change with score of >8 (range, 0-10)**** |
|
Gender |
P= 0.58 |
P=0.03 |
P=0.32 |
P=0.41 |
|
Male |
1.13 (0.74, 1.71) |
0.61 (0.39, 0.95)a |
0.68 (0.31, 1.47) |
0.84 (0.55, 1.28) |
|
Female |
Ref |
Ref |
Ref |
Ref
|
|
Age groups |
P=0.87 |
P=0.16 |
P=0.71 |
P=0.023 |
|
21-40 years |
1.39 (0.40, 4.71) |
0.76 (0.22, 2.67) |
0.81 (0.07, 9.05) |
2.59 (0.51, 13.06) |
|
41-60 years |
1.14 (0.37, 3.53) |
1.02 (0.32, 3.27) |
1.01 (0.11, 9.26) |
2.91 (0.63,13.58) |
|
61-80 years |
1.10 (0.34, 3.35) |
0.64 (0.20, 2.08) |
1.43 (0.16, 13.12) |
4.76 (1.01, 22.37)a |
|
>80 years |
Ref |
Ref |
Ref |
Ref
|
|
Race |
P=0.99 |
P=0.60 |
P=0.77 |
P=0.48 |
|
African American |
1.10 (0.41, 2.80) |
0.91 (0.45, 1.85) |
0.49 (0.11, 2.24) |
1.35 (0.68, 2.70) |
|
Hispanic or Latino |
1.04 (0.33, 3.24) |
0.92 (0.31, 2.77) |
0.86 (0.09, 7.94) |
1.13 (0.36, 3.54) |
|
Asian |
0.78 (0.19, 3.25) |
0.59 (0.31, 1.12) |
2.04 (0.76, 5.47) |
0.63 (0.31, 1.29) |
|
American Indian or Alaskan native |
0.95 (0.31,2.89) |
— |
— |
3.60 (0.31, 41.22) |
|
Hawaiian or Pacific Islander |
—– |
4.15 (0.49, 35.11) |
1.19 (0.13, 11.28) |
2.23 (0.58, 8.52) |
|
Other |
0.96 (0.19, 4.83) |
0.90 (0.34, 2.35) |
1.60 (0.29, 8.76) |
1.46 (0.56, 3.82) |
|
White/Caucasian |
Ref |
Ref |
Ref |
Ref |
|
ap-value <0.05 —, no odds ratio calculable since no patients in this category * Reference category is ULT was not prescribed ** Reference category is preference for non-pharmacological treatment options (cherry extract or gout-specific diet modification) for gout *** Reference category is urate-lowering medication adherence of ≤80% in the last month **** Reference category is the likelihood of diet change with a score ≤8 (range 0-10) |
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Conclusion:
Only 57% of gout patients reported having been prescribed ULT by their healthcare providers. 40% gout patients responding to the survey said that they preferred non- pharmacological interventions. Further study would be of interest to ascertain what they expected from those interventions.
To cite this abstract in AMA style:
Singh JA, Shah N, Edwards NL, Schumacher HR Jr.. Treatment of Gout with Pharmacological Vs. Non-Pharmacological Complementary Therapy in the U.S.: An Internet Survey [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/treatment-of-gout-with-pharmacological-vs-non-pharmacological-complementary-therapy-in-the-u-s-an-internet-survey/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-gout-with-pharmacological-vs-non-pharmacological-complementary-therapy-in-the-u-s-an-internet-survey/