What was previously known: non-pharmacological measures (NPM) are recommended to reduce hyperuricemia. Like other urate-lowering therapies these measures are under-used in the management of gout.
What this research adds relevant for clinicians: there are three patient profiles in function of their NPM compliance (from ‘very good’ to ‘bad responders’). Some factors (age, metabolic syndrome, excessive alcohol consumption, age of gout) could allow differentiating between profiles and adapting the physicians’ approach, recommendations, and follow-up for a more personalized management of patients with gout.
Gout management includes non-pharmacological measures (NPM). The main objective of this study was to describe the NPM proposed by physicians and their implementation by patients after 3–6 months. The secondary objective was to identify NPM compliance profiles among these patients.
Ancillary observational study using the GOSPEL French cohort of 1003 patients with gout, based on questionnaires for physicians and patients at inclusion and then after 3–6 months. Patients were included by a representative sample of 398 general practitioners (GP) and 109 private-practice rheumatologists. Modifiable risk factors of hyperuricemia and proposed NPM were compared. Patient compliance profiles were identified by multiple correspondence and hierarchical clustering analysis.
The study included 630 patients: 80.7% were obese or overweight, 51% reported excessive alcohol consumption. Physicians identified fewer modifiable risk factors than their real prevalence in the cohort. Physicians proposed NPM to 57% of patients, particularly diet modifications (46.4%). Increasing physical activity (P < 0.0001) was the best followed NPM. The physician's influence in the decision of starting NPM was more frequent among GPs’ patients (P = 0.01). Three patients’ compliance profiles were identified. “Very good responders” (55.8%) implemented all the proposed NPM. “Good responders” (12.7%) had a more severe disease and followed the proposed NPM, but for alcohol consumption. “Bad responders” (31.5%) did not modify their life style: these were older patients with a very recent gout diagnosis.
More personalized care about NPM requires adapting the practitioner's approach to patients' compliance profiles, especially elderly patients with recent gout.Le texte complet de cet article est disponible en PDF.
Keywords : Gout, Non-pharmacological, Patient compliance
Vol 86 - N° 2P. 225-231 - mars 2019 Retour au numéro
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