Importance of Compliance
Patient compliance is important to successful gout therapy. Inconsistent use of medication may precipitate additional acute gout attacks in response to fluctuations of the serum urate level. Withdrawal of urate-lowering therapy may have the same effect. Patients must understand that antihyperuricemic therapy requires a lifelong commitment, and they must be prepared to continue therapy even if a flare occurs during treatment.
A Dutch study by de Klerk et al used electronic medication event monitors to follow 127 patients for 1 year. They found that compliance among gout patients (n = 29) taking prophylactic or antihyperuricemic therapy was much lower than in rheumatoid arthritis (RA) patients taking NSAIDs or DMARDs (n = 81) and polymyalgia rheumatica (PMR) (n = 17) sufferers taking prednisone.
The authors found especially low compliance with maintenance prophylactic therapy in gout patients (65% of total doses taken; 44% compliance with daily dosing schedule), and somewhat better compliance with combined uric acid lowering agents (84% of total doses taken; 74% compliance with daily dosing schedule).
A subsequent validation study with these same patients (N = 85) by de Klerk et al compared compliance rates among rheumatology patients with responses to the Compliance-Questionnaire-Rheumatology (CQR) and found 4 of the 19 elements to be highly predictive of compliance:
- Fear of forgetting to take the medication
- Wanting to continue functioning well
- Having a consistent routine (eg, medication stored in the same place)
- Response to side effects
How might you address such issues with your patients? Consider the following:
- Do they understand the commitment they are making to chronic treatment and the potential consequences of not following through on a consistent basis?
- Do they understand the short- and long-term effects of chronic hyperuricemia in gout such as recurrent attacks, the development of tophi and joint, nerve, and kidney damage?
- Are they equipped with a system to remember their medication schedule? Can you address the multiple medications and varying schedules they may have?
- Have you reviewed the possibility of a treatment-induced flare and why this type of flare may be a sign that their medication is working?
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