Abstract
BackgroundAlthough international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout.MethodsA qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used.ResultsParticipants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring.ConclusionPatients’ understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients’ perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through “a joint effort over a period of time”.
Highlights
International guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment
Patients were recruited through General Practitioners (GPs), rheumatology clinics, gout support groups, our expert advisory panel, online advertising and snowballing through personal contacts
All participants talked about their views and experiences of treatment, and factors affecting their use of ULT
Summary
International guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. Current international guidelines recommend treatment of acute attacks to reduce pain and inflammation [4,5,6], and encourage urate-lowering therapy (ULT) for patients with two or more acute attacks per year, tophi, renal stones, radiological damage or impaired renal function [5, 6]. Monitoring and up-titration of ULT to achieve a target SUA level are not performed in most patients [10, 14,15,16]
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