Non-pharmacologic measures for gout management in the prospective GOSPEL cohort physicians' practice and patients' compliance profiles

Abstract : Objectives - 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. Methods - 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. Results - 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. Conclusion - More personalized care about NPM requires adapting the practitioner's approach to patients' compliance profiles, especially elderly patients with recent gout.
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Submitted on : Thursday, September 13, 2018 - 3:26:05 PM
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Anthony Chapron, Typhaine Chopin, Maxime Esvan, Ea Hang-Korng, Frédéric Lioté, et al.. Non-pharmacologic measures for gout management in the prospective GOSPEL cohort physicians' practice and patients' compliance profiles. Joint Bone Spine, Elsevier Masson, 2018, 86 (2), pp.225-231. ⟨10.1016/j.jbspin.2018.06.013⟩. ⟨hal-01862274⟩

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