Uhlig Till, Karoliussen Lars F, Sexton Joe, Provan Sella A, Haavardsholm Espen A, Dalbeth Nicola, Hammer Hilde Berner
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Rheumatology (Oxford). 2025 Apr 1;64(4):1799-1806. doi: 10.1093/rheumatology/keae514.
Patients with gout need to adhere to medication over time to achieve good outcomes. We assessed self-reported adherence to medication with urate lowering therapy (ULT) 5 years after a treat-to-target intervention and studied how non-adherence was related to baseline demographic and disease variables.
Patients in the NOR-Gout observational study were included after a recent gout flare and serum urate >360 µmol/l. Patients [mean age 56.2 (S.D. 13.6), 94.5% males, 17.2% with tophi] attended tight-control visits over one year with escalating urate lowering therapy using a treat-to-target strategy. Five-year follow-up included the Medication Adherence Report Scale (MARS-5) questionnaire (range 5-25) for adherence. Flares and SUA target achievement were compared for 5-year adherence to medication.
At 5 years most of the 163 patients used ULT (95.1%). MARS-5 adherence scores after 5 years were high (median 24, interquartile range 22-25). Patients in the lowest MARS-5 quartile had, compared with the highest quartile, more often a flare during the last year of follow-up (33.3% vs 9.5%, P = 0.004) and reached the 5-yr serum urate treatment target less frequently (45.2% vs 87.5%, P < 0.001). Baseline lower age (OR 0.56, 95%CI 0.39-0.79), non-European origin (OR 0.22, 95%CI 0.06-0.80), lower SF-36 mental health scores (OR 0.94, 95%CI 0.91-0.98) and less joint pain during last flare (OR 0.73, 95%CI 0.58-0.92) were independent risk factors for non-adherence to medication.
Patients reported high adherence to medication after 5 years. Non-adherence was related to more flares and less urate target achievement. Younger age and non-European origin were associated with non-adherence.
痛风患者需要长期坚持用药以取得良好疗效。我们评估了达标治疗干预5年后患者自我报告的降尿酸治疗（ULT）用药依从性，并研究了不依从与基线人口统计学和疾病变量之间的关系。
NOR-Gout观察性研究中的患者在近期痛风发作且血清尿酸>360µmol/l后纳入。患者[平均年龄56.2（标准差13.6），94.5%为男性，17.2%有痛风石]在一年中接受严格控制访视，采用达标治疗策略逐步加强降尿酸治疗。五年随访包括使用药物依从性报告量表（MARS-5）问卷（范围5-25）评估依从性。比较5年用药依从性患者的痛风发作情况和血清尿酸达标情况。
5年后，163例患者中的大多数使用了ULT（95.1%）。5年后MARS-5依从性评分较高（中位数24，四分位间距22-25）。MARS-5四分位数最低的患者与最高四分位数的患者相比，在随访的最后一年痛风发作更频繁（33.3%对9.5%，P=0.004），达到5年血清尿酸治疗目标的频率更低（45.2%对87.5%，P<0.001）。基线年龄较小（比值比0.56，95%置信区间0.39-0.79）、非欧洲裔（比值比0.22，95%置信区间0.06-0.80）、SF-36心理健康评分较低（比值比0.94，95%置信区间0.91-0.98）以及上次发作时关节疼痛较轻（比值比0.73，95%置信区间0.58-0.92）是不依从用药的独立危险因素。
患者报告5年后用药依从性较高。不依从与更多的痛风发作和更低的尿酸达标率相关。年龄较小和非欧洲裔与不依从有关。
