LAUSR

Background Low adherence to medication is a concern in gout where urate lowering therapy (ULT) is indicated to prevent disease severity and comorbidities. The beliefs patients have about medication may impact on the success of achieving these treatment goals. Objectives To study which factors were associated to beliefs about medicines in patients with a recent gout attack and a need for ULT. Methods Baseline data from a prospective observational study were used in patients with crystal-proven gout who presented after a recent gout flare with insufficiently treated serum urate (sUA) level (>360 μmol/L/>6 mg/dl). In these patients a treat-to-target approach was planned to meet the treatment target (sUA <360 μmol/L, or <300 μmol/L if clinical tophi). Assessment included demographic and clinical data, baseline serum urate levels, medication, self-administered comorbidity questionnaire (SCQ), physical function (HAQ), and SF-36 mental (MCS) and physical component summaries. The Beliefs in Medicines Questionnaire (BMQ)(1 assesses patient beliefs about medicines on four subscales: necessity and concerns specific for the patient, and generally on overuse and harm. Respondents indicated their degree of agreement with each individual statement about medicines on a 5-point Likert scale, (1=strongly disagree to 5=strongly agree). Scores within the four subscales (necessity, concerns, overuse, harm) were summed (ranges 5–25 and 4–20). Calculation of the necessity-concerns differential gave the relative importance for the patient for taking medicines. Results 163 patients were included at baseline, 93.3% men, 90.5% caucasian, mean (SD) age 57.0 (14.1) years, disease duration 8.0 (7.7) years). Mean sUA level was 487 (SD 82) µmol/L at baseline, body mass index 28.9 (4.7) kg/m2, comorbidity score (SCQ) 3.6 (3.2), and physical function (HAQ) 0.35 (0.55). 18.8% (n=28) had tophi, and 30.1% (n=43) were using allopurinol. Scores for the BMQ subscales (SD) were for necessity 16.8 (4.3), concerns 13.7 (5.0), overuse 10.6 (2.7), and harm 9.5 (2.4). The specific necessity-concerns differential was 3.1 (5.7), with median 2.5. Patients expressing higher versus lower beliefs in importance of medication (necessity-concern higher than median) demonstrated in bivariate comparisons statistically significantly differences (table 1). The level of serum urate was not associated with any BMQ subscale. In logistic regression analyses, also adjusting for age and gender in the final model, high beliefs in the relative importance of medication were independently associated with not using allopurinol medication (OR 0.41, 95% CI 0.18–0.94), with higher BMI (OR=1.11 per unit, 95% CI 1.02–1.20), and better mental health (SF36 MCS) (OR 1.04 per unit, 95% CI 1.01–1.08). High belief (>median) Low belief p-value BMI 29.6 28.2 0.048 Comorbidity score (SCQ) 2.3 4.4 0.02 Taking allopurinol 25.8% 37.9% 0.09 SF36 MCS 50.8 47.1 0.03 BMQ overuse 9.9 11.4 0.001 BMQ harm 8.9 10.2 0.001 Conclusions Unexpectedly, using allopurinol medication was inversely associated with high beliefs, whereas higher BMI and better mental health were positively associated with high beliefs in the importance of medication in gout patients. These findings do not allow conclusions on causality, and beliefs in medicines in gout patients should also be studied longitudinally and in relationship to therapy response. Reference [1] Horne R, et al. Psychology & Health1999;14(1):1–24. Disclosure of Interest None declared