Perspective of Dutch Patients with Gout on Continuation or Discontinuation of Urate-Lowering Therapy During Remission: A Mixed-Methods Study

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Iris Rose Peeters, Frouwke Veenstra, Sophie A. C. Wanten, Johanna E. Vriezekolk, Cornelia H. van den Ende, Alfons A. den Broeder, Noortje van Herwaarden, Lise M. Verhoef, Marcel Flendrie
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Abstract

Objective

Long-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT). A lifelong treat-to-target approach is advocated, although a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission. Exploring the beliefs of patients with gout on long-term ULT strategies during remission is important for optimizing gout management. We aimed to identify factors that influence the decision for continuation or discontinuation of ULT and to determine their relative importance according to patients with gout in remission.

Methods

A mixed-methods design was used. First, semistructured interviews (substudy 1) were conducted to identify barriers and facilitators for the (dis)continuation of ULT using inductive thematic analysis. Afterwards, these barriers/facilitators were summarized into neutrally phrased items and used in a maximum difference scaling study (substudy 2) to determine their relative importance using the rescaled probability score.

Results

Substudies 1 and 2 included 18 and 156 patients, respectively. Substudy 1 yielded 22 items within 10 overarching themes. Substudy 2 revealed that the perceived risk of joint damage and gout flares and that ULT use gives some assurance were the most important items. The costs, ease of receiving ULT, and its practical use were the least important items.

Conclusion

These results can aid shared decision-making and provide input for what is important to discuss with patients with gout in remission when they consider ULT discontinuation. The emphasis should be on the risk of having gout flares and joint damage, not so much on facilitating how easily medication is received.

Abstract Image

荷兰痛风患者对缓解期继续或停止降尿酸治疗的看法:一项混合方法研究。
背景:痛风的长期治疗以通过降尿酸盐疗法(ULT)降低血清尿酸盐为基础1、2。尽管在缓解期可以考虑尝试停止超低尿酸治疗(减量至)(从治疗到避免症状的方法),但仍提倡终生从治疗到目标的方法。探讨痛风患者对缓解期长期超量治疗策略的看法对于优化痛风治疗非常重要:确定影响继续或停止超量治疗决定的因素,并根据处于缓解期的痛风患者确定这些因素的相对重要性:方法:采用混合方法设计。首先,进行了半结构式访谈(子研究 1),利用归纳式主题分析确定了(不)继续使用 ULT 的障碍和促进因素。然后,将这些障碍/促进因素归纳为中性措辞的项目,并在最大差异标度研究(MaxDiff,子研究 2)中使用重标概率分(RPS)确定其相对重要性:子研究 1 和子研究 2 分别包括 18 名和 156 名患者。子研究 1 在 10 个总体主题中产生了 22 个项目。子研究 2 显示,认为关节损伤和痛风复发的风险以及使用超短波治疗能在一定程度上保证超短波治疗的使用是最重要的项目。结论:这些结果有助于共同决策,并为处于缓解期的痛风患者在考虑停用超短波治疗时需要讨论的重要事项提供了参考。重点应放在痛风复发和关节损伤的风险上,而不是如何方便地接受药物治疗上。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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