title: Overcoming adherence issues and other barriers to optimal care in gout.
abstract: OBJECTIVE
  This review presents research published over the last year examining use of urate-lowering therapy (ULT) as well as trends over time in adherence to this class of agents. Additionally, it explores factors associated with nonadherence to ULTs for chronic gout and interventions to improve chronic gout management.
  
  
  RESULTS
  New literature suggests prescriptions of ULTs for prevalent and incident gout patients remains lower than expected based on the burden of the disease in the population. Overall ULT adherence remains suboptimal, in part related to inadequate patient education and copayment costs; although one study demonstrated improvement in adherence over a 15-year study period. Finally, interventions that include patient education and medication titration based on laboratory results successfully lowered serum urate levels to less than 6 mg/dl in the majority of patients.
  
  
  CONCLUSIONS
  Gout remains a prevalent disease that is poorly managed despite effective treatments. Recent research suggests that ULTs are underutilized and even when prescribed are not well adhered to. Patient-centered interventions that focus on education about pharmacologic therapy and lifestyle modifications with medication titration have resulted in a greater proportion of patients achieving recommended serum urate levels.
authors: Departments of Orthopedics and Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors: Navine
authors: N
authors: Nasser-Ghodsi
authors: Leslie R
authors: LR
authors: Harrold
mesh_terms: D002908:Chronic Disease; D019468:Disease Management; D006073:Gout / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D055118:Medication Adherence; D058996:Quality Improvement
chemical_list: D006074:Gout Suppressants