title: A cross-sectional internet-based patient survey of the management strategies for gout.
abstract: BACKGROUND
  Almost half of the patients with gout are not prescribed urate-lowering therapy (ULT) by their health care provider and >50 % use complementary and alternative therapies. Diet modification is popular among gout patients due to known associations of certain foods with gout flares. The interplay of the use of dietary supplements, diet modification, and ULT adherence in gout patients is not known. Despite the recent interest in diet and supplements, there are limited data on their use. Our objective was to assess ULT use and adherence and patient preference for non-pharmacological interventions by patients with gout, using a cross-sectional survey.
  
  
  METHODS
  People who self-reported physician-diagnosed gout during their visit to a gout website ( http://gouteducation.org ) were invited to participate in a brief anonymous cross-sectional Internet survey between 08/11/2014 to 04/14/2015 about the management of their gout. The survey queried ULT prescription, ULT adherence, the use of non-pharmacological interventions (cherry extract, diet modification) and the likelihood of making a lifelong diet modification for gout management.
  
  
  RESULTS
  A total of 499 respondents with a mean age 56.3 years were included; 74% were males and 74% were White. Of these, 57% (285/499) participants were prescribed a ULT for gout, of whom 88% (251/285) were currently taking ULT. Of those using ULT, 78% (97/251) reported ULT adherence >80%. Gender, race, and age were not significantly associated with the likelihood of receiving a ULT prescription or ULT adherence >80%. Fifty-six percent of patients with gout preferred ULT as a lifelong treatment for gout, 24% preferred cherry extract and 16% preferred diet modification (4% preferred none). Men had significantly lower odds of preferring ULT as the lifelong treatment choice for gout vs. other choices (p = 0.03). We found that 38.3% participants were highly motivated to make a lifelong dietary modification to improve their gout (score of 9-10 on a 0-10 likelihood scale). Older age was significantly associated with high level of willingness to modify diet (p = 0.02).
  
  
  CONCLUSIONS
  We found that only 57% of gout patients reported being prescribed ULT. 40% of gout patients preferred non- pharmacological interventions such as cherry extract and diet modification for gout management. The latter finding requires further investigation.
authors.affiliation: Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.com.|Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. Jasvinder.md@gmail.com.|Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Jasvinder.md@gmail.com.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
authors.forename: Nipam
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: N Lawrence
authors.initials: NL
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D019468:Disease Management; D011307:Drug Prescriptions; D005260:Female; D006073:Gout / Q000178:diet therapy / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D020407:Internet; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D010936:Plant Extracts / Q000627:therapeutic use; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014527:Uric Acid / Q000378:metabolism*
chemical_list: D010936:Plant Extracts; D014527:Uric Acid