Optimism as a predictor of poor comoliance with urate-lowering therapy in patients with gout: a prospective study

Abstract

Background Gout is an inflammatory disease that can cause pain and damage to joints and organs. Compliance with urate-lowering therapy (ULT) in patients with gout is poor worldwide, and few studies have focused on the association between psychology and compliance. Psychological dysfunction (such as anxiety and depression) is common in patients with gout and is correlated with health-related quality of life. This study aimed to investigate the psychological status related to poor compliance in gout patients. Methods A total of 530 patients with gout, 174 with ankylosing spondylitis (AS), 60 with rheumatoid arthritis (RA), and 324 healthy volunteers were included. Compliance with ULT was investigated using the medication possession ratio (MPR) over 3 months. The Life Orientation Test-Revised (LOT-R) was used to assess optimism in patients with gout and controls. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the severity of anxiety and depression. First, we compared the psychological status between gout patients and controls. Therefore, Spearman rank correlation analysis was used to determine the relationships between psychological and clinical variables. Finally, binary logistic regression analyses were used to analyze the predictors of poor compliance in patients with gout. Results The LOT-R scores of patients with gout were higher than those of patients with AS and RA (p < 0.05), while the SAS and SDS scores of patients with gout were lower than those of patients with AS and RA (p < 0.05). Among 530 patients with gout, 55.1% had an MPR < 0.8, and the MPR was negatively correlated with the LOT-R score (p < 0.05). Insufficient education, living in the countryside, having a high SUA concentration, and having a high LOT-R score predicted poor compliance with ULT (p < 0.05). Conclusions Gout patients share a similar optimistic status with healthy controls but are more optimistic than AS and RA patients. However, optimistic gout patients were more likely to have poorer compliance. Trial registration: Not applicable.