Discussion

Our study provides information on patient knowledge and perceptions regarding gout management. Several deficits in knowledge were identified in the study sample, including in the quality assessment of knowledge about gout, information about gout, and demographic information.11 However, the deficits were greater in those with uncontrolled gout. Thirty-one percent of patients reported having uncontrolled gout, and 69% of patients reported having controlled gout. Males were more likely than females to be affected by uncontrolled gout. This result was consistent with the study by Richette et al. (2018) in France; with a 62-item questionnaire and 246 patients, the study also showed that gout status had no association with gender.12 In our study, age had a significant association with gout status: there were more cases of gout as age increased; this result contradicts those of the study by Richette et al. (2018). In another study by Gaffo (2018) and the Global Health Living Foundation in Jordan (with a sample of 103 patients, 41 with flare-ups and 62 without flare-ups), it was shown that the incidence of gout among the patients was associated with age.13 Nationality had no association with gout status in our study. However, educational status was significantly associated with gout status, as patients with bachelor’s degrees had the highest incidence of gout compared with others.14Job status was significantly associated with gout status. Patients with full-time employment were more susceptible to gout than retirees, those with part-time jobs, or students without jobs. Physicians and patient height were not significantly associated with gout status. BMI had a significant association with gout status in this sample, with a high BMI being a risk factor and a low BMI being protective. Several factors may contribute to the patient knowledge deficits and the incorrect medication beliefs identified here.15 Most of the patients had been diagnosed with gout less than 3 years before completing the survey, and duration of disease was associated with gout status. Patients with longer intervals since diagnosis were less susceptible to gout flare-ups compared with those who had more recent diagnoses. The majority of patients had been diagnosed with gout between the ages of 25 and 64 years. Patients who had been diagnosed between 25 years and 64 years of age were less susceptible to gout flare-ups compared with those diagnosed outside of this interval. The majority of patients had three to six gouty attacks per year, but the frequency of such attacks had no association with the patients’ gout statuses at the time of survey completion. Most patients had one to two gouty attacks per year, and this status had a significant association with the patients’ gout statuses at the time of survey completion. We found that knowledge and medical beliefs had significant impacts on gout status. For the treatment of acute gout, there are individualizable treatment strategies. Paracetamol, ibuprofen, and colchicine are considered among the most effective drugs to treat gout attacks; it is also important to increase fluid intake. There was a significant association between patients’ knowledge about drugs for treating gout attacks and their gout status. Overall, patients in the study sample considered all of the well-established lifestyle measures to control their gout. Patients with controlled gout considered a reduction of meat and bean consumption as the second-line lifestyle measure to control gout, while patients with uncontrolled gout considered exercise and weight loss as the second-line lifestyle measures. Notably, there was no significant association between patients’ implemented lifestyle measures in treating gout and their gout statuses.16In the quality-of-life assessment, patients were very satisfied in terms of their job performance, work lives and careers, daily demands and chores, health services, sleep quality, and support from family and friends. There was a significant association between the patients’ quality-of-life assessments related to gout and their gout statuses. The opposite was found in a study conducted in Australia,17 which demonstrated gout to have a significant impact on patients’ lives; the findings suggested that the patients’ primary concerns were poor mobility and the pain associated with gout flare-ups. The study report also covered the social impacts of gout and its negative effects on productivity. Our study indicated different ways by which patients manage their gout: 46% of patients sought advice from a nutritionist, 90.1% spoke with doctors about minimizing the consumption of foods that contain high levels of uric acid (such as meat and legumes), and 62.4% spoke with their doctors about how to treat acute gout attacks. About three-quarters of patients (77.9%) spoke with their doctors about medications that can lower uric acid levels in the blood and how to prevent gout attacks, and 85% of the patients spoke with their doctors about the ideal levels of uric acid in their blood that should be achieved after treatment for gout. Nearly three-quarters of participants (74.2%) spoke with their doctors about adopting healthy lifestyle choices, such as eating moderate amounts of red meat, legumes, and shrimp to reduce the levels of uric acid in their blood (in addition to taking medication), and 50% of the patients spoke with their doctors about smoking cessation to manage acute gout. Management perceptions were significantly associated with gout status.