VBCR - October 2013, Volume 2, No 5 - Gout

By Rosemary Frei, MSc

A new multicenter study confirms that there is an independent association between gout and gout-related characteristics on the one hand and functional impairment and quality of life on the other. For example, polyarticular joint involvement is significantly associated with increased disability and with poorer overall quality of life for this patient population (Scirè CA, et al. Arthritis Res Ther. 2013;15:R101).

Investigators from the Italian Society for Rheumatology’s Kick-off of the Italian Network for Gout (KING) recruited patients with gout who were se­lected by random sampling from rheumatology centers across Italy for this national, multicenter, cohort study. A total of 446 patients with gout from 30 rheumatology centers between June 2011 and January 2012 were included in the study. Overall, 99% of the patients were Caucasian, 90.4% were male, and their average age was 63.9 years. Most were overweight or obese, and 90% had at least 1 comorbidity.

Furthermore, more than 92% of the patients fulfilled the preliminary American College of Rheumatology criteria for gout. The median disease duration at baseline was 3.8 years. Approximately 30% of the patients had an attack of gout in the month before the baseline clinical evaluation. Of the patients, 410 had their serum urate levels assessed at baseline, and 214 (52.2%) of these patients had levels of >6 mg/dL, despite the majority receiving urate-lowering therapy.

Health Assessment Questionnaire–Disability Index (HAQ-DI) scores were assessed for 444 of the patients. Of these, 72 (16.2%) patients had scores corresponding to moderate functional ability, and 22 (4.95%) had scores indicative of severe disability. The median HAQ-DI score was 0.25.

As expected, the patients’ Short Form-36 Physical Component Summary (SF-36 PCS) scores were lower than for individuals in the age- and sex-matched general population.

The results also revealed that female sex and lower education significantly influenced functional disability and SF-36 PCS scores. Furthermore, having comorbidities and being overweight or obese were significantly associated with higher HAQ-DI scores and with lower SF-36 PCS scores in age- and sex-adjusted models.

In addition, indications of chronic disease, such as longer disease duration and the presence of tophi, as well as the presence of uncontrolled joint inflammation, were significantly associated with higher HAQ-DI scores and lower SF-36 PCS scores. For example, polyarticular involvement was associated with an odds ratio of 3.82 for a higher HAQ-DI score. Gout duration of more than 5 years was associated with an odds ratio of 2.03, and the presence of tophi was associated with an odds ratio of 1.92.

“In this context, given that excess disability is seen in patients whose disease has evolved to a chronic arthropathy, we concluded that—independently of the obvious need to control general risk factors, such as hypertension, diabetes, obesity—preventing the transition from acute to chronic arthropathy by appropriate therapeutic strategies is the mainstay of the management of gout, in order to limit both short- and long-term consequences of the disease,” said principal investigator Carlo A. Scirè, MD, PhD, Coordinator of the Epidemiology Unit, Italian Society for Rheumatology, Milan.

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