A large proportion of patients with gout have uncontrolled disease, according to recent research published in The Journal of Rheumatology.1 These patients have significantly worse functioning, quality of life, and work productivity.
“Gout control remains a considerable clinical challenge, with less than one-third of patients achieving adequate control in this analysis,” Robert Morlock, PhD, Ardea Biosciences, Inc, San Diego, CA, and colleagues explained. “This challenge is augmented by the observation that daily function, quality of life, and work productivity are significantly worse in those patients with gout whose disease is inadequately controlled.”
Using data from the Adelphi Real World Disease Specific Programme—a cross-sectional survey of patients with gout in the United States, as well as in France, Germany, and the United Kingdom—the investigators assessed health-related quality of life (HRQOL), work productivity, and activity limitations of patients with gout that was inadequately controlled with conventional urate-lowering therapy (ULT) for ≥3 months, compared with patients with gout that was adequately controlled.
Overall, 440 physicians were recruited, as were 1204 patients with gout. Of these patients, 69.4% had inadequate control (mean age, 61 years), and 30.6% had adequate control (mean age, 63 years) when taking their current ULT medication. The investigators observed that time since diagnosis of gout was statistically significantly less for patients with uncontrolled gout, compared with patients with controlled disease: 52 and 74 months, respectively. In addition, the time spent taking current ULT was less for patients with uncontrolled disease (32 months) than patients with controlled disease (57 months). Allopurinol, febuxostat, and probenecid were the current ULTs most patients were taking.
The investigators observed that patients with uncontrolled disease had significantly worse functioning and HRQOL, compared with patients with disease under control. In particular, they found that a greater percentage of patients with uncontrolled gout had issues performing activities such as mobility, self-care, and usual activities, compared with patients with controlled disease. These patients also had more pain and discomfort, and anxiety and depression. Furthermore, patients with inadequately controlled gout rated how their health was that day lower on a scale from 0 to 100, compared with patients with adequately controlled gout (69.2 vs 78.1). Performing most activities of the PROMIS HAQ (Patient Reported Outcomes Measurement Information System Health Assessment Questionnaire) domains was also reported to be more difficult in this group. However, no difference was seen between the 2 groups for the need of buttonhooks/zipper pulls/gadgets or help to get dressed, and need for a long-handled appliance or help reaching something. Overall, the PROMIS HAQ score was significantly lower in patients with uncontrolled disease.
Compared with patients with controlled gout, patients with uncontrolled disease had lower productivity. Of note, patients with gout overall missed an average of 3.6% of their work time because of their disease. Patients with uncontrolled disease reported being significantly more impaired while working (19.1% vs 5.2%), as well as having greater overall work impairment because of their gout (20.4% vs 5.6%). They also missed significantly more time from work (4.5%) compared with patients with controlled disease (1.3%).
Dr Morlock and colleagues noted that these results are consistent with the literature. Strategies are needed to improve management of patients with gout who have uncontrolled disease.
- Wood R, Fermer S, Ramachandran S, et al. Patients with gout treated with conventional urate-lowering therapy: association with disease control, health-related quality of life, and work productivity. J Rheumatol. 2016 Apr 1. Epub ahead of print.