Gout impacts on function and health-related quality of life beyond associated risk factors and medical conditions: results from the KING observational study of the Italian Society for Rheumatology (SIR)

Abstract

IntroductionGout is the most prevalent arthritis and significantly impacts on function and quality of life. Given that gout associates with disabling comorbid conditions, it is not clear whether such a complex of diseases accounts for the increased disability or if gout may play a role by itself. This study aims to evaluate the specific influence of gout and disease-related features on functional disability and health-related quality of life (HRQoL) in patients with gout followed in rheumatology clinics.MethodsA random sample of patients was drawn from clinical registries of 30 rheumatology clinics across Italy. Sociodemographic, general health and gout-specific variables were collected. Functional disability and HRQoL were assessed by the health assessment questionnaire (HAQ) and the Physical and Mental Component Summary scores (PCS and MCS) of the Short Form-36 (SF-36). Crude and adjusted ordinal logistic and linear regression models were applied to investigate the specific contribution of different variables on HAQ and SF-36 scores. Results are presented as odds ratio (OR) or mean difference (MD) and 95% confidence intervals.ResultsOut of 446 patients with gout, 90% were males with a mean age of 63.9 years and median disease duration of 3.8 years; the majority of patients were overweight or obese, and with several comorbidities; 21.1% showed at least moderate disability; the PCS score was significantly lower than expected age- and gender-matched samples in the general population, while MCS score was not. After adjusting for potential sociodemographic and general-health confounders, gout-specific variables significantly impacted on HAQ, including polyarticular involvement OR 3.82 (1.63, 8.95), presence of tophi OR 1.92 (1.07, 3.43) and recent attacks OR 2.20 (1.27, 3.81). Consistent results were found for PCS. The impairment of PCS compared to the general population was limited to patients with features of chronic gout. MCS was only affected by recent attacks (MD -2.72 [-4.58, -0.86]) and corticosteroid treatment (-3.39 [-5.30,-1.48]).ConclusionsThe data from the KING study confirm that gout impacts on disability and provide evidence for an independent association of gout and gout-related features with functional outcome and HRQoL. This result supports the need to improve specific treatment in gout.

Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study

“…This suggests that gout severity, in this case a combination of several poor gout characteristics, influences mental health. In particular, currently experiencing a gout attack has been associated with poorer general mental health in gout patients previously [20]. As our findings were not maintained after this adjustment, this suggests that though frequently experiencing attacks may contribute to some gout patients experiencing anxiety or depression, it alone is not enough to lead to these mental health comorbidities.…”

“…However, when classification by gout characteristics was applied, such as by the number of painful joints [18], number of attacks in a 12-month period [14,[18][19][20] or disease duration [20], associations were found between gout and poorer general psychological health (as measured using the SF12 or SF36). This suggests that different gout characteristics may be important in identifying those patients more likely to experience poorer psychological health.…”

Prevalence and associations of gout and hyperuricaemia: results from an Australian population‐based study

“…One study found that after adjusting for potential medical and socio-demographic confounders, gout was an independent predictor for lower quality of life and functional outcomes. 14 This study was, however, performed using gout patients from rheumatology clinics rather than the general population. Gout patients with frequent flares and the presence of tophi have lower HRQoL.…”

Association of Clinical Manifestations and Comorbidities With Quality-of-Life Measures in Patients With Gout

“…В частности, группой итальянских ученных во главе с C.A. Scire была выполнена серия исследований [23,24], направленных на определение влияния клини-ческих проявлений подагры и сопутствующих заболева-ний на исходы подагры. Авторы выделили 10 клиниче-ских показателей прогностически тяжелой болезни.…”