Gout Flares Are Both Common and Underreported in the US

Jasvinder A. Singh, MD, MPH

Credit: UAB Birmingham

A new cross-sectional study has confirmed that gout flares are both common and underreported in adults in the United States with gout.¹

“Importantly, to our knowledge, no previous studies have assessed both types of gout flares, those self-treated early by the patient and prevented or minimized and those more symptomatic gout flares that require the administration of a prescription drug and/or a health care visit. Gout flares are often self-treated by patients, and in clinical trials, rates of flares are captured using patient diaries2,” lead investigator Jasvinder A. Singh, MD, MPH, Professor of Medicine and Epidemiology and Musculoskeletal Outcomes Research Endowed Professor of Medicine, University of Alabama Birmingham and Director, Rheumatology Research, Birmingham VA Medical Center, and Section Chief, Senior Faculty, Baylor College of Medicine, Texas, and colleagues wrote.¹

Singh and colleagues collected data from adult participants via an online survey. For the 933 participants with gout, the survey contained questions about treatments, serum urate levels, severity, satisfaction with control, and gout flares. These participants also completed the Veterans RAND 12-Item Health Survey, the Generalized Anxiety Disorder 7-Item Scale, and the Patient Health Questionnaire 9-Item Scale. The investigators used multivariable-adjusted logistic regression analyses to determine factors predictive of reporting gout flares to a physician.

The investigators found that compared with those without gout (n = 30,146), people with gout were older, with an average age of 58.3 years (standard deviation [SD], 13.3) compared with an average age of 45.4 years [SD, 16.1; P < .001), and more were male (76.3% vs 46.9%; P <.001), White (80.5% vs 76.8%; P = .01), and married or living with their partner (58.9% vs 52.8%; P <.001).¹

People with gout had an average of 6.6 flares per year, 1.9 of which per year were reported to their physician, and nearly 72% of which were either not reported to physicians or pretreated or prevented. Participants reported preventing 3.0 gout flares per year by pretreating, and these participants experienced 3.6 flares per year.¹

People with gout that were younger (P = .01), had a high school education or less (P = .05), had a lower Charlson Comorbidity Index score (P = .05), and were not taking a urate-lowering therapy (P = .001) were less likely to report gout flares. Those reporting only some or none of their flares had almost twice the rate of gout flares in the last 12 months than those reporting all of their gout flares (4.4 [SD 6.4] vs 2.7 [SD 5.1] gout flares; P <.001).¹

According to a multivariate model with sensitivity analyses, those taking a urate lowering therapy (ULT; odds ratio [OR], 1.35 [95% CI,1.02–1.83]) were more likely to report all gout flares and those who had gout for a longer time (OR, 0.996 [95% CI, 0.995–0.998]) were less likely to report all gout flares. Participants with tophi (OR, 2.84 [95% CI, 1.82–4.44]) were more likely to use flare prevention medications and those with higher comorbid conditions (OR, 0.96 [95% CI, 0.92–1.00]) were less likely to report all gout flares.¹

“The majority of gout flares are underreported (ie, patients report only a third of gout flares to physicians). Reliance on clinical documentation of physician-reported gout flares is insufficient to assess the true patient burden of gout. Those least likely to pretreat and not report gout flares are younger patients, are more likely to be women, experience greater disease severity, and are more likely to have comorbid depression or anxiety. Disparity in reporting gout flares reveals a missed window of opportunity that is essential to ensure optimal management in a large proportion of patients,” Singh and colleagues concluded.¹

REFERENCES

• Singh JA, Morlock A, Morlock R. Gout Flare Burden in the United States: A Multiyear Cross-Sectional Survey Study. ACR Open Rheumatol. Published online November 5, 2024. doi: 10.1002/acr2.11759

• Teoh N, Gamble GD, Horne A, et al. The challenges of gout flare reporting: mapping flares during a randomized controlled trial. BMC Rheumatol 2019; 3(1): 27.