Study Assesses the Impact of Chronic Refractory Gout on Daily Life

Vibeke Strand, MD

Credit: PRIME Education

Patients with chronic refractory gout report symptoms that are burdensome to everyday life, according to research published in Rheumatology and Therapy.¹ The domains and concepts included in the Health Assessment Questionnaire-Disability Index (HAQ-DI) and Medical Outcomes Survey Short Form-36 (SF-36) were relevant to understanding the burden of disease and the conceptual model emphasizes a better understanding of the experiences of these patients.

The impact of gout flares on physical quality of life has been shown to be similar to other chronic health conditions. Additionally, health related quality of life (HRQoL) has demonstrated decreased SF-36 scores in all domains except physical functioning and general health in patients with increased gout flares.²

“Long-term mismanagement of gout and/or resistance to treatment leads to refractory gout, which has been defined as a condition where target serum uric acid (sUA) levels below 6 mg/dl are not adequately sustained,” wrote a team of investigators led by Vibeke Strand, MD, associated with the Division of Immunology/Rheumatology at Stanford University School of Medicine. “Painful arthritis, destructive tophi, and negative impacts on physical function and health-related quality of life (HRQoL) are observed in refractory gout. Given this, the assessment and monitoring of the impact of gout from the patient perspective is critical.”

To understand the symptoms and impacts of chronic gout on HRQoL, investigators conducted a literature review to identify and review articles focused on the symptoms and impacts of gout, as well as studies examining SF-36 and HAQ-DI in gout. Eligible studies were those that discussed the presentation of symptoms and/or general impacts of HRQoL. Zoom interviews were conducted between October and December 2021.

Qualitative interviews of 20 subjects with chronic gout were conducted. Findings were used to develop a conceptual model and determine the suitability of these questionnaires in evaluating HRQoL in this patient population.

The mean age of patients was 55.9 years, 70.0% (n = 14) were male, 55.0% (n = 11) were non-Hispanic White, and 60.0% (n = 12) reported severe gout flares. Severe tophi severity, defined as > 3 tophi in ≤ 6 months, was reported by 35.0% (n = 7) subjects.

The most commonly reported symptoms were bodily pain (90.0%, n = 18), joint tenderness (90.0%, n = 18), joint swelling (90.0%, n = 18), and joint pain (80.0%, n = 16). The most frequently reported impacts were difficulties climbing a flight of stairs (100.0%, n = 20), climbing several flights of stairs (100.0%, n = 20), climbing 5 steps (95.0%, n = 19), completing chores (95.0%, n = 19), and running errands and shopping (95.0%, n = 19).

All items evaluated from the SF-36 and HAQ-DI were reported by ≥ 25% of subjects and mapped to concepts elicited by participants.

Investigators noted limitations including not meeting the racial and ethnicity targets, which could have hindered generalization. Additionally, as it was a qualitative study, it did not include psychometric evidence. Further research could validate these measures within the chronic refractory gout population.

“The targeted literature review and qualitative interviews demonstrate that patients with chronic refractry gout experience symptoms and impacts that are highly bothersome and burdensome to their everyday lives, impacting both their physical and emotional health,” investigators concluded. “Both HAQ-DI and SF-36 mapped directly to symptoms and impacts experienced by participants interviewed in this study, thereby confirming the final conceptual model.”

References

1. ^{Strand V, Pillinger MH, Oladapo A, Yousefian C, Brooks D, Kragh N. Patient Experience with Chronic Refractory Gout and Its Impact on Health-Related Quality of Life: Literature Review and Qualitative Analysis. Rheumatol Ther. Published online August 5, 2024. doi:10.1007/s40744-024-00697-8.}
2. ^{Becker MA, Schumacher HR, Benjamin KL, Gorevic P, Greenwald M, Fessel J, et al. Quality of life and disability in patients with treatment-failure gout. J Rheumatol. 2009;36(5):1041–8.}