Study Examines the Complex Impact of Gout on Work, Employment

Cesar Díaz-Torné, MD, PhD

Credit: Doctoralia

A recent study presented at the 2024 European Congress of Rheumatology (EULAR) highlighted the multifaceted impact of gout on a patient’s work and employment, with results underscoring the importance of effective disease management and workplace adaptations.¹

“Gout is the most common form of inflammatory arthritis that causes pain and inflammation and reduces patients’ quality of life,” wrote a team of investigators led by Cesar Díaz-Torné, MD, PhD, associated with the Hospital de la Santa Creu i Sant Pau, Spain.¹ “Previous qualitative studies have analyzed the impact of gout on various domains, but there have been no previous studies designed to examine its impact on work and employment.”

Prior data analyzing the impact of gout on work absence and productivity revealed patients with gout had 4.56 more annual absence days among all prespecified categories of health-related work absence compared with those without gout. These patients were also less productive, although not significantly, compared with controls.²

This qualitative study used semi-structured interviews to better understand how gout influences both work and employment. Eligible participants lived in New Zealand and Spain, met the 2015 American College of Rheumatology (ACR)/EULAR classification criteria for gout, and had experienced a gout flare at some point during their working years. The diversity of demographics, job types, and gout characteristics were ensured using a purposive sampling technique.¹

Interviewers asked participants about the impact of their gout while working, co-worker reactions, job changes, and disclosure. The interviews were recorded and transcribed.¹

In total, 18 patients were included in the study, with subjects ranging in age from 29 to 74 years and most (n = 16/18) were male. Occupations of patients included engineers, teachers, a government officer, an architect, and a wharf worker.¹

Ultimately, 6 key themes were identified:

• Gout Factors: Subjects identified the critical factors of gout as the intensity of pain, the location of joints affected, and the presence of tophi. Although severe flares made work nearly impossible, mild flares were still inconvenient.
• Work Factors: Unsurprisingly, jobs with higher physical requirements were particularly challenging among patients. Other factors that majorly impacted the ability to continue working included a lack of workplace flexibility, such as the inability to change meeting dates, adapt tasks, or work remotely if necessary.
• Physical Experiences: The physical experiences described included working with discomfort due to gout and the inability to work. The severity of the gout flare greatly impacted the ability to work as well as concentration. Difficulty to commute to the workplace was also an important variable.
• Emotional Experiences: Patients reported feelings of embarrassment about their diagnosis and wanting to hide it from their coworkers, specifically younger people and women. They also felt responsible for any reduced efficiency, missed work, and the need for help. Some subjects reported feelings of depression due to physical limitations and guilt, particularly if they believed their condition was self-inflected.
• Social Experiences: Gout’s influence reached beyond work and affected other areas of their lives, including concerns about the prioritization of work over other life roles, disclosing their condition to their employers and coworkers, and the negative financial impact.
• Positive Impacts of Effective Gout Management: Patients believed that effectively managing their gout was a crucial factor in improving work experiences. The key elements to reduce pain intensity, prevent flares, and maintain employment were managing flares with nonsteroidal anti-inflammatory drugs (NSAIDs), understanding the condition, and receiving regular urate-lowering therapy.

References

1. ^{Diaz-Torne C, Pou MA, Horne A, Gasteiger C, et al. Is Gout the Boss? A Qualitative Interview Study Exploring the Impact of Gout on Work. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.}
2. ^{Kleinman NL, Brook RA, Patel PA, et al. The impact of gout on work absence and productivity. Value Health. 2007;10(4):231-237. doi:10.1111/j.1524-4733.2007.00173.x}