Women With Gout Underinformed on Self-Management Practices

Although women with gout had modestly worse disease severity and illness perception when compared with men, they were less informed regarding self-management, according to a study published in BMC Musculoskeletal Disorders.¹

Ulrika Bergsten, RN, PhD

Credit: ResearchGate.net

“Gout is more common in men and less well studied in women,” wrote Ulrika Bergsten, RN, PhD, Research and Development Department, Region Halland, and a team of Swedish investigators. “Several comorbidities… have been reported to be less frequent in women compared to men. Furthermore, urate-lowering therapy (ULT) has been reported as less frequent in women compared to men whereas the impact of gout on quality of life (QoL) has been reported as greater in women. These factors, in addition to others, such as illness perception, can influence the care provided and possibly lead to gender differences in disease management.”

Gout treatment revolves around lowering serum urate, which includes ULT and lifestyle changes. Recommended nonpharmacological changes are mainly weight loss and dietary changes such as reducing the intake of seafood, alcohol, and meat.²

Adult patients with gout, selected from 12 primary and secondary care centers in Sweden between 2015 and 2017, were invited to participate in a questionnaire evaluating gender differences between men and women with gout. Information collected included gout characteristics, demographics, disease severity, disease management, alcohol use, dietary changes, comorbidities, education, QoL, and illness perception (evaluated using the Brief Illness Perception Questionnaire [B-IPQ]). The B-IPQ measures the psychological burden of illness using 8 dimensions: consequences, timeline, personal control, treatment control, identify, concerns, understanding, and emotional response.

Gender comparisons were assessed using linear regression models, T-tests, Chi square tests, and ANalysis Of VAriance (ANOVA). Functional status was determined using the Health Assessment Questionnaire (HAQ), while the impact of disease was evaluated using the Gout Assessment Questionnaire (GAQ).

Of the 1589 patients sent the questionnaire, 868 (54.6%) patients completed the survey. Although women (n = 177, 20%) reported slightly higher symptom severity, with more women reporting moderate, severe, and very severe gout (P = .011), they had comparable flare frequencies when compared with men. Women also reported modest but significantly worse illness perception regarding identity, concerns, consequences, and emotional response (P <.05), which remained after adjusting for age. Daily activities, including sleeping (P <.001) and walking (P = .042), as well as quality of life (QoL, P = .004) were also significantly worse when compared with men.

Although female respondents reported higher alcohol consumption (P <.001) and were more frequently obese (38% vs 21%, respectively; P <.001), obese women received significantly less advice regarding weight reduction (47% vs 65%, respectively; P = .041) when compared obese men. Women were more likely to act on dietary advice they received and reported more dietary changes, even though advice was more often given to men (53% vs 22%, respectively; P <.001).

Investigators noted that the cross-sectional design limited the study and that results may not be generalizable to non-responders. They also stated that a possible misclassification of gout could have impacted findings; however, previous studies of gout diagnoses have shown a high validity. Additionally, gender differences regarding physician advice and dietary changes may not be generalizable to other health care systems.

“Despite overall similarities, in our setting men and women are given different advice regarding disease management and differ with regard to implementation of given advice,” investigators concluded.¹ “These differences call for further investigation of how to tailor and optimize health care advice and treatment of gout in subgroups of patients.”

References

1. ^{Bergsten U, Dehlin M, Klingberg E, Landgren AJ, Jacobsson LTH. Gender differences in illness perceptions and disease management in patients with gout, results from a questionnaire study in Western Sweden. BMC Musculoskelet Disord. 2023;24(1):300. Published 2023 Apr 15. doi:10.1186/s12891-023-06416-8}
2. ^{Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Liote F, et al. EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheumatic Dis. 2006;65(10):1312–24.}