SLR - September 2009 - Essam Khedr
Reference:
Becker, M., Schumacher, H.R., Benjamin, K.L., Gorevic, P., Greenwald, M., et al. (2009). Quality of life and disability in patients with treatment-failure gout. Journal of Rheumatology 36(5):1041-1048.
Scientific Literature Reviews
Reviewed by: Essam Khedr, DPM
Residency Program: Saint Vincent Hospital/Worcester Medical Center
Podiatric Relevance:
Gout is a common chronic condition diagnosed and treated by the podiatric physician. This study shows how treatment failure gout can affect the quality of life of these patients.
Methods:
Inclusion criteria in this study including subjects with symptomatic crystal-proven gout of at least 2 years duration in addition to intolerance or refractoriness to conventional urate-lowering therapies. Serum uric acid (SUA) concentration, swollen and tender joint counts, frequency and severity of gout flares, tophus assessments, comorbidities, and patient-reported outcomes data were collected. Health Assessment Questionnaire-Damage Index data were collected. Analyses included correlations of patient-reported outcomes with clinical variables and changes in clinical status.
Results:
Mean age of study subjects was 59 years. Mean scores on SF-36 physical functioning subscales were 34.2–46.8, analogous to persons aged ≥ 75 years in the general population. Subjects with more severe gout at baseline had worse health-related quality of life (HRQOL) in all areas (p < 0.02 for all measures), compared to patients with mild-moderate disease. Number of flares reported in the past year, number of tender joints, swollen joints, and tophi correlated significantly with some or all HRQOL and disability measures. SUA was not significantly correlated with any HRQOL or disability measure. Subjects with co-morbidities experienced worse physical, but not mental, functioning.
Conclusions:
Severe gout is associated with poor HRQOL and disability, especially for patients who
experience more gout flares and have a greater number of involved joints. Subject perceptions of gout-related functioning and pain severity appear to be highly sensitive indicators of HRQOL and disability.