Background/Aims
Gout is associated with physical co-morbidities and a reduction in physical health-related quality of life. However, the association between gout and psychological comorbidity (depression and anxiety) has received less attention. A secondary analysis of data from a five-year prospective cohort study was performed to determine the prevalence and incidence of anxiety and depression in people with gout, and gout characteristics associated with psychological co-morbidity.
Methods
Adults aged ≥18 years with gout were identified via Read codes or allopurinol prescriptions from 20 general practices across the West Midlands. Questionnaires were mailed at baseline and at 12-, 36- and 60-months. Questionnaire data included socio-demographics, gout-related characteristics (flare frequency, oligo- or poly-articular gout, gout duration and allopurinol use) and validated anxiety (GAD-7) and depression (PHQ-9) questionnaires. Current anxiety and depression were defined as scores>10 on the GAD-7 and PHQ-9 respectively. The prevalence and incidence of new-onset anxiety or depression were described at 12, 36 and 60 months in those without anxiety and depression at baseline. Binary logistic regression used to determine baseline gout characteristics associated with developing new-onset anxiety or depression at each time point (odds ratios (OR), 95% confidence intervals (CI), adjusted for age, gender and deprivation).
Results
Of 1184 baseline responders, 721, 605 and 411 responded at 12-, 36- and 60-months, respectively. The peak prevalence of both depression and anxiety was at baseline at 12.6% and 10.0%, respectively. Responders with anxiety (GAD-7 ≥10) or depression (PHQ-9 ≥10) at baseline were excluded from new-onset analysis. Over five years, one in thirteen (7.5%) developed new-onset anxiety, and one in eleven (9.2%) developed new-onset depression at any future time point. Developing anxiety was associated with a history of oligo- or poly-articular gout flares at baseline (OR 2.31, 95% CI:1.26 to 4.23) but not flare frequency, gout duration, or allopurinol use. New-onset depression was associated with allopurinol use at baseline (OR 1.93, 95% CI: 1.01 to 3.69) but not flare frequency, gout duration, or oligo- or poly-articular gout flares.
Conclusion
Psychological co-morbidity is common in people living with gout; clinicians should be aware of this when assessing and treating people with gout.
Disclosure
J.J.R. Higgs: None. L. Clarson: None. R. Bajpai: None. S. Muller: None. E. Roddy: None.
Objectives: To evaluate treatment outcomes in patients from a low-middle income country (LMIC) with esophageal carcinoma who underwent esophagectomy after neoadjuvant chemoradiation (NACRT/S). Methods: Between 2010 and 2020, 254 patients (median follow-up: 53 months) met our inclusion criteria. Out-of-Field nodal regions were determined by reviewing individual radiotherapy plans. Cox regression modelling was performed to analyze overall survival (OS) and recurrence-free survival (RFS), while pathological complete response (pCR) prediction utilized Poisson regression. Results: The median OS was 71.4 months (IQR: 19.6-∞), RFS did not reach the median and pCR rate was 46%. On multivariable Cox regression, BMI [0.93 (0.89–0.98); 0.94 (0.89–0.99)] and absence of out-of-field node with extranodal extension (ENE)[0.22 (0.09–0.53); 0.30 (0.12–0.75)] influenced OS and RFS, respectively. Age [1.03 (1.01–1.06)], nodal stage [cN2-3 vs cN0: 2.67 (1.08–6.57)] and adventitial involvement [2.54 (1.36–4.72)] also influenced OS, while involved margins [3.12 (1.24–7.81)] influenced RFS. On multivariable Poisson regression, non-CROSS-chemotherapy regimens [0.65 (0.44–0.95)] and residual primary disease on pre-surgical imaging [0.73 (0.57–0.93)] were significantly associated with pCR. The most frequently involved in-field and out-of-field nodal regions were the peri-esophageal and peri-gastric (greater and lesser curvature) regions, respectively. Conclusions: NACRT/S is feasible and effective in patients from LMIC. Out-of-field ENE merits further investigation as a prognostic factor since it significantly influenced both OS and RFS. Advances in knowledge: The results of clinical trials are replicable in LMICs. Out-of-field ENE is an independent prognostic factor for OS and RFS.
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