Patients with Gout Treated with Conventional Urate-lowering Therapy: Association with Disease Control, Health-related Quality of Life, and Work Productivity

Abstract

Objective.Implications of inadequate gout control were assessed through health-related quality of life (HRQOL) and work productivity of patients with gout adequately controlled while taking conventional urate-lowering therapy (ULT) for ≥ 3 months vs those whose gout was inadequately controlled.Methods.Retrospective data were drawn from the Adelphi Disease Specific Programme (DSP), a cross-sectional survey of patients with gout in France, Germany, the United Kingdom, and the United States. Patients completed these questionnaires: EQ-5D (3L), Patient Reported Outcomes Measurement Information System (PROMIS) Health Assessment Questionnaire (HAQ), and Work Productivity and Activity Impairment. Inadequate control was defined as the most recent serum uric acid (SUA) level > 6 mg/dl (> 360 µmol/l) or ≥ 2 flares in the last 12 months; adequate control as SUA level ≤ 6 mg/dl (≤ 360 µmol/l) and 0 flares. Appropriate statistical tests were used to assess differences between groups.Results.There were 836 (69%) inadequately and 368 (31%) adequately controlled gout cases. Mean age was 61 and 63 years and duration of current ULT was 32 and 57 months, respectively. Patients experiencing inadequate control reported significantly worse functioning and HRQOL, as measured by the EQ-5D (0.790 vs 0.877; difference: −0.087; p < 0.001) and PROMIS HAQ (13.21 vs 6.91; difference: 6.30; p < 0.001) scales. Productivity was also more impaired (work time missed: 4.5% vs 1.3%; impairment while working: 19.1% vs 5.2%; overall work impairment: 20.4% vs 5.6%; activity impairment: 20.3% vs 5.3%; all p < 0.001).Conclusion.Less than one-third of patients had gout that was adequately controlled. Those experiencing inadequately controlled gout reported significantly worse functioning, quality of life, and work productivity. Gout treatment strategies to improve disease control may lead to improvements in HRQOL and productivity.

Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study

“…While the HRQoL physical component was worse in respondents with gout, this did not quite reach accepted levels of statistical significance after adjustment for sociodemographic variables. Nonetheless, these results are consistent with previous studies reporting impaired physical HRQoL [ 22 ], worsening function, and impaired work productivity in those with sub-optimally controlled gout [ 46 ].…”

Chasing crystals out of the body: will treat to serum urate target for gout help us get there?

“…This sUA target achievement is based on the saturation point for monosodium urate since achievement of target sUA <6 mg/dL has been shown to lead to dissolution of crystals,17 as well lower risk of gout flares, tophi and medical care costs 18–21. A higher sUA is associated with a higher risk of gout flares,18–21 which present with severe pain and reduction of health-related quality of life (HRQoL) 22 23. This makes sUA a biomarker that has high clinical relevance.…”

Management of gout in older people

“…An acute attack is a self‐limiting condition that, apart from being very painful, substantially intrudes on the sufferer's life. If attacks are recurrent, commonly due to inadequate management, quality of life is considerably reduced, a fact that is generally underappreciated …”

“…If attacks are recurrent, commonly due to inadequate management, quality of life is considerably reduced, a fact that is generally underappreciated. 19,20 Gout occurs in people with raised serum concentrations and body loads of urate, the circulating ionised form of uric acid. This condition is known as hyperuricaemia.…”