Which factors predict discordance between a patient and physician on a gout flare?

Abstract

Objective To investigate the factors associated with discordance between patient and physician on the presence of a gout flare. Methods Patients’ self-reports of current gout flares were assessed with the question, ‘Are you having a gout flare today?’ which was then compared with a concurrent, blinded, physician’s assessment. Based on agreement or disagreement with physicians on the presence of a gout flare, flares were divided into concordant and discordant groups, respectively. Within the discordant group, two subgroups—patient-reported flare but the physician disagreed and physician-reported flare but the patient disagreed—were identified. The factors associated with discordance were analysed with multivariable logistic regression analysis. Results Of 268 gout flares, 81 (30.2%) flares were discordant, with either patient or physician disagreeing on the presence of a flare. Of the discordant flares, in 57 (70.4%) the patient reported a flare but the physician disagreed. In multivariable logistic regression analysis adjusted for demographics, disagreement among patients and physicians on the presence of a gout flare was associated with lower pain scores at rest [odds ratio (OR) for each point increase on 0–10 point pain scale 0.81 (95% Wald CI 0.73, 0.90), P < 0.0001] and less presence of joint swelling [OR 0.24 (95% CI 0.10, 0.61), P = 0.003] or joint warmth [OR 0.39 (95% CI 0.20, 0.75), P = 0.005]. Conclusion Although patients and physicians generally agree about the presence of gout flare, discordance may occur in the setting of low pain scores and in the absence of swollen or warm joints.

Generalized pain hypersensitivity and associated factors in gout

“…However, when patients still report pain symptoms or flares despite ULT treatment, physicians often decide to switch to a more symptom-driven therapy. However, the patient's perspective on the presence of an actual gout flare can be different from the physician's perspective, with the main drivers of Page 10 of 18 Rheumatology disagreement being lower pain scores at rest and less presence of joint swelling or joint warmth [31].…”

“…However, when patients still report pain symptoms or flares despite ULT treatment, physicians often decide to switch to a more symptom-driven therapy. However, the patient’s perspective on the presence of an actual gout flare can be different from the physician’s perspective, with the main drivers of disagreement being lower pain scores at rest and less presence of joint swelling or joint warmth [ 31 ]. If patient-reported pain symptoms or flares are due to generalized pain hypersensitivity, these are not likely to respond to anti-inflammatory drugs and therefore patients with generalized pain hypersensitivity may report more pain even after progressing in their therapy plan.…”

Medical Students’ Perspective and Knowledge of Asymptomatic Hyperuricemia and Gout Management: A Cross-Sectional Study

“…In Australia, the prevalence of gout varies from 0.8% (self-reported) to 6.8% (self-reported doctor diagnosed gout), showing a poor understanding of the condition among patients [ 46 , 47 ]. Moreover, there are studies reporting discordance between patients and physicians on a presence of a gout flare, with a rate as high as 30% [ 48 ]. Furthermore, patients report poor follow-up and disease monitoring from their physicians, as well as a lack of discussion about treatment options [ 38 ].…”

Investigating gout flares: beyond a definition

“…Many of these features could lack specificity, by being shared by other inflammatory arthritis (such as psoriatic arthritis and rheumatoid arthritis). To underscore this uncertainty, in as many as 30.2% of suspected gout flares there were discordant opinions between diagnosing physicians and the patients about the presence of a gout flare [9]. This brief review will summarize the efforts that have been done to define and characterize a gout flare in clinical studies.…”