Abstract
ObjectivesTo examine gout-related, comorbid, and sociodemographic characteristics associated with generic and disease-specific health-related quality of life (HRQOL) in gout.MethodsAdults with gout from 20 general practices were mailed a questionnaire containing the Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form-36 Physical Function subscale (PF-10), Gout Impact Scale (GIS), and questions about gout-specific, comorbid and sociodemographic characteristics. Variables associated with HRQOL were examined using multivariable linear regression models.ResultsA total of 1184 completed questionnaires were received (response 65.9%). Worse generic and gout-specific HRQOL was associated with frequent gout attacks (≥5 attacks PF-10 β = −4.90, HAQ-DI β = 0.14, GIS subscales β = 8.94, 33.26), current attack (HAQ-DI β = 0.15, GIS β = −1.94, 18.89), oligo/polyarticular attacks (HAQ-DI β = 0.11, GIS β = 0.78, 7.86), body pain (PF-10 β = −10.68, HAQ-DI β = 0.29, GIS β = 2.61, 11.89), anxiety (PF-10 β = −1.81, HAQ-DI β = 0.06, GIS β = 0.38, 1.70), depression (PF-10 β = −1.98, HAQ-DI β = 0.06, GIS 0.42, 1.47) and alcohol non-consumption (PF-10 β = −16.10, HAQ-DI β = 0.45). Gout-specific HRQOL was better in Caucasians than non-Caucasians (GIS β = −13.05, −13.48). Poorer generic HRQOL was associated with diabetes mellitus (PF-10 β = −4.33, HAQ-DI β = 0.14), stroke (PF-10 β = −12.21, HAQ-DI β = 0.37), renal failure (PF-10 β = −9.43, HAQ-DI β = 0.21), myocardial infarction (HAQ-DI β = 0.17), female gender (PF-10 β = −17.26, HAQ-DI β = 0.43), deprivation (PF-10 β = −7.80, HAQ-DI β = 0.19), and body mass index ≥35 kg/m2 (PF-10 β = −6.10, HAQ-DI β = 0.21).ConclusionsHRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy. Both gout-specific and generic questionnaires identify the impact of disease-specific features on HRQOL but studies focusing on comorbidity should include generic instruments.
Highlights
Gout is the commonest inflammatory disease in the UK with a prevalence of 2.5%.[1]
Worse generic and goutspecific Health-related quality of life (HRQOL) was associated with frequent gout attacks (≥5 attacks PF-10 β=-4.90, Health Assessment Questionnaire Disability Index (HAQ-DI) β=0.14, Gout Impact Scale (GIS) subscales β=8.94 to 33.26), current attack (HAQ-DI β=0.15, GIS β=-1.94 to 18.89), oligo/polyarticular attacks (HAQ-DI β=0.11, GIS β=0.78 to 7.86), body pain (PF-10 β=-10.68, health assessment questionnaire (HAQ)-DI β=0.29, GIS β=2.61 to 11.89), anxiety (PF-10 β=-1.81, HAQ-DI β=0.06, GIS β=0.38 to 1.70), depression (PF-10 β=-1.98, HAQ-DI β=0.06, GIS 0.42 to 1.47) and alcohol non-consumption (PF-10 β=-16.10, HAQ-DI β=0.45, GIS β=4.94)
HRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy
Summary
Gout is the commonest inflammatory disease in the UK with a prevalence of 2.5%.[1]. Health-related quality of life (HRQOL) is impaired in those with gout compared to age- and sex-matched study controls, [2] as well as USA normative distributions.[3,4,5] Impairment in HRQOL in gout may be due to its diseasespecific features such as excruciatingly painful attacks, frequency of attacks, number of joints involved in an attack, pain in between attacks and long-term joint damage due to accumulation of tophi.[4,6,7,8] Gout is frequently associated with hypertension, renal and cardiovascular diseases as well as sociodemographic characteristics (age, gender, body mass index (BMI)).[9]HRQOL has been advocated as an important outcome domain in studies of chronic gout by the Outcome Measure in Rheumatology Clinical Trials (OMERACT) group [10] and can be measured using generic or gout-specific questionnaires. Generic instruments have the advantage of measuring all important aspects of HRQOL in any population, enabling comparison across different conditions and interventions,[11] but may be less responsive to change in specific conditions.[12] The generic Health Assessment Questionnaire Disability Index (HAQ-DI) [13] and Medical Outcomes Study Short Form 36 (SF-36) [14] have been endorsed by the OMERACT group to measure disability and HRQOL in gout.[10] The more recently developed gout-specific Gout Impact Scale (GIS) measures HRQOL through 5 subscales (concern overall (CO), medication side-effects (MSE), unmet treatment need (UTN), wellbeing during attack (WBDA) and concern during attack (CDA)).[15]
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