Refractory Gout & Health-Related Quality-of-Life (HRQOL)

Session: Crystal Associated Arthropathies

Presentation: 25 – Health-Related Quality-of-Life (HRQOL) of Patients with Refractory Gout (Refractory-Gout) and US Veterans Administration Patients with Gout+Comorbities (VA-Gout) is Poor, and Comparable to that in other Severe Chronic Conditions

Category: 14. Metabolic and crystal arthropathies

Author(s): Vibeke Strand1, Jasvinder A. Singh2, John Sundy3, H. Ralph Schumacher4, Michael Becker5, N. Lawrence Edwards6. 1Stanford School of Medicine, Stanford, CA; 2Minneapolis VA Medical Center, Minneapolis, MN; 3Duke University School of Medicine, Raleigh, NC; 4University of Pennsylvania School of Medicine, Philadephia, PA; 5University of Chicago School of Medicine, Chicago, IL; 6University of Florida School of Medicine, Miami, FL

Abstract:
Purpose: HRQOL was assessed in 2 gout populations using Short Form-36 (SF-36). Results were compared with age and gender matched US norms, patients with osteoarthritis and hypertension (OA/HTN)1 and published values from randomized controlled trials (RCTs) in rheumatoid arthritis (RA)2 and systemic lupus (SLE)3.

Methods: A 12-month observational study enrolled 110 patients with Refractory-Gout and ≥1 of the following: ≥3 flares/year, chronic synovitis/arthropathy, or tophi, with SF-36 at baseline (BL) and bi-monthly.4 A survey of VA-Gout included demographics, ICD-9 codes for: gout; arthritic and medical comorbidities; and SF-36V.5

Results: Refractory-Gout patients were 81.8% male; 68.2% Caucasian; 20% African-American; mean age 59; 65% had 3-6 flares; 21%: >6 flares/year; and 70% had tophi. Comorbidities included: HTN: 71%; OA: 42%; renal dysfunction/lithiasis: 49%; diabetes: 14%. From the VA dataset, 1,090 (2.7%) had an ICD-9 diagnosis for gout; were 99% male, 97% Caucasian; mean age, 68 years; mean (standard deviation) 1.5 (1.1) medical and 0.6 (0.9) arthritic comorbidities. Medical or arthritic comorbidities predicted clinically/statistically lower adjusted scores in all SF-36 domain and physical component summary (PCS) scores. HRQOL was poor and similar in both gout populations. Refractory-Gout and VA-Gout patients reported lower mean scores than age/gender matched norms or subjects with OA/HTN (Table). These decrements were similar to those reported in RCTs in patients with longstanding RA and active SLE (Table).

Conclusions: Gout patients can have severe disease that adversely affects their HRQOL. Reported SF-36 scores were low, and similar in Refractory-Gout and VA-Gout populations; much lower than age/gender norms or subjects with OA/HTN and comparable to those in patients with longstanding RA and active SLE. These data underscore the need for effective treatment of gout.

Chronic Conditions	Physical Function	Role Physical	Bodily Pain	General Health	Vitality
Refractory-Gout	46.8	35	45.6	42.6	45
VA-Gout	43.6	42.9	44	46.4	42
Age-gender-matched U.S. norms (ref 1)	70.3	65.1	69.3	61.5	59.2
U.S norms for Osteoarthritis (OA) and Hypertension (age 65-74, ref 1)	57.4	38.2	55.4	59	49.5.
Rheumatoid Arthritis (ref 2)	26.2-57.4	10.7-49.7	30.0-50.0	34.9-59.0	31.0-49.5
Systemic Lupus Erythematosus (ref 3)	53.5-66.5	44.8-57.7	46.9-64.3	37.3-48.2	37.6-49.8

References:
1. Ware JE Jr.et al. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA; 1993.
2 Strand V et al Am J Managed Care 2007; 13:S237-S251.
3 Strand V et al Ann Rheum Ds 2007; 66:SII:482
4 Sundy JS et al: Ann Rheum Ds 2007; 66: SII:
5 Singh JA et al Ann Rheum Dis 2008; 67: doi:10.1136/ard.2007.081604

Research Method: Observational

Type of Trial: Other

Phase: Other

Gout Dictionary: Refractory-Gout = resistant to treatment