Health-related quality of life in gout: a primary care-based mixed methods study

Abstract

Background: Gout is the most prevalent inflammatory arthritis (2.5%) and may affect Health Related Quality Of Life (HRQOL) through its disease features, associated co-morbid and sociodemographic characteristics.

Methods: A systematic review of HRQOL in gout and the instruments used to measure it was performed. 1805 eligible patients in primary care were mailed a questionnaire to ascertain selfreported HRQOL (measured using Health Assessment Questionnaire Disability Index (HAQ-DI), Short-Form 36 Physical Function subscale (PF-10) and Gout Impact Scale (GIS)), gout, co-morbid and socio-demographic characteristics. Univariate unadjusted (T-test and analysis of variance) and multivariate adjusted (linear regression models) associations between HRQOL and independent variables were examined. Focus group interviews of participants’ perspectives towards gout and its treatments affecting HRQOL were conducted and thematic analysis performed.

Results: 22 studies in the systematic review identified poor physical HRQOL in those with gout and co-morbidities. Existing studies were limited by use of either generic or gout-specific HRQOL questionnaires and mostly secondary care settings. 1184 completed questionnaires were received (response 65.5%). On multivariate adjusted analysis, worse generic and gout-specific HRQOL was associated with higher attack frequency, history of oligo/polyarticular attacks,
allopurinol, body pain, depression, alcohol consumption and age. HRQOL measured using the GIS only was associated with serum uric acid >360µmol/L and currently having an attack and using the PF-10 and HAQ-DI only with female gender, stroke and angina. The key themes arising from the qualitative interviews were the impact of gout characteristics, misunderstanding of gout and lack of information from physicians.

Conclusions: HRQOL in gout is affected by disease severity, medical and psychological comorbidities and socio-demographic characteristics. Urate-lowering treatment should be initiated early to prevent disease progression. Co-morbidities should be screened for and treated alongside gout. Factors associated with HRQOL differ according to the instrument used and the choice of
instrument will depend upon the objectives of future research studies.