Background Gout is the most common inflammatory arthritis, experienced by 2.5% of UK adults and predominately managed in primary care. Gout patients frequently experience comorbidity, the presence of one or more additional disorder or disease with an index condition. Whilst the association with physical conditions has been widely investigated, research into the potential association between gout populations and specific psychological comorbidity remains limited, as does the role of different gout characteristics on such comorbid experience.
Objectives To examine the prevalence of anxiety and depression comorbidity in gout and the characteristics of gout with which these are associated.
Methods As part of a longitudinal cohort study, a baseline questionnaire was sent to 1,805 participants with gout aged ≥18 years from UK primary care. Participants had a gout diagnosis or prescriptions for allopurinol or colchicine in their medical records two years prior to the baseline questionnaire. Prevalence of anxiety was defined using the Generalised Anxiety Disorder (GAD-7) questionnaire and depression using the Patient Health Questionnaire (PHQ-9). Logistic regression analysis was used to examine the association between the presence of either of these psychological comorbidities and several gout characteristics, including; i) the frequency of gout attacks in the last 12 months, ii) use of allopurinol, iii) history of polyarticular gout and iv) the age at which the diagnosis of gout had been made. Crude associations were reported as odds ratios (OR) and 95% confidence intervals (CI) initially, followed by associations adjusted for age, gender, deprivation status, body mass index, other comorbidities (hypertension, hyperlipidaemia, diabetes mellitus, angina, myocardial infarction, kidney stones, transient ischaemic attack, kidney failure or stroke) and alcohol consumption.
Results 1,184 participants responded to the baseline questionnaire (65.6%). Prevalence of comorbid anxiety was found in 10.0% of participants, depression in 12.6%. Three or more gout attacks in 12 months was associated with the presence of anxiety (OR 1.78 (95% CI 1.0 to 3.1)) and depression (2.65 (95% CI 1.5 to 4.5)). History of polyarticular gout was associated with depression only (adjusted OR 2.28 (95% CI 1.5 to 3.5)). No association was found between the use of allopurinol or gout duration and the presence of anxiety or depression.
Conclusions Of gout patients attending UK primary care, around 10% will also have comorbid anxiety or depression. In particular, those who have experienced frequent gout attacks or have gout in multiple joints are significantly more likely to experience these psychological comorbidities. The presence of anxiety and/or depression may influence adherence to medication and participation in routine reviews, hence impacting adversely on the outcome of gout management. Whilst further evidence is needed to support the routine screening of patients with gout for anxiety and depression, clinicians should be aware that these problems often coexist and may adversely impact on health outcomes for this frequently neglected group.
Disclosure of Interest None declared
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