Background Gout has a significant impact on Health Related Quality Of Life (HRQOL). Existing studies are limited by use of only generic HRQOL questionnaires or being undertaken in selective populations such as hospital clinics. We undertook the first large primary care study of gout to use both disease-specific and generic HRQOL questionnaires.
Objectives To investigate the cross-sectional associations between socio-demographic, comorbid and gout characteristics and HRQOL using the Health Assessment Questionnaire Disability Index (HAQ-DI), Short-Form 36 Physical Function subscale (PF10) and Gout Impact Scale (GIS).
Methods Patients with gout registered with 20 UK general practices were identified by gout consultations or prescriptions for colchicine or allopurinol in the preceding 2 years. 1805 eligible patients were mailed a questionnaire to ascertain self-reported gout characteristics, comorbidities and HRQOL. Serum uric acid and tophi were ascertained from consenting participants' medical records. Differences between mean scores of HRQOL were assessed using t test and analysis of variance (ANOVA). Associations between HRQOL and independent variables were assessed in univariable and multivariable linear regression models (adjusted for age, gender, socio-economic status and comorbidities).
Results 1184 completed questionnaires were received (adjusted response 65.5%). Mean age (SD) of the responders was 65.63 (12.48), 83.6% were males and 95.1% Caucasian. The mean frequency (SD) of attacks over the last year was 1.66 (1.72) and 36.8% had polyarticular gout. The median (Interquartile range) dose of allopurinol was 300 mg (100 mg-300 mg). The commonest co-existing comorbidity was hypertension (61.8%).
Worse generic and gout-specific HRQOL was seen in females, current or polyarticular gout, increasing attack frequency, comorbidities (stroke and renal failure), anxiety, depression, body pain, obesity, no further education, and highest neighbourhood deprivation (p<0.05).
Those taking allopurinol had greater HAQ-DI disability but lower GIS unmet treatment need. Diabetes and hypertension were risks for worse health (PF10) and disability (HAQ-DI) but led to lower GIS medication side effects and concern overall respectively. Using the GIS, poor HRQOL was seen with hyperuricaemia, non- Caucasian ethnicity and being unmarried/living alone.
On multivariable analysis attack frequency, polyarticular gout, allopurinol use, current gout attack and anxiety remained significantly associated (p<0.05) with GIS. Body pain and depression remained associated with GIS (p 0.01), PF10 (p 0.01) and HAQ-DI (p 0.01), whilst alcohol frequency was associated with PF10 (p<0.01) and HAQ-DI (p 0.01).
Conclusions Gout characteristics were associated only with gout-specific HRQOL and frequency of alcohol intake only with generic HRQOL measures. Pain and depression were associated with both types of measure. Use of the GIS and generic questionnaires together may provide the optimal chance of detecting gout-specific and other characteristics affecting all aspects of HRQOL. Further prospective studies of HRQOL measures will help identify factors that are predictive of a poor outcome and hence help target early intervention.
Disclosure of Interest None declared