Background Gout and osteoarthritis (OA) are common in the United States, but little is known about potential associations of OA and hyperuricemia/gout with clinical outcomes.
Objectives This study examined variations in gout severity, management, and healthcare utilization among gout patients with and without OA.
Methods Data were assessed from a survey of US physicians and patient chart audits. Participating physicians managed the care of ≥50 patients with gout annually; chart audits were of their most recent 5 consecutive adult patients with confirmed gout. Gout severity was measured by physician global assessment, flares, organ/joint damage, and tophi. Treatment characteristics, presence of clinician-confirmed OA, and sociodemographic factors were identified. Descriptive and multivariate (stepwise logistic regression) statistics analyzed the differences among gout patients with and without clinician-confirmed comorbid OA, and assessed urate-lowering therapy (ULT) use and gout control.
Results Overall, 1159 charts of gout patients were abstracted (230 w/ OA, 929 w/o; 81% male; 71% white); the proportion of patients aged ≥61 was greater for those with gout and OA than those with gout but without OA (63% vs 32%; P<0.001). Patients with gout and OA had longer mean duration of gout (63 vs 41 months), were more likely to have tophi (44% vs 19%), joint damage (31% vs 11%), and clinician-rated severe gout (31% vs 12%) than those without OA (all P<0.01). Patients with gout and OA were also more likely to receive ULT (89% vs 70%; P<0.01), and among those receiving ULT, OA patients treated with allopurinol received a higher average daily dose (325 mg vs 296 mg; P=0.031). Gout patients with OA were more likely to have additional comorbidities (cardiovascular disease, kidney disease, COPD, depression, diabetes, hyperlipidemia, hypertension, obesity, prostate problems [men]) and have chronic pain than those without OA (all P<0.05). Gout patients with OA reported more office visits (4.0 vs 3.5), were more likely to have an emergency department visit (17% vs 9%), and were more likely to require surgery for gout in the past 12 months (3% vs 0.3%) (all P<0.01). In both groups, ULT use was associated with better gout control, but the specific factors predictive of ULT use and disease control varied between those with and without OA.
Conclusions Gout patients with OA were more likely to have a greater impact on health system spending, with additional comorbidities and more severe gout than those without OA. These data suggest that gout patients with OA constitute a less healthy group in need of more careful monitoring and more aggressive gout management.
Acknowledgements This study was sponsored by AstraZeneca.
Disclosure of Interest S. Krasnokutsky Samuels: None declared, M. Pillinger: None declared, S. Kabadi Employee of: AstraZeneca, D. Taylor Employee of: Ironwood, R. Morlock Consultant for: AstraZeneca, Ironwood, Ardea Biosciences