Abstract
Although high prevalence of gout in Māori and Pacific people is well-documented, the experience of disease in these groups has not been explored in detail. The aim of this analysis was to describe the experience and impact of gout in Māori and Pacific people. Patients with gout for <10 years were recruited from primary and secondary care settings into a prospective observational study (n = 291; 37 Māori, 35 Pacific, and 219 not Māori or Pacific). Participants attended a baseline study visit which included a comprehensive clinical assessment. Serum urate, flare frequency and activity limitation were recorded at baseline and after 1 year. Māori and Pacific participants had earlier age of onset (by 9 years), higher flare frequency and more features of joint inflammation. Serum urate concentrations were higher in the Māori and Pacific patients at baseline, despite greater use of allopurinol. Māori and Pacific patients reported greater pain and activity limitation and lower health-related quality of life. The cost of gout treatment was more than three times higher in the Māori and Pacific patients. After 1 year, the higher flare frequency and activity limitation persisted in the Māori and Pacific patients. Māori and Pacific people with gout experience early onset, severe disease with frequent flares and poorly controlled hyperuricaemia. Māori and Pacific ethnicity should be recognised as a prognostic factor for more severe outcomes in this disease, and intensive efforts should be made to work with these patients to control serum urate and prevent flares.
Similar content being viewed by others
References
Becker MA, Schumacher HR, Benjamin KL et al (2009) Quality of life and disability in patients with treatment-failure gout. J Rheumatol 36(5):1041–1048
Dalbeth N, Collis J, Gregory K, Clark B, Robinson E, McQueen FM (2007) Tophaceous joint disease strongly predicts hand function in patients with gout. Rheumatology (Oxford) 46(12):1804–1807
Saseen JJ, Agashivala N, Allen RR, Ghushchyan V, Yadao AM, Nair KV (2012) Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacks. Rheumatology (Oxford) 51(11):2004–2012
Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N (2011) The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol 17(1):1–6
Lennane GA, Rose BS, Isdale IC (1960) Gout in the Maori. Ann Rheum Dis 19:120–125
Prior IA, Rose BS, Harvey HP, Davidson F (1966) Hyperuricaemia, gout, and diabetic abnormality in Polynesian people. Lancet 1(7433):333–338
Prior IA, Welby TJ, Ostbye T, Salmond CE, Stokes YM (1987) Migration and gout: the Tokelau Island migrant study. Br Med J (Clin Res Ed) 295(6596):457–461
Winnard D, Wright C, Taylor WJ et al (2012) National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology (Oxford) 51(5):901–909
Jackson G, Wright C, Thornley S et al (2012) Potential unmet need for gout diagnosis and treatment: capture-recapture analysis of a national administrative dataset. Rheumatology (Oxford) 51(10):1820–1824
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20(3):895–900
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483
Wolfe F, Michaud K, Pincus T (2004) Development and validation of the health assessment questionnaire II: a revised version of the health assessment questionnaire. Arthritis Rheum 50(10):3296–3305
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41
Gibson T, Waterworth R, Hatfield P, Robinson G, Bremner K (1984) Hyperuricaemia, gout and kidney function in New Zealand Maori men. Br J Rheumatol 23(4):276–282
Simmonds HA, McBride MB, Hatfield PJ, Graham R, McCaskey J, Jackson M (1994) Polynesian women are also at risk for hyperuricaemia and gout because of a genetic defect in renal urate handling. Br J Rheumatol 33(10):932–937
Phipps-Green AJ, Hollis-Moffatt JE, Dalbeth N et al (2010) A strong role for the ABCG2 gene in susceptibility to gout in New Zealand Pacific Island and Caucasian, but not Maori, case and control sample sets. Hum Mol Genet 19(24):4813–4819
Hollis-Moffatt JE, Gow PJ, Harrison AA et al (2011) The SLC2A9 nonsynonymous Arg265His variant and gout: evidence for a population-specific effect on severity. Arthritis Res Ther 13(3):R85
Hollis-Moffatt JE, Xu X, Dalbeth N et al (2009) Role of the urate transporter SLC2A9 gene in susceptibility to gout in New Zealand Maori, Pacific Island, and Caucasian case–control sample sets. Arthritis Rheum 60(11):3485–3492
Dalbeth N, Kumar S, Stamp L, Gow P (2006) Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol 33(8):1646–1650
Hench PS (1947) Gout and gouty arthritis. In: Cecil RL (ed) A textbook of medicine, 7th edn. Saunders, Philadelphia, pp 673–685
Kumar S, Gow P (2002) A survey of indications, results and complications of surgery for tophaceous gout. N Z Med J 115(1158):U109
Lee SJ, Hirsch JD, Terkeltaub R et al (2009) Perceptions of disease and health-related quality of life among patients with gout. Rheumatology (Oxford) 48(5):582–586
Strand V, Khanna D, Singh JA, Forsythe A, Edwards NL (2012) Improved health-related quality of life and physical function in patients with refractory chronic gout following treatment with pegloticase: evidence from phase III randomized controlled trials. J Rheumatol 39(7):1450–1457
Dalbeth N, Petrie KJ, House M et al (2011) Illness perceptions in patients with gout and the relationship with progression of musculoskeletal disability. Arthritis Care Res 63(11):1605–1612
Acknowledgments
This work was funded by the Arthritis New Zealand, the University of Auckland and the Henry Cotton Charitable Trust. We thank Drs. Doone Winnard and Sai Boladuadua for their review of this manuscript.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dalbeth, N., House, M.E., Horne, A. et al. The experience and impact of gout in Māori and Pacific people: a prospective observational study. Clin Rheumatol 32, 247–251 (2013). https://doi.org/10.1007/s10067-012-2110-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-012-2110-5