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Ye J, Zhang Y, Zhang W, Doherty M, Lu N, Zeng C, Lei G, Wei J, Ding X. Secular trend of gout incidence in the UK: an age-period-cohort analysis. BMJ Open 2024; 14:e079665. [PMID: 38286703 PMCID: PMC10826541 DOI: 10.1136/bmjopen-2023-079665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES The incidence of gout in the UK appears to have declined since 2013; however, whether such a trend occurred across participants born in different years (ie, birth cohort) is unknown. We aimed to examine the effects of the birth cohort on gout incidence using an age-period-cohort (APC) model. DESIGN Cross-sectional study. SETTING Nationwide data from the UK primary care database. PARTICIPANTS Individuals between 30 and 89 years of age were included. We excluded individuals who had gout history when entering the database and individuals with less than 1 year of continuous follow-up between 1 January 1999 and 31 December 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Gout was identified using READ codes assigned by general practitioners. The incidence of gout between 1999-2013 and 2011-2019 was analysed with APC model. RESULTS The incidence of gout between 1999 and 2013 increased with birth cohorts. Compared with those born in 1949-1953 (reference), the age-adjusted and period-adjusted rate ratios (RRs) of incident gout increased from 0.39 (95% CI 0.34 to 0.46) in participants born in 1910-1914 to 2.36 (95% CI 2.09 to 2.66) in participants born in 1979-1983 (p for trend <0.001). In contrast, the incidence of gout between 2011 and 2019 decreased with birth cohorts. Compared with those born in 1949-1953 (reference), the age-adjusted and period-adjusted RRs of incident gout declined from 2.75 (95% CI 2.30 to 3.28) in participants born in 1922-1926 to 0.75 (95% CI 0.65 to 0.87) in participants born in 1976-1980 but then increased slightly to 0.95 (95% CI 0.77 to 1.17) in participants born in 1985-1989. CONCLUSIONS The gout incidence between 1999 and 2013 in the UK increased with the birth cohorts and then decreased between 2011 and 2019 except for those born after 1980. Future monitoring is needed to help identify aetiological factors and guide preventive and treatment strategies for gout.
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Affiliation(s)
- Jing Ye
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, and the Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Pain Centre Versus Arthritis, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Pain Centre Versus Arthritis, Nottingham, UK
| | - Na Lu
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Sivasegaran S, Hanafi NSH. Perceptions and practices of self-management among adult patients with gout at a primary care clinic: A qualitative study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:72. [PMID: 38213387 PMCID: PMC10781610 DOI: 10.51866/oa.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction Gout is a chronic disease commonly associated with other comorbidities. Patients' perceived quality of life empowers them in managing their health. Self-management is imparted as part of management among patients with chronic disease. This study aimed to explore the perceptions and practices of self-management among patients with gout from different ethnic groups in Malaysia. Methods A qualitative study was conducted among Malay, Chinese and Indian patients with gout via semi-structured in-depth interviews at the primary care clinic of University Malaya Medical Centre in either English or Malay language. All participants had a gout duration of more than 6 months and were either taking urate-lowering drugs or not using them at all. Results A total of 20 participants were successfully recruited for the study. Among the participants, 18 were men, while two were women. Further, nine were Malays; six, Chinese; and four, Indians. The age ranged from 29 to 81 years, while the gout duration ranged from 1 to 30 years. From the interviews, three themes emerged: experiences with gout, types of self-management of gout and factors influencing self-management of gout. Conclusion Diet control is the main self-management practice of patients with gout. Traditional medicine practices include natural methods such as consumption of different types of vegetable juices, pineapple and papaya. Each ethnicity has its own unique beliefs and food cultures. By understanding the self-management practices of patients from diverse ethnic backgrounds, healthcare practitioners can tailor the treatment of gout to individual needs.
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Affiliation(s)
- Suhashini Sivasegaran
- MD, MMed, Klinik Kesihatan Sandakan, K.M 3.2, Jln Utara Beg Berkunci No. 4, Sandakan, Sabah, Malaysia.
| | - Nik Sherina Haidi Hanafi
- MBBS, MFamMed, PhD, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chapman LS, Flurey CA, Redmond AC, Richards P, Hofstetter C, Tapster B, Emmel J, Helliwell PS, Menz HB, Hannan MT, Shea B, Siddle HJ. Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: A systematic review of qualitative studies to inform the work of the OMERACT Foot and Ankle Working Group. Semin Arthritis Rheum 2023; 61:152212. [PMID: 37207417 DOI: 10.1016/j.semarthrit.2023.152212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES This study aimed to determine outcome domains of importance to patients living with foot and ankle disorders in rheumatic and musculoskeletal diseases (RMDs), by exploring the symptoms and impact of these disorders reported in existing qualitative studies. METHODS Six databases were searched from inception to March 2022. Studies were included if they used qualitative interview or focus group methods, were published in English, and involved participants living with RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) who had experienced foot and ankle problems. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool and confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. All data from the results section of included studies were extracted, coded and synthesised to develop themes. RESULTS Of 1,443 records screened, 34 studies were included, with a total of 503 participants. Studies included participants with rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and a mixed population (n = 3), who live with foot and ankle disorders. Seven descriptive themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, work disruption, financial burden and emotional impact. Descriptive themes were inductively analysed further to construct analytical themes relating to potential outcome domains of importance to patients. Foot or ankle pain was the predominant symptom experienced by patients across all RMDs explored in this review. Based on grading of the evidence, we had moderate confidence that most of the review findings represented the experiences of patients with foot and ankle disorders in RMDs. CONCLUSIONS Findings indicate that foot and ankle disorders impact on multiple areas of patients' lives, and patients' experiences are similar regardless of the RMD. This study will inform the development of a core domain set for future foot and ankle research and are also useful for clinicians, helping to focus clinical appointments and measurement of outcomes within clinical practice.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK.
| | - Caroline A Flurey
- School of Social Sciences, College of Health, Science, and Society, University of the West of England, Bristol, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Bethany Tapster
- Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jenny Emmel
- Library Service, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Marian T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Chapman LS, Jones J, Redmond AC, Flurey CA, Richards P, Hofstetter C, Smith TO, Arnold JB, Hannan MT, Maxwell LJ, Menz HB, Shea B, Golightly YM, Tugwell P, Beaton D, Conaghan PG, Helliwell PS, Siddle HJ. Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session. Semin Arthritis Rheum 2023; 61:152210. [PMID: 37156170 DOI: 10.1016/j.semarthrit.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Foot and ankle involvement is common in rheumatic and musculoskeletal diseases, yet high-quality evidence assessing the effectiveness of treatments for these disorders is lacking. The Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group is developing a core outcome set for use in clinical trials and longitudinal observational studies in this area. METHODS A scoping review was performed to identify outcome domains in the existing literature. Clinical trials and observational studies comparing pharmacological, conservative or surgical interventions involving adult participants with any foot or ankle disorder in the following rheumatic and musculoskeletal diseases (RMDs) were eligible for inclusion: rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathies, crystal arthropathies and connective tissue diseases. Outcome domains were categorised according to the OMERACT Filter 2.1. RESULTS Outcome domains were extracted from 150 eligible studies. Most studies included participants with foot/ankle OA (63% of studies) or foot/ankle involvement in RA (29% of studies). Foot/ankle pain was the outcome domain most commonly measured (78% of studies), being the most frequently specified outcome domain across all RMDs. There was considerable heterogeneity in the other outcome domains measured, across core areas of manifestations (signs, symptoms, biomarkers), life impact, and societal/resource use. The group's progress to date, including findings from the scoping review, was presented and discussed during a virtual OMERACT Special Interest Group (SIG) in October 2022. During this meeting, feedback was sought amongst delegates regarding the scope of the core outcome set, and feedback was received on the next steps of the project, including focus group and Delphi methods. CONCLUSION Findings from the scoping review and feedback from the SIG will contribute to the development of a core outcome set for foot and ankle disorders in RMDs. The next steps are to determine which outcome domains are important to patients, followed by a Delphi exercise with key stakeholders to prioritise outcome domains.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Jennifer Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | | | - John B Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Marian T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorcas Beaton
- Department of Occupational Science and Occupational Therapy, Institute for Work and Health, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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Illness perception and treatment experience in patients with gout: a descriptive qualitative study. Clin Rheumatol 2022; 41:1185-1195. [PMID: 35013834 DOI: 10.1007/s10067-021-06014-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore the illness perception and treatment experience of gout patients in China. METHODS A descriptive qualitative approach was used. In-depth semi-structured individual interviews were conducted among 18 adults with gout between August 2020 and December 2020. The Common-Sense Model of Self-Regulation was used as the conceptual framework for developing interview guide and data analysis. Interviews were audio recorded, transcribed, independently coded, and analyzed for themes. RESULTS The 18 gout patients aged 23-77 years old, with 16 being male. Four themes were generated to reflect the experience of patients with gout: limited knowledge of gout, various but inadequate sources of gout knowledge, multifaceted influences of gout, and seeking for diversified disease treatment methods. CONCLUSION There is a gap between patients' anticipation and practical service that is closely linked with subsequent poor gout management among the participants. The findings indicate a need of strengthening health education about gout by considering building nurse-led support groups and developing mobile health applications, as well as addressing the long-term influence of the Chinese alcoholic drinking culture to promote patients' effective disease management. KEY POINTS • This qualitative study fills a knowledge gap on illness perception and treatment experience among Chinese gout patients, exploring how these patients perceived gout and manage gout. • The gout patients in this study reported disparity between personal anticipation and healthcare service that largely contributes to their poor gout management. • The Chinese alcoholic drinking culture embedded in personal, professional, and social activities posed extra difficulties and challenges on modifying lifestyle for gout patients that needs to be addressed for promoting gout management among this group.
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Abstract
Gout flares are central to the patient experience of gout and are included in the Outcome Measures in Rheumatology (OMERACT) core outcome domain set for long-term gout studies. Although a valid definition for gout flare has been developed, there is no consensus around how flare outcomes are measured and reported in long-term clinical studies. Current methods of flare measurement, which are centered on measuring flares as a binary outcome (i.e., present vs absent), do not reflect the variable pattern of flares over time, nor the multidimensional patient experience of gout flares which include factors related to pain severity, functional disability, impact on family and social life, and psychological wellbeing. This review will discuss the importance and challenges of gout flare measurement.
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Affiliation(s)
- Sarah Stewart
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Angelo Gaffo
- Department of Medicine, University of Alabama and Birmingham, Alabama, United States.
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Coleman W, Spencer D, Wong P, Manolios N. An enquiry into the crippling gout affecting Pacific Islander and Māori men in Western Sydney. Int J Rheum Dis 2021; 24:1394-1401. [PMID: 34611996 DOI: 10.1111/1756-185x.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Despite the effectiveness and availability of urate-lowering therapies (ULT), we continue to see a number of advanced cases of tophaceous gout in the Pacific Islander and Māori population in Western Sydney. Although the high prevalence and increased severity of gout in this cohort has been well documented, there has been little qualitative research undertaken in Australia into the lived experience of this group of people. It is this gap in the research that our study aimed to address. METHODS Participants were recruited from the rheumatology clinics at Westmead and Blacktown Hospitals. Those eligible to participate were Pacific Islander and Māori patients with tophaceous gout currently living in the Western Sydney Local Health District (WSLHD). Data collection took the form of 10 semi-structured interviews, which were subsequently transcribed verbatim. A thematic analysis of the data was then performed. RESULTS Thematic analysis identified 6 key themes: lack of understanding of the disease and its potential effects; missed opportunities for intervention and disjointed care; chronic reliance upon corticosteroids; trivialization of gout as a nuisance illness; the substantial financial impact of chronic illness; and the all-consuming nature of severe gout. CONCLUSION The human cost of severe tophaceous gout in this cohort is immense. All 10 participants exemplified the disease's devastating social effects. We propose 4 key recommendations: improved education regarding diagnosis and management; immediate prescription of ULT at first presentation; a lower threshold for out-of-hospital rheumatologist referral; and improved follow-up through a nurse- and pharmacist-led collaborative gout management program.
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Affiliation(s)
- William Coleman
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - David Spencer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia.,Rural Clinical School Coffs Harbour Campus, The University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Manolios
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
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Yin Y, Wang H, Fan CF, Chen H. Potential Development of a Mobile Application for Gout Self-Management: What Support Do Patients Need? Patient Prefer Adherence 2021; 15:2231-2238. [PMID: 34629866 PMCID: PMC8493006 DOI: 10.2147/ppa.s310689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE With the increasing prevalence and chronic course of gout, the use of mobile health (mHealth) applications (APPs) for gout self-management is attracting considerable research attention as an effective approach to improving health outcomes. However, there is limited knowledge regarding the self-management support that a mHealth APP for gout should provide to patients according to their needs. The aim of this study was to interview patients with gout and identify their needs with respect to gout self-management support. PATIENTS AND METHODS We conducted qualitative research using a purposive sampling method from January 2019 to August 2019. Individual face-to-face semi-structured interviews were conducted with patients recruited from West China Hospital in Sichuan, China. The qualitative data were transcribed verbatim and analyzed by thematic analysis. RESULTS Ten male patients with gout were included in the final analysis. Instrumental, psychological, and relational support emerged as themes describing the needs of patients for gout self-management support. The instrumental support included health education, hospital registration, setting reminders, and shopping. Psychological support referred to helping patients mitigate various negative emotions. Relational support included interactions with healthcare providers and fellow patients. CONCLUSION The present findings indicate that healthcare providers or companies should develop mHealth APPs for gout self-management based on the needs of patients.
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Affiliation(s)
- Yao Yin
- Department of Neurology/Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Huan Wang
- Department of Nursing, The Third Hospital of Mianyang, Mianyang, Sichuan Province, People's Republic of China
| | - Chao-Feng Fan
- Department of Neurology/Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Liddle J, Richardson JC, Hider SL, Mallen CD, Watson L, Chandratre P, Roddy E. 'It's just a great muddle when it comes to food': a qualitative exploration of patient decision-making around diet and gout. Rheumatol Adv Pract 2021; 5:rkab055. [PMID: 34514294 PMCID: PMC8421808 DOI: 10.1093/rap/rkab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Our aim was to understand whether, why and how patients choose to modify their diets after developing gout. Methods We conducted an inductive thematic secondary analysis of qualitative data from 43 interviews and four focus groups with UK participants with gout (n = 61). Results Participants commonly initiated dietary changes as part of a self-management strategy for gout. Reasons for making such dietary changes included: desperation; a desire for control; and belief that it would be possible to achieve successful management through diet alone; but not weight loss. Participants who did not make changes or who reverted to previous dietary patterns did so because: they believed urate-lowering therapy was successfully managing their gout; medication allowed normal eating; they did not find ‘proof’ that diet would be an effective treatment; or the dietary advice they found was unrealistic, unmanageable or irrelevant. Dietary modification was patient led, but patients would have preferred the support of a health-care professional. Beliefs that diet could potentially explain and modify the timing of flares gave patients a sense of control over the condition. However, the belief that gout could be controlled through dietary modification appeared to be a barrier to acceptance of management with urate-lowering therapy. Conclusions Perceptions about gout and diet play a large role in the way patients make decisions about how to manage gout in their everyday lives. Addressing the reasons why patients explore dietary solutions, promoting the value of urate-lowering therapy and weight loss and drawing on strong evidence to communicate clearly will be crucial in improving long-term clinical management and patient experience.
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Affiliation(s)
- Jennifer Liddle
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne
| | - Jane C Richardson
- School of Law and Social Justice, University of Liverpool, Liverpool
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Fuller A, Cai K, Filippou G, Pascart T, Diaz-Torne C, Hensey O, Grossberg D, Christensen R, Shea B, Singh JA, Tedeschi SK, Dalbeth N, Abhishek A. Experience and impact of crystal pyrophosphate deposition (CPPD) from a patient and caregiver perspective: A qualitative exploration from the OMERACT CPPD working group. Semin Arthritis Rheum 2021; 51:655-660. [PMID: 33941385 PMCID: PMC10061547 DOI: 10.1016/j.semarthrit.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore the lived experience of people with calcium pyrophosphate deposition (CPPD) disease and the impact of this condition on their daily lives. METHODS Patients with CPPD and their caregivers were invited to take part in a one-to-one (patient only) or paired (patient and caregiver) semi-structured interview. Interviews covered patients' diagnosis and treatment experiences, and the impact of CPPD on their daily lives. Transcribed interviews were analysed using inductive thematic analysis. RESULTS 28 patient interviews, six of which included a caregiver, were conducted across five countries. Acute CPP crystal arthritis flares resulted in temporary but profound disability for most patients, disrupting their ability to go about day-to-day activities, and they sought immediate medical attention. CPPD+OA and chronic CPP crystal inflammatory arthritis presented patients with longer term limitations in daily lives. Patients and their caregivers described these disruptions and limitations, which included a reduced ability or inability to complete household and self-care tasks, exercise, socialise, work and drive. They also described how arthritis pain and resulting limitations adversely impacted upon patients' psychological wellbeing. Delays in referral to specialists and diagnostic uncertainty were described by many. Lack of appropriate treatment or access to treatments only upon worsening of symptoms impacted upon the length of time some patients spent in pain and with functional limitations. CONCLUSION This study is the first to demonstrate the wide-ranging impact of CPPD, and highlights the need for improved diagnosis, physician training, as well as greater emphasis upon finding targeted therapies to specifically treat CPPD.
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Affiliation(s)
- Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
| | - Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Georgios Filippou
- Rheumatology Unit, ASST-Fatebenefratelli L, Sacco University Hospital, University of Milan, Italy
| | - Tristan Pascart
- Department of Rheumatology, Hopital Saint-Philibert, Lille Catholic University, Lille, France
| | - Cesar Diaz-Torne
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona, Spain
| | - Owen Hensey
- The Central Remedial Clinic, Dublin, Ireland
| | - David Grossberg
- Holy Cross Hospital, Silver Spring, MD, USA; Suburban Hospital, Bethesda, MD, USA
| | - Robin Christensen
- Department of Clinical Research, Copenhagen and Research Unit of Rheumatology, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Southern Denmark, Odense University Hospital, Denmark
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA; Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Epidemiology at the UAB School of Public Health, Birmingham, AL, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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11
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Coleshill MJ, Aung E, Carland JE, Faasse K, Stocker S, Day RO. Rebranding Gout: Could a Name Change for Gout Improve Adherence to Urate-Lowering Therapy? Ther Innov Regul Sci 2020; 55:138-141. [PMID: 32661926 DOI: 10.1007/s43441-020-00198-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
Gout is the most common form of inflammatory arthritis in men, yet both patients and the public often do not recognise gout as a form of arthritis. Instead, due to historical misconceptions, gout is typically seen as a lifestyle disease caused by poor diet. In reality, there are a number of risk factors that contribute to gout, including genetic factors. Views of gout as precipitated by lifestyle alone can lead to stigma, and maladaptive beliefs that it should be treated primarily through dietary changes. This is thought to contribute to poor uptake of, and adherence to, effective pharmaceutical treatments. Gout has some of the poorest medication adherence rates of any chronic disease, contributing to suboptimal health outcomes for patients. Recent research suggests that when gout is referred to as 'urate crystal arthritis' (a rarely used name for gout), the perception of the disease by members of the public was more accurate. It was viewed as being less under personal control (i.e. less appropriately managed by behaviours such as dietary intake), and more appropriately managed by long-term medical treatment. This finding raises the possibility that patients themselves might also benefit from gout being explicitly labelled as arthritis. Indeed, parallels can be drawn between this case and other diseases that have recently had their names changed to improve outcomes, namely primary biliary cirrhosis and schizophrenia. A movement away from the term gout may benefit those living with the disease by changing illness perceptions and increasing uptake of, and adherence to, guideline-recommended treatment(s).
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Affiliation(s)
- Matthew J Coleshill
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia. .,Department of Clinical Pharmacology, & Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Level 2 Xavier Building, Darlinghurst, NSW, 2010, Australia.
| | - Eindra Aung
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacology, & Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Level 2 Xavier Building, Darlinghurst, NSW, 2010, Australia
| | - Jane E Carland
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacology, & Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Level 2 Xavier Building, Darlinghurst, NSW, 2010, Australia
| | - Kate Faasse
- School of Psychology, UNSW Sydney, Sydney, NSW, Australia
| | - Sophie Stocker
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacology, & Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Level 2 Xavier Building, Darlinghurst, NSW, 2010, Australia
| | - Richard O Day
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacology, & Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Level 2 Xavier Building, Darlinghurst, NSW, 2010, Australia
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12
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Stewart S, Guillen AG, Taylor WJ, Gaffo A, Slark J, Gott M, Dalbeth N. The experience of a gout flare: a meta-synthesis of qualitative studies. Semin Arthritis Rheum 2020; 50:805-811. [PMID: 32554059 DOI: 10.1016/j.semarthrit.2020.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/03/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
AIMS Gout flares are an important concern for people with gout and an understanding of patients' experiences with gout flares is central in developing meaningful outcome measures for clinical trials. This study aimed to systematically review and thematically synthesize the qualitative literature reporting the patient experience of gout flares, to inform the development of flare-specific outcome measures. METHODS MEDLINE, EMBASE, CINAHL Plus and PsycINFO electronic databases were searched in October 2019 to identify original qualitative research articles reporting on the patient experience of gout flares. Methodological quality of all included papers was assessed using the Critical Appraisal Skills Program (CASP) tool. Following data extraction, coding and synthesis was undertaken using reflexive thematic analysis. RESULTS Sixteen papers reporting the patient experience of gout flares were included. The majority of CASP criteria were met by most studies, indicating good methodological quality. Four predominant and overlapping themes were identified from the thematic analysis: gout flare characteristics (pain, swelling, location, duration and frequency); impact on function and activities of daily living (walking, housework and yard work, self-care, exercise and sports, driving, sleep); effects on social and family life (social participation, inability to plan, employment, dependency, relationships, intimacy); and psychological impact (boredom, irritability, fear, shame and embarrassment, isolation, financial worry, depression and anxiety). CONCLUSIONS Gout flares impact many aspects of patients' lives, including physical and psychological and social and family life. The patient experience of gout flares goes beyond what is routinely measured in research settings. Measurement and reporting methods that capture these aspects of patients' experiences with gout flares would provide more meaningful outcome measures in clinical trials of flare prevention.
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Affiliation(s)
- Sarah Stewart
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Andrea Garcia Guillen
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - William J Taylor
- Department of Medicine, University of Otago, PO Box 7343, Wellington South 6242, New Zealand.
| | - Angelo Gaffo
- School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Julia Slark
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Merryn Gott
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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13
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Krasnoryadtseva A, Derksen C, Dalbeth N, Petrie KJ. Not Every Picture Tells a Story: A Content Analysis of Visual Images in Patient Educational Resources About Gout. J Rheumatol 2020; 47:1815-1821. [DOI: 10.3899/jrheum.191245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 01/23/2023]
Abstract
Objective.The aim of this study was to evaluate which concepts about gout and its treatment are reflected in images in online educational resources about gout.Methods.A Google search was performed to identify English-language patient resources from medical and health organizations and health education websites in 7 countries: Australia, Canada, Ireland, New Zealand, South Africa, UK, and USA. Two raters independently coded the images in the resources into 5 main categories: clinical presentations of gout, urate/monosodium urate (MSU) crystals, medicines, food/healthy lifestyle, and other advice for people with gout.Results.In total, 103 resources were identified; 28 resources without images were excluded. Seventy-one educational resources with a total of 310 images were included in the study sample. Of the 310 images, clinical presentations of gout were depicted in 92 images (30%), food/healthy lifestyle in 73 images (24%), urate/MSU crystals in 50 (16%), medicines in 14 (5%). Urate-lowering medication was shown only in 1 image (0.3%) and just 6 images (2%) depicted a serum urate target. Ninety-one images (29%) did not convey specific information about gout.Conclusion.Key concepts about gout and treatment are underrepresented in the images used in educational resources for patients. A large proportion of the images do not convey useful information about gout or its management.
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14
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Abstract
PURPOSE OF REVIEW Recent studies have produced evidence regarding the patient perspectives in gout including from disease experience to disease outcomes. Therefore, an overview on the topic can help improve our understanding of the patient experience. RECENT FINDINGS This article explores several aspects of the patient perspective including the impact of gout on a patient's life, patient knowledge and beliefs regarding gout and its treatments, patient-perceived barriers to optimal medication adherence in gout and patient's perception of their gout. This article also summarizes any evidence of the association of patient perceptions to patient outcomes in gout. SUMMARY A recognition of patient perspectives in gout has the potential to positively impact clinical care for gout. Discussion of disease impact, misperceptions about benefits/harms of urate-lowering therapy (ULT), and patient values/preferences regarding pharmacological and nonpharmacological treatments can lead to a better shared decision-making and improved outcomes in gout. These findings emphasize the importance of inclusion of patient perspective not only in clinical care and quality improvement and research initiatives but also in the design and implementation of the research agenda in gout. Inclusion of patient-reported outcomes in clinical research is likely to improve its relevance to patients with gout.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center.,Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham.,Department of Epidemiology at the UAB School of Public Health, Birmingham, USA
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15
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Bursill D, Taylor WJ, Terkeltaub R, Abhishek A, So AK, Vargas-Santos AB, Gaffo AL, Rosenthal A, Tausche AK, Reginato A, Manger B, Sciré C, Pineda C, van Durme C, Lin CT, Yin C, Albert DA, Biernat-Kaluza E, Roddy E, Pascual E, Becce F, Perez-Ruiz F, Sivera F, Lioté F, Schett G, Nuki G, Filippou G, McCarthy G, da Rocha Castelar Pinheiro G, Ea HK, Tupinambá HDA, Yamanaka H, Choi HK, Mackay J, ODell JR, Vázquez Mellado J, Singh JA, Fitzgerald JD, Jacobsson LTH, Joosten L, Harrold LR, Stamp L, Andrés M, Gutierrez M, Kuwabara M, Dehlin M, Janssen M, Doherty M, Hershfield MS, Pillinger M, Edwards NL, Schlesinger N, Kumar N, Slot O, Ottaviani S, Richette P, MacMullan PA, Chapman PT, Lipsky PE, Robinson P, Khanna PP, Gancheva RN, Grainger R, Johnson RJ, Te Kampe R, Keenan RT, Tedeschi SK, Kim S, Choi SJ, Fields TR, Bardin T, Uhlig T, Jansen T, Merriman T, Pascart T, Neogi T, Klück V, Louthrenoo W, Dalbeth N. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis 2019; 78:1592-1600. [PMID: 31501138 DOI: 10.1136/annrheumdis-2019-215933] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.
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Affiliation(s)
- David Bursill
- Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Alexander K So
- Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland
| | - Ana Beatriz Vargas-Santos
- Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angelo Lino Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ann Rosenthal
- Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany
| | - Anthony Reginato
- Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Bernhard Manger
- Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carlo Sciré
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlos Pineda
- Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Caroline van Durme
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Congcong Yin
- Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Daniel Arthur Albert
- Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | - Edyta Biernat-Kaluza
- Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland
| | - Fernando Perez-Ruiz
- Rheumatology Division, Cruces University Hospital, Baracaldo, Spain.,Department of Medicine, University of the Basque Country, Biscay, Spain.,Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Frédéric Lioté
- Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France.,Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Georg Schett
- Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - George Nuki
- Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Hang-Korng Ea
- Department of Rheumatology, Hôpital Lariboisière, Paris, France
| | | | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hyon K Choi
- Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Mackay
- President and CEO, Aristea Therapeutics, San Diego, California, USA
| | - James R ODell
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Janitzia Vázquez Mellado
- Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jasvinder A Singh
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D Fitzgerald
- Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Leo Joosten
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA
| | - Lisa Stamp
- Department of Medicine, Otago University, Christchurch, New Zealand
| | - Mariano Andrés
- Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México
| | - Masanari Kuwabara
- Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.,Department of Cardiology, Toranomon Hospital, Minato-ku, Japan
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael S Hershfield
- Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Pillinger
- Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA
| | | | - Naomi Schlesinger
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nitin Kumar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA
| | - Ole Slot
- Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Sebastien Ottaviani
- Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Paul A MacMullan
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Peter T Chapman
- Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand
| | - Peter E Lipsky
- CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA
| | - Philip Robinson
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Puja P Khanna
- Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rada N Gancheva
- Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA
| | - Ritch Te Kampe
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea
| | - Theodore R Fields
- Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tim Jansen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Tony Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Klück
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Bowen-Davies Z, Muller S, Mallen CD, Hayward RA, Roddy E. Gout Severity, Socioeconomic Status, and Work Absence: A Cross-Sectional Study in Primary Care. Arthritis Care Res (Hoboken) 2019; 70:1822-1828. [PMID: 29579363 DOI: 10.1002/acr.23562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/20/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence. METHODS Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (ORadj ; 95% confidence intervals [95% CIs]) were calculated using logistic regression models (adjusted for age, sex, body mass index, gout severity, and comorbidities). RESULTS A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (ORadj 0.54 [95% CI 0.36-0.81]) and oligoarticular/polyarticular attacks (ORadj 0.72 [95% CI 0.50-1.05]). Lower area-level deprivation was associated with fewer attacks (≥2) (ORadj 0.71 [95% CI 0.51-0.98]). Work absence was associated with having had ≥2 gout attacks in the last year (ORadj 2.91 [95% CI 1.22- 6.92]), oligoarticular/polyarticular attacks (ORadj 3.10 [95% CI 1.46-6.61]), and shorter disease duration (>18 years) (ORadj 0.13 [95% CI 0.03-0.50]). CONCLUSION Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.
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Affiliation(s)
| | - Sara Muller
- Research Institute for Primary Care & Health Sciences, Keele University, UK
| | - Christian D Mallen
- Research Institute for Primary Care & Health Sciences, Keele University, UK
| | - Richard A Hayward
- Research Institute for Primary Care & Health Sciences, Keele University, UK
| | - Edward Roddy
- Research Institute for Primary Care & Health Sciences, Keele University, Keele UK, and Haywood Academic Rheumatology Centre, Haywood Hospital, UK
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17
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Kummer S, Walter FM, Chilcot J, Emery J, Sutton S, Scott SE. Do cognitive heuristics underpin symptom appraisal for symptoms of cancer?: A secondary qualitative analysis across seven cancers. Psychooncology 2019; 28:1041-1047. [PMID: 30828881 DOI: 10.1002/pon.5049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To explore the evidence for cognitive heuristics or "rules of thumb" used within patients' reports of symptom appraisal and decisions to seek help for symptoms of cancer. METHODS A secondary analysis of interviews from existing studies that explored symptom appraisal in patients who had sought help for potential symptoms of cancer. Transcripts from n = 50 in-depth interviews with patients referred with symptoms suspicious of cancer (pancreas, colorectal, oral, lung, melanoma, breast, and prostate) were re-analysed using a deductive thematic approach underpinned by the heuristics outlined in the Common Sense Model of Illness Self-regulation as set within the Model of Pathways to Treatment. RESULTS The most dominant heuristic in patient reports was the Rate of change rule (ie, symptoms that are worsening, increasing, or have a sudden onset [rather than improving, stable or decreasing in number] are more likely to indicate illness). There was also support for the Duration rule, Pattern rule, Chronology rule, Severity (of interference) rule, Age-illness rule, Novelty rule, Similarity rule, Location rule, and Optimistic bias rule. There was a lack of evidence for the Prevalence and Stress-illness rules. CONCLUSIONS People do appear to use heuristics to guide their appraisal of symptoms and their perceived need for healthcare. Heuristics may be an important aspect underlying symptom misinterpretation, thus making them key targets for interventions. For instance, campaigns could tackle cognitive biases rather than focusing on specific symptom awareness. Myth-busting messages could highlight that intermittent, mild symptoms, and symptoms that are not worsening can be signs of a serious health problem.
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Affiliation(s)
- Sonja Kummer
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.,Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
| | - Jon Emery
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.,Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Suzanne E Scott
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London
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18
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Ramsubeik K, Ramrattan LA, Kaeley GS, Singh JA. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2018; 10:235-252. [PMID: 30515250 PMCID: PMC6262501 DOI: 10.1177/1759720x18807117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We aimed to systematically review the effectiveness of healthcare behavioral and education interventions for gout patients on clinical outcomes. METHODS We searched multiple databases to identify trials or observational studies of educational or behavioral interventions in gout. Risk of bias was assessed with the Cochrane tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale for observational studies. We estimated odds ratios (ORs) for categorical and standardized mean difference (SMD) for continuous measures using a random-effects model. RESULTS Overall, eight (five RCTs and three observational) studies met the inclusion criteria and examined pharmacist-led interventions (n = 3), nurse-led interventions (n = 3) and primary care provider interventions (n = 2). Compared with the control intervention (usual care in most cases), a higher proportion of those in the educational/behavioral intervention arm achieved serum urate (SU) levels <6 mg/dl, 47.2% versus 23.8%, the OR was 4.86 [95% confidence interval (CI), 1.48, 15.97; 4 RCTs] with moderate quality evidence. Compared with the control intervention, a higher proportion of those in the educational/behavioral intervention arm were adherent to allopurinol, achieved at least a 2 mg/dl decrease in SU, achieved an SU < 5 mg/dl, had a reduction in the presence of tophi at 2 years, had improved quality of life as assessed with SF-36 physical component scores, had a higher knowledge about gout and higher patient satisfaction (moderate-low quality evidence). CONCLUSION Educational and behavioral interventions can improve gout outcomes in the short-intermediate term. Randomized trials are needed to assess its impact on long-term gout outcomes.
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Affiliation(s)
- Karishma Ramsubeik
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Laurie Ann Ramrattan
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Gurjit S. Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jasvinder A. Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham VA Medical Center, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL, 35294, USA
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Howren A, Cox SM, Shojania K, Rai SK, Choi HK, De Vera MA. How patients with gout become engaged in disease management: a constructivist grounded theory study. Arthritis Res Ther 2018; 20:110. [PMID: 29859127 PMCID: PMC5984761 DOI: 10.1186/s13075-018-1608-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background Prior qualitative research on gout has focused primarily on barriers to disease management. Our objective was to use patients’ perspectives to construct an explanatory framework to understand how patients become engaged in the management of their gout. Methods We recruited a sample of individuals with gout who were participating in a proof-of-concept study of an eHealth-supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics. Semistructured interviews were used. We analyzed transcripts using principles of constructivist grounded theory involving initial coding, focused coding and categorizing, and theoretical coding. Results Twelve participants with gout (ten males, two females; mean age, 66.5 ± 13.3 years) were interviewed. The analysis resulted in the construction of three themes as well as a framework describing the dynamically linked themes on (1) processing the diagnosis and management of gout, (2) supporting management of gout, and (3) interfering with management of gout. In this framework, patients with gout transition between each theme in the process of becoming engaged in the management of their gout and may represent potential opportunities for healthcare intervention. Conclusions Findings derived from this study show that becoming engaged in gout management is a dynamic process whereby patients with gout experience factors that interfere with gout management, process their disease and its management, and develop the practical and perceptual skills necessary to manage their gout. By understanding this process, healthcare providers can identify points to adapt care delivery and thereby improve health outcomes.
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Affiliation(s)
- Alyssa Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Susan M Cox
- University of British Columbia, School of Population & Public Health, Vancouver, BC, Canada
| | - Kam Shojania
- Arthritis Research Canada, Richmond, BC, Canada.,Faculty of Medicine, Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Sharan K Rai
- Arthritis Research Canada, Richmond, BC, Canada.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Hyon K Choi
- Arthritis Research Canada, Richmond, BC, Canada.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, BC, Canada. .,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.
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20
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Rai SK, Choi HK, Choi SHJ, Townsend AF, Shojania K, De Vera MA. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford) 2018; 57:1282-1292. [PMID: 29672772 DOI: 10.1093/rheumatology/kex530] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/18/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. METHODS We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. RESULTS We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. CONCLUSION Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.
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Affiliation(s)
- Sharan K Rai
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyon K Choi
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sally H J Choi
- Arthritis Research Canada, Vancouver, BC, Canada.,Undergraduate Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne F Townsend
- Arthritis Research Canada, Vancouver, BC, Canada.,University of Exeter Medical School, Exeter, UK
| | - Kam Shojania
- Arthritis Research Canada, Vancouver, BC, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary A De Vera
- Arthritis Research Canada, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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21
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Bursill D, Taylor WJ, Terkeltaub R, Dalbeth N. The nomenclature of the basic disease elements of gout: A content analysis of contemporary medical journals. Semin Arthritis Rheum 2018; 48:456-461. [PMID: 29706241 DOI: 10.1016/j.semarthrit.2018.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is currently no standardised nomenclature for the basic disease elements of gout. This study aimed to identify these elements and examine how they are labelled in contemporary medical literature. METHODS We analysed articles from the ten highest ranked general rheumatology journals, and five highest ranked general internal medicine journals (by Impact Factor, according to 2015 Thomson-Reuters Journal Citation Reports), published between 1 January 2012 and 31 January 2017. For each journal, articles relevant to gout and hyperuricaemia were identified by the search terms 'gout' and/or 'urate' and/or 'uric acid' using MEDLINE. Basic disease elements were identified and their labels extracted. Labels designated 'unique' used different words or phrases to describe an element. RESULTS A total of 549 articles were analysed. Eleven basic disease elements and 343 unique labels were identified. Labelling was imprecise for most elements. 'An episode of acute inflammation triggered by the presence of pathogenic crystals' was represented by a total of 162 unique labels; 33.6% of articles referring to this element used at least four unique labels. For articles referencing 'the circulating form of the final enzymatic product generated by xanthine oxidase in purine metabolism in humans', the labels 'uric acid' and 'urate' were used with similar frequency (63.0% and 62.5%, respectively), and both labels were used in 25.9% of articles. CONCLUSION Labelling of the basic disease elements of gout is characterised by imprecision, inaccuracy and lack of clarity. Consensus regarding the nomenclature of these elements is required.
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Affiliation(s)
- David Bursill
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand; Adelaide Medical School, University of Adelaide, Australia
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Robert Terkeltaub
- Veterans Affairs Medical Center, University of California, San Diego, CA
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand.
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22
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Singh JA. Any sleep is a dream far away: a nominal group study assessing how gout affects sleep. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/kex535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, University of Alabama, Birmingham, AL, USA
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL, USA
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23
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Abhishek A, Doherty M. Incident gout and erectile dysfunction: is hyperuricaemia the elephant in the room? Arthritis Res Ther 2017; 19:184. [PMID: 28797283 PMCID: PMC5553804 DOI: 10.1186/s13075-017-1394-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The first prospective population-based study to examine risk of erectile dysfunction in men with gout in the western world has been published. It reports that following their first diagnosis of gout, men have a 31% higher risk of erectile dysfunction than matched controls, although the absolute increase in risk is small. Of interest, the incidence of erectile dysfunction reported in this study is tenfold higher than those reported in nation-wide cohort studies from Taiwan. There is a need for further prospective cohort studies to examine the possible mechanistic association between gout, hyperuricaemia and erectile dysfunction.
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24
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Dowell A, Morris C, Macdonald L, Stubbe M. "I can't bend it and it hurts like mad": direct observation of gout consultations in routine primary health care. BMC FAMILY PRACTICE 2017; 18:91. [PMID: 29047331 PMCID: PMC5648494 DOI: 10.1186/s12875-017-0662-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations. METHODS Secondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions. RESULTS Two main themes emerged from the data; the importance of gout and 'telling' versus 'listening' in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed. CONCLUSION Our observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines.
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Affiliation(s)
- Anthony Dowell
- Department Primary Health Care & General Practice, University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Caroline Morris
- Department Primary Health Care & General Practice, University of Otago, 23a Mein Street, Wellington, New Zealand.
| | - Lindsay Macdonald
- Department Primary Health Care & General Practice, University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Maria Stubbe
- Department Primary Health Care & General Practice, University of Otago, 23a Mein Street, Wellington, New Zealand
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25
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Singh JA. Gout and comorbidity: a nominal group study of people with gout. Arthritis Res Ther 2017; 19:204. [PMID: 28915838 PMCID: PMC5603046 DOI: 10.1186/s13075-017-1416-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidities are common in patients with gout, yet qualitative research is lacking. The study objective was to examine the impact of gout on comorbidities. METHODS Nine nominal groups were conducted. Patients with gout discussed and rank-ordered their concerns in response to the question, "How does gout or its treatment affect your other conditions and their treatment?" RESULTS Nine nominal groups had 45 gout patients, with mean age 61 years (standard deviation (SD) 10.7) and mean gout duration 14.9 years (SD 12). Of these, 62% were men, 45% African-American, 51% married and 63% were currently using allopurinol. The most frequently cited highly ranked concerns among the nine nominal groups were: (1) interaction of gout medication with medications for other medical conditions (three groups); (2) worsening of other medical comorbidities, including hospitalizations (seven groups); (3) worsening of anxiety and depression (three groups); (4) significant dietary changes for gout that contrasted with diet for other conditions (three groups); (5) new diseases diagnosed due to gout (three groups); (6) irreversible joint damage (three groups); (7) inability to exercise and weight gain (four groups); and (8) gout misdiagnosed as another health condition (three groups). Other domains ranked highly were: (1) impact of gout on daily life and activities, including the ability to work and social activities (six groups); (2) medication side effects, real and perceived (nine groups); (3) weight loss due to gout related to frequent flares (one group); and (4) cost and burden (three groups). CONCLUSIONS Gout and the medications used for its treatment have a significant effect on comorbidities and their management. These findings provide insights into potential targets for improving outcomes in patients with gout.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
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26
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Walsh CP, Prior JA, Chandratre P, Belcher J, Mallen CD, Roddy E. Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. BMC Musculoskelet Disord 2016; 17:394. [PMID: 27639692 PMCID: PMC5027094 DOI: 10.1186/s12891-016-1252-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients' perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use. METHODS A health questionnaire was sent to 1805 people with gout aged ≥18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics. RESULTS One thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively). CONCLUSIONS Patients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of ULT.
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Affiliation(s)
- Ciaran P Walsh
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - James A Prior
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - Priyanka Chandratre
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - John Belcher
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
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27
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Morris C, Macdonald L, Stubbe M, Dowell A. "It's complicated" - talking about gout medicines in primary care consultations: a qualitative study. BMC FAMILY PRACTICE 2016; 17:114. [PMID: 27542754 PMCID: PMC4992199 DOI: 10.1186/s12875-016-0515-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/16/2016] [Indexed: 01/10/2023]
Abstract
Background Gout is the most common form of inflammatory arthritis. It is associated with substantial co-morbidity and often managed in primary care. A greater understanding of the communication process between patients and healthcare professionals provides one way of improving the management of this condition. This paper describes communication about gout medicines and treatment between patients and primary care health professionals during routine consultations. Methods Video-recordings of 31 individual healthcare consultations between patients and a range of primary care practitioners (general practitioners, practice nurses, podiatrists, dietitians) from an archived database were reviewed. Consultations that encompassed any discussion about gout medicines and treatment were included (n = 27) and were not solely restricted to those where gout was the presenting complaint. Themes were derived from an inductive qualitative analysis, from clinical and linguistic perspectives, based on the conversation between patients and practitioners about medicines and visual observation of these interactions. Results A number of factors were identified that had the potential to impact on the optimal management of gout in primary care. These included level of patient knowledge, patient attitudes to medicines, and the attributes of practitioner communication with patients. The latter related to the style of delivery and content of the information provided, and the ability of practitioners to make use of opportunities that arose to discuss these issues. Conclusions Patients with gout communicate at varying levels of complexity with a diverse range of primary care healthcare professionals about the treatment of their condition. It is important that all practitioners engaging with gout patients in this setting are knowledgeable about the current management of gout, provide clear, consistent and accurate messages, remain aware that these messages may need repeating over time, and are supportive of patients’ medicine-taking preferences.
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Affiliation(s)
- Caroline Morris
- Department Primary Health Care & General Practice, University of Otago, Wellington, 23a Mein Street, Wellington, New Zealand.
| | - Lindsay Macdonald
- Department Primary Health Care & General Practice, University of Otago, Wellington, 23a Mein Street, Wellington, New Zealand
| | - Maria Stubbe
- Department Primary Health Care & General Practice, University of Otago, Wellington, 23a Mein Street, Wellington, New Zealand
| | - Anthony Dowell
- Department Primary Health Care & General Practice, University of Otago, Wellington, 23a Mein Street, Wellington, New Zealand
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28
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Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, Hider S. "Why me? I don't fit the mould … I am a freak of nature": a qualitative study of women's experience of gout. BMC WOMENS HEALTH 2015; 15:122. [PMID: 26710971 PMCID: PMC4693432 DOI: 10.1186/s12905-015-0277-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/11/2015] [Indexed: 01/21/2023]
Abstract
Background Gout is more common in men, and is often perceived by both patients and health practitioners to be a disorder of men, but its prevalence in women is increasing. Little is known about women’s experience of gout and the impact it has on their lives. It is important for practitioners to be aware of these areas, given the increasing numbers of women with gout they are likely to see in the future. This study aimed to explore women’s experiences of gout. Methods A qualitative research design was used. Semi-structured interviews were conducted with 43 people, of whom 14 were women. Interviews were video and/or tape recorded and transcribed verbatim. Data from the interviews was first grouped into broad categories, followed by a more detailed thematic analysis and interpretation. Results Participants’ ages ranged from 32 to 82. Nine participants were retired and five were in fulltime work. Four themes emerged: (1) experience of onset, help seeking and diagnosis (2) understanding and finding information about gout, (3) impact on identity, and (4) impact on roles and relationships. Conclusions The diagnostic process for women with gout can be uncertain due to lack of awareness of gout in women (by health care professionals and women themselves). Women do not have a good understanding of the condition and find it difficult to find information that feels relevant to them. Gout has a major impact on women’s identity and on their roles and relationships. These findings are of importance to health care professionals dealing with women with potential gout and those with an existing diagnosis.
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Affiliation(s)
- Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Samantha Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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