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Dehlin M, Muller S, Mallen C, Landgren AJ, Watson L, Jacobsson L, Roddy E. Sex and country differences in gout: cross-country comparison between Sweden and the UK. Scand J Rheumatol 2023; 52:673-682. [PMID: 36815837 DOI: 10.1080/03009742.2023.2177383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Compare characteristics, sex differences, and management of gout in Sweden and the UK. METHOD The results from two separate primary care gout surveys from Sweden and the UK were compared. Participants aged ≥18 years with gout were sent a questionnaire asking about lifestyle, gout characteristics, uratelowering therapy (ULT), comorbidities, disability, and disease impact. For sex comparison, participants were pooled across countries. RESULTS In total, 784 (80% male) participants from Sweden and 500 (87% male) from the UK were included. Swedish patients were significantly older at gout onset, mean (SD) age 72 (12) versus 63 (13) years, (p<0.0001), with more comorbidities, and more frequent use of ULT (48% vs 35%, p=0.0005, age-adjusted). Use of alcohol and diuretics was significantly more common among UK patients, who also reported a higher number of gout flares, mean (SD) 2.2 (1.7) versus 1.6 (3.6), (p=0.003) age-adjusted. Females with gout were older at gout onset, mean (SD) age 67 (13) versus 56 (15), (p<0.0001), more often obese, and reported higher use of diuretics. Furthermore, females reported greater impact of gout, more pain and physical limitations, whereas no sex differences were seen in ULT or flares. CONCLUSIONS In the UK, gout was more frequently associated with modifiable risk factors. People with gout in Sweden were more commonly taking ULT and had lower frequency of gout flares and impact of gout. Females with gout more commonly took diuretics, had higher body mass index, and reported greater physical disability, which should be considered when managing gout in women.
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Affiliation(s)
- M Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Muller
- School of Medicine, Keele University, Keele, UK
| | - C Mallen
- School of Medicine, Keele University, Keele, UK
| | - A J Landgren
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - L Watson
- School of Medicine, Keele University, Keele, UK
| | - Lth Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Roddy
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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2
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Watson L, Belcher J, Nicholls E, Chandratre P, Blagojevic-Bucknall M, Hider S, Lawton SA, Mallen CD, Muller S, Rome K, Roddy E. Factors associated with change in health-related quality of life in people with gout: a 3-year prospective cohort study in primary care. Rheumatology (Oxford) 2023; 62:2748-2756. [PMID: 36545704 PMCID: PMC10393433 DOI: 10.1093/rheumatology/keac706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/02/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE To describe factors associated with change in health-related quality of life (HRQOL) in people living with gout in primary care. METHODS In a UK prospective cohort study, adults with a diagnosis of gout registered with 20 general practices completed the Gout Impact Scale (GIS; scale 0-100), 36-item Short Form Physical Function subscale (PF-10; 0-100) and HAQ Disability Index (HAQ-DI; 0-3) via postal questionnaires at baseline and 6, 12, 24 and 36 months. Linear mixed modelling was used to investigate factors associated with changes in HRQOL over 3 years. RESULTS A total of 1184 participants responded at baseline (adjusted response 65.6%); 990 (83.6%) were male, with a mean age of 65.6 years (s.d. 12.5). A total of 818, 721, 696 and 605 responded at 6, 12, 24 and 36 months, respectively. Factors associated with worse disease-specific and generic HRQOL over 3 years were flare frequency (five or more flares; GIS subscales, PF-10), oligo/polyarticular flares (GIS subscales, PF-10, HAQ-DI), worse pain (GIS subscales, PF-10, HAQ-DI), body pain (GIS subscales, PF-10, HAQ-DI) and more severe depression (GIS subscales, PF-10, HAQ-DI) (P ≤ 0.05). More severe anxiety was associated with worse disease-specific HRQOL only (GIS subscales). Older age (PF-10), being female (PF-10, HAQ-DI) and BMI (HAQ-DI) were associated with worse generic HRQOL (P ≤ 0.05). CONCLUSION Gout-specific, comorbid and sociodemographic factors were associated with change in HRQOL over a 3-year period, highlighting people at risk of worse outcomes who could be targeted for interventions.
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Affiliation(s)
| | | | - Elaine Nicholls
- School of Medicine, Keele University, Keele, UK
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Priyanka Chandratre
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | | | - Christian D Mallen
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Sara Muller
- School of Medicine, Keele University, Keele, UK
| | - Keith Rome
- School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Edward Roddy
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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3
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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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4
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Bajpai R, Muller S, Mallen C, Watson L, Richette P, Hider SL, Roddy E. Onset of comorbidities and flare patterns within pre-existing morbidity clusters in people with gout: 5-year primary care cohort study. Rheumatology (Oxford) 2021; 61:407-412. [DOI: 10.1093/rheumatology/keab283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Objective
To investigate the onset of comorbidities and pattern of flares over 5 years according to baseline comorbidity clusters in people with gout.
Methods
In a prospective primary care-based cohort study, adults aged ≥18 years with gout were identified from primary care medical records in 20 general practices across the West Midlands, UK and followed up over 5 years. Four clusters of participants have been defined previously according to baseline comorbidity status. The associations of (i) incident comorbidities and (ii) gout flares with baseline cluster membership were estimated using age and sex-adjusted Poisson regression and mixed effects ordinal logistic regression, respectively.
Results
The comorbidity with the highest incidence was coronary artery disease (39.2%), followed by hypertension (36.7%), chronic kidney disease stage ≥3 (18.1%), obesity (16.0%), hyperlipidaemia (11.7%), diabetes (8.8%) and cancer (8.4%). There were statistically significant associations observed between cluster membership and incidence of coronary artery disease, hyperlipidaemia, heart failure and hypertension. In each cluster, nearly one-third of participants reported two or more gout flares at each time-point. History of oligo/polyarticular flares (odds ratio [OR]= 2.16, 95% confidence interval [CI]: 1.73, 2.70) and obesity (1.66, 95% CI: 1.21, 2.25) were associated with increasing flares whereas current use of allopurinol was associated with lower risk (0.42, 95% CI: 0.34–0.53). Cluster membership was not associated with flares.
Conclusion
Substantial numbers of people in each cluster developed new comorbidities that varies by cluster membership. People also experienced multiple flares over time, but these did not differ between clusters. Clinicians should be vigilant for the development of new comorbidities in people with gout.
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Affiliation(s)
- Ram Bajpai
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Lorraine Watson
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Pascal Richette
- Service de Rhumatologie, APHP, Hôpital Lariboisière
- Inserm, UMR-S 1132, Université de Paris, Paris, France
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK
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5
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Huijbrechts EJ, Dekker J, Tenten-Diepenmaat M, Gerritsen M, van der Leeden M. Clinical guidance for podiatrists in the management of foot problems in rheumatic disorders: evaluation of an educational programme for podiatrists using a mixed methods design. J Foot Ankle Res 2021; 14:15. [PMID: 33632287 PMCID: PMC7908782 DOI: 10.1186/s13047-020-00435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Background Foot and ankle problems are common in rheumatic disorders and often lead to pain and limitations in functioning, affecting quality of life. There appears to be large variability in the management of foot problems in rheumatic disorders across podiatrists. To increase uniformity and quality of podiatry care for rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis (SpA), and gout a clinical protocol has been developed. Research objectives [1] to evaluate an educational programme to train podiatrists in the use of the protocol and [2] to explore barriers and facilitators for the use of the protocol in daily practice. Method This study used a mixed method design and included 32 podiatrists in the Netherlands. An educational programme was developed and provided to train the podiatrists in the use of the protocol. They thereafter received a digital questionnaire to evaluate the educational programme. Subsequently, podiatrists used the protocol for three months in their practice. Facilitators and barriers that they experienced in the use of the protocol were determined by a questionnaire. Semi-structured interviews were held to get more in-depth understanding. Results The mean satisfaction with the educational programme was 7.6 (SD 1.11), on a 11 point scale. Practical knowledge on joint palpation, programme variation and the use of practice cases were valued most. The protocol appeared to provide support in the diagnosis, treatment and evaluation of foot problems in rheumatic disorders and the treatment recommendations were clear and understandable. The main barrier for use of the protocol was time. The protocol has not yet been implemented in the electronic patient file, which makes it more time consuming. Other experienced barriers were the reimbursement for the treatment and financial compensation. Conclusions The educational programme concerning the clinical protocol for foot problems in rheumatic disorders appears to be helpful for podiatrists. Podiatrists perceived the protocol as being supportive during patient management. Barriers for use of the protocol were identified and should be addressed prior to large scale implementation. Whether the protocol is also beneficial for patients, needs to be determined in future research.
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Affiliation(s)
- E J Huijbrechts
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands. .,Fontys University of applied sciences
- Department of allied health professionals, Fontys Paramedische Hogeschool, Eindhoven, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Saxion University of applied sciences
- department of healthcare, Saxion, Enschede, The Netherlands
| | - M Gerritsen
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
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Latent Class Growth Analysis of Gout Flare Trajectories: A Three‐Year Prospective Cohort Study in Primary Care. Arthritis Rheumatol 2020; 72:1928-1935. [DOI: 10.1002/art.41476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/30/2020] [Indexed: 01/22/2023]
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7
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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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8
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Bevis M, Blagojevic-Bucknall M, Mallen C, Hider S, Roddy E. Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology (Oxford) 2018; 57:1358-1363. [PMID: 29672754 DOI: 10.1093/rheumatology/key096] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate how comorbid conditions cluster in patients with gout in a UK primary care population. Methods A cross-sectional study was performed using baseline data from a primary-care-based prospective observational cohort of people aged ⩾18 years with gout. Participants with gout were identified through primary care medical records. Factor analysis was performed to obtain distinct clusters of comorbidity variables including obesity, hypertension, diabetes mellitus, hyperlipidaemia, coronary heart disease, heart failure, chronic kidney disease (CKD) and cancer. Hierarchical cluster analysis of patient observations was also performed to identify homogenous subgroups of patients based on combinations of their comorbidities. Results Four distinct comorbidity clusters (C1-C4) were identified in 1079 participants [mean (s.d.) age 65.5 years (12.5); 909 (84%) male]. Cluster C1 (n = 197, 18%) was the oldest group and had the most frequent attacks of gout; 97% had CKD. Participants in C2 (n = 393, 36%) had isolated gout with few comorbidities but drank alcohol more frequently. In cluster C3 (n = 296, 27%), hypertension, diabetes mellitus, hyperlipidaemia, coronary heart disease and/or CKD were prevalent, and urate-lowering therapy was prescribed more frequently than in other clusters. All patients in C4 (193, 18%) had hypertension and were more likely to be obese than other clusters. Conclusion Four distinct comorbidity clusters were identified. People with multiple comorbidities were more likely to receive allopurinol. Tailoring of treatments depending on cluster and comorbidities should be considered.
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Affiliation(s)
- Megan Bevis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Samantha Hider
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK.,Staffordshire and Stoke-on-Trent Rheumatology Partnership NHS Trust, Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK.,Staffordshire and Stoke-on-Trent Rheumatology Partnership NHS Trust, Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
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9
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Health-related quality of life in gout in primary care: Baseline findings from a cohort study. Semin Arthritis Rheum 2018; 48:61-69. [PMID: 29398125 PMCID: PMC6089841 DOI: 10.1016/j.semarthrit.2017.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
Objectives To examine gout-related, comorbid, and sociodemographic characteristics associated with generic and disease-specific health-related quality of life (HRQOL) in gout. Methods Adults with gout from 20 general practices were mailed a questionnaire containing the Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form-36 Physical Function subscale (PF-10), Gout Impact Scale (GIS), and questions about gout-specific, comorbid and sociodemographic characteristics. Variables associated with HRQOL were examined using multivariable linear regression models. Results A total of 1184 completed questionnaires were received (response 65.9%). Worse generic and gout-specific HRQOL was associated with frequent gout attacks (≥5 attacks PF-10 β = −4.90, HAQ-DI β = 0.14, GIS subscales β = 8.94, 33.26), current attack (HAQ-DI β = 0.15, GIS β = −1.94, 18.89), oligo/polyarticular attacks (HAQ-DI β = 0.11, GIS β = 0.78, 7.86), body pain (PF-10 β = −10.68, HAQ-DI β = 0.29, GIS β = 2.61, 11.89), anxiety (PF-10 β = −1.81, HAQ-DI β = 0.06, GIS β = 0.38, 1.70), depression (PF-10 β = −1.98, HAQ-DI β = 0.06, GIS 0.42, 1.47) and alcohol non-consumption (PF-10 β = −16.10, HAQ-DI β = 0.45). Gout-specific HRQOL was better in Caucasians than non-Caucasians (GIS β = −13.05, −13.48). Poorer generic HRQOL was associated with diabetes mellitus (PF-10 β = −4.33, HAQ-DI β = 0.14), stroke (PF-10 β = −12.21, HAQ-DI β = 0.37), renal failure (PF-10 β = −9.43, HAQ-DI β = 0.21), myocardial infarction (HAQ-DI β = 0.17), female gender (PF-10 β = −17.26, HAQ-DI β = 0.43), deprivation (PF-10 β = −7.80, HAQ-DI β = 0.19), and body mass index ≥35 kg/m2 (PF-10 β = −6.10, HAQ-DI β = 0.21). Conclusions HRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy. Both gout-specific and generic questionnaires identify the impact of disease-specific features on HRQOL but studies focusing on comorbidity should include generic instruments.
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10
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Fu T, Cao H, Yin R, Zhang L, Zhang Q, Li L, Gu Z. Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study. BMC Musculoskelet Disord 2017; 18:429. [PMID: 29100504 PMCID: PMC5670742 DOI: 10.1186/s12891-017-1787-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/25/2017] [Indexed: 12/22/2022] Open
Abstract
Background Gout is a painful, inflammatory disease that may cause decreased function and health-related quality of life (HRQoL). Limited study did not take the influence of gout characteristics and anxiety on HRQoL into consideration and there are no studies associated with functional disability in individuals with gout from China. This study aims to investigate the related factors of functional disability and HRQoL in gout patients recruited from China. Methods A total of 226 consecutive gout patients and 232 age- and gender-matched healthy individuals were involved in the study. A series of questionnaires (the Short Form 36 health survey, the Patient Health Questionnaire, the Generalized Anxiety Disorder questionnaire, the 10 cm Visual Analog Scale, and the Health Assessment Questionnaire-Disability Index) were applied. Blood samples were taken to examine the level of serum uric acid. Independent samples t-tests, Chi square tests, U test, Spearman rank correlation, logistic regression modeling, and linear regression were used to analyze the data. Results After adjusted demographic variables, individuals with gout have poorer HRQoL compared to healthy controls. Univariate tests presented that patients with functional disability had longer disease duration, more frequent flares/last year, more severe total pain, more number of tophi, higher degree of depression and anxiety, with a trend toward diabetes, the treatment of colchicine and corticosteroids use, compared to patients without functional disability. Meanwhile, place of residence, hypertension, DM, disease duration, cardiovascular disease, number of flares/last year, total pain, more number of tophi, presence of tender joints, depression, anxiety, currently using colchicine and corticosteroids were correlated significantly with HRQoL. Additionally, multiple regression analysis identified severe pain, depression, and colchicine use as predictors of functional disability. Cardiovascular disease, total pain, number of flares/last year, presence of tender joints, depression, anxiety, colchicine and corticosteroids use contributed to low HRQoL. Conclusions After adjusted demographic variables, gout subjects have poorer HRQoL compared to healthy controls. Chinese gout population experiencing poor HRQoL and functional disability were likely to suffer from gout-related features and psychological problems. The results underscore the need of effective interventions including psychological nursing and appropriate treatment approaches to reduce their functional disability and improve their HRQoL.
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Affiliation(s)
- Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Haixia Cao
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Rulan Yin
- School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Lijuan Zhang
- School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Qiuxiang Zhang
- School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Liren Li
- School of Nursing, Nantong University, Nantong, Jiangsu, People's Republic of China.
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China.
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11
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Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study. Joint Bone Spine 2016; 83:553-8. [DOI: 10.1016/j.jbspin.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/19/2015] [Indexed: 11/20/2022]
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12
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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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Stewart S, Morpeth T, Dalbeth N, Vandal AC, Carroll M, Davidtz L, Mawston G, Otter S, Rome K. Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study. Gait Posture 2016; 44:18-22. [PMID: 27004627 DOI: 10.1016/j.gaitpost.2015.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/09/2015] [Accepted: 11/04/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability. METHOD Gait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure. RESULTS At the self-selected speed, gout participants demonstrated increased step time (p=0.017), and stance time (p=0.012), and reduced velocity (p=0.031) and cadence (p=0.013). At the fast speed, gout participants demonstrated increased step time (p=0.007), swing time (p=0.005) and stance time (p=0.019) and reduced velocity (p=0.036) and cadence (p=0.009). For participants with gout, step length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); stride length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); and velocity was correlated with total MFPDI (r=-0.60, p=0.011), function (r=-0.63, p=0.007) and work/leisure (r=-0.53, p=0.030). CONCLUSION Gait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand.
| | - Trish Morpeth
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand; Health Intelligence and Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Lisa Davidtz
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Grant Mawston
- Department of Physiotherapy, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Simon Otter
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand; School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR, UK
| | - Keith Rome
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
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Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. "You want to get on with the rest of your life": a qualitative study of health-related quality of life in gout. Clin Rheumatol 2015; 35:1197-205. [PMID: 26245722 PMCID: PMC4844632 DOI: 10.1007/s10067-015-3039-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/30/2022]
Abstract
The objective of the study is to examine the impact of gout and its treatments on health-related quality of life (HRQOL) using focus group interviews. From the baseline phase of a cohort study of HRQOL in gout, 17 participants (15 males, mean age 71 years) with varying attack frequency and treatment with and without allopurinol participated in one of four focus group interviews. All interviews were audio-recorded and transcribed verbatim. Data was analysed thematically. Physical and psychosocial HRQOL in gout was affected by characteristics of acute gout (particularly the unpredictable nature of attacks, location of joint involved in an attack, pain and modifications in lifestyle), lack of understanding of gout by others (association with unhealthy lifestyle, symptoms ridiculed as non-severe and non-serious) as well as participants (not considered a disease) and the lack of information provided by physicians (about causes and pharmacological as well as non-pharmacological treatments of gout). Participants emphasised the impact of acute attacks of gout and prioritised dietary modifications and treatment of acute attacks over long-term urate-lowering therapy. Characteristics of acute gout, lack of understanding and information about gout and its treatments perpetuate poor HRQOL. HRQOL (maintenance of usual diet and reduced frequency of attacks) was associated with urate-lowering treatment. Better patient, public and practitioner education about gout being a chronic condition associated with co-morbidities and poor HRQOL may improve understanding and long-term treatment of gout.
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Affiliation(s)
- Priyanka Chandratre
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Jennifer Liddle
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Jane Richardson
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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15
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Roddy E, Muller S, Rome K, Chandratre P, Hider SL, Richardson J, Blagojevic-Bucknall M, Mallen CD. Foot problems in people with gout in primary care: baseline findings from a prospective cohort study. J Foot Ankle Res 2015. [PMID: 26207143 PMCID: PMC4512156 DOI: 10.1186/s13047-015-0090-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Foot problems are common in people with gout yet the prevalence of current foot problems in people with gout and the burden they present to healthcare systems is not known. This cross-sectional study aimed to determine the prevalence and associations of hallux valgus, foot pain and disability in people with gout, and to assess the frequency with which foot problems lead to consultation with healthcare professionals. Methods Adults registered with 20 general practices who had consulted their GP about gout or been prescribed allopurinol or colchicine in the preceding two years were mailed a questionnaire. Prevalence of hallux valgus, foot pain in the last month, and disabling foot pain in the mailed population were ascertained using validated instruments and estimated by inverse-weighted logistic regression. Associations with socio-demographic, comorbid and gout-specific factors were examined using logistic regression. Participants were asked if they had seen health care professionals for foot problems within the preceding 12 months. Results One thousand one hundred eighty-four questionnaires were received (response 66 %). Prevalence of hallux valgus was 36.3 %, foot pain in the last month 22.3 % and disabling foot pain 14.5 %. Hallux valgus associated with age (adjusted OR 1.47 per 10-year increase, 95 % CI 1.26, 1.72) and female gender (2.03; 1.31, 3.15). Foot pain in the last month associated with age (1.24; 1.00, 1.55), obesity (BMI 30.0–34.9 2.67; 1.32, 5.38; BMI ≥ 35.0 3.16; 1.44, 6.93), mild depression (2.04; 1.09, 3.81) and polyarticular gout attacks (1.86; 1.18, 2.95). Disabling foot pain associated with age (1.42; 1.08, 1.87), obesity (BMI 30.0–34.9 3.73; 1.54, 9.09; BMI ≥ 35.0 4.36; 1.64, 11.64), depression (mild 2.63; 1.25, 5.53; moderate 3.53; 1.11, 11.26) and ischaemic heart disease (2.45; 1.32, 4.53). In the previous 12 months, 495 (42.8 %) reported consulting their GP about their feet and 281 (23.7 %) a podiatrist/chiropodist. Conclusions Foot problems are common in people with gout and frequently lead to healthcare consultation. Hallux valgus has similar associations to those seen in the general population, whereas foot pain associates with obesity and gout characteristics, and disabling foot pain with obesity and comorbidity. Patient assessment should consider foot problems and offer specific treatment where relevant.
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Affiliation(s)
- Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Sara Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, AUT University, Auckland, 1020 New Zealand
| | - Priyanka Chandratre
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Jane Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Milisa Blagojevic-Bucknall
- 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
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