Concerns of Patients With Gout Are Incompletely Captured by OMERACT-Endorsed Domains of Measurement for Chronic Gout Studies:

Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout

OBJECTIVE

To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS).

METHODS

Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state.

RESULTS

Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively.

CONCLUSION

Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity.

Concurrent validity of provisional remission criteria for gout: a dual-energy CT study

Background

Provisional gout remission criteria including five domains (serum urate, tophus, flares, pain due to gout, and patient global assessment) have been proposed. The aim of this study was to test the concurrent validity of the provisional gout remission criteria by comparing the criteria with dual-energy CT (DECT) findings.

Methods

Patients with gout on allopurinol ≥ 300 mg daily were prospectively recruited into a multicenter DECT study. Participants attended a standardized study visit which recorded gout flare frequency in the preceding 12 months, physical examination for tophus, serum urate, and patient questionnaires. DECT scans of both hands/wrists, feet/ankles/Achilles, and knees were analyzed by two DECT radiologists. The relationship between the DECT urate crystal volume and deposition with individual domains as well as the provisional remission criteria set was analyzed.

Results

The provisional remission criteria were fulfilled in 23 (15.1%) participants. DECT urate crystal deposition was observed less frequently in those fulfilling the provisional remission criteria (44%), compared with those not fulfilling the criteria (73.6%, odds ratio 0.28, P = 0.004). The median (range) DECT urate crystal volume was 0.00 (0.00–0.46) cm³ for those fulfilling the remission criteria, compared with 0.08 (0.00–19.53) cm³ for those not fulfilling the criteria (P = 0.002). In multivariate regression analysis, the serum urate and tophus domains were most strongly associated with DECT urate crystal deposition.

Conclusions

In people with gout established on allopurinol, a state of remission as defined by the provisional remission criteria is associated with less DECT urate crystal deposition. While this study provides support for the validity of the provisional gout remission criteria, it also demonstrates that some crystal deposition may be present in people achieving these criteria.

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1941-8) contains supplementary material, which is available to authorized users.

Discrepancies in how the impact of gout is assessed in outcomes research compared to how health professionals view the impact of gout, using the lens of the International Classification of Functioning, Health and Disability (ICF)

The International Classification of Functioning, Disability and Health (ICF) provides a common language to understand what health means. An ICF core set, a list of ICF categories affected by a certain disease, is useful to objectify the content validity of a health status measurement. This study aims to identify the potential items of a gout specific 'ICF core set'. A three-round Delphi exercise was conducted, using web-based questionnaires. Health professionals, specialized in gout, nominated and subsequently rated the relevance of life areas divided into ICF categories. Agreement was determined by using the UCLA/RAND criteria. Simultaneously, a systematic review of gout measure outcomes was conducted. The results of these studies were compared using the second level of the ICF categories. In the Delphi study, consensus was found for 136 relevant ICF categories. The literature study extracted 134 different ICF categories in 149 articles. Three hundred and ten were non-defined outcomes. A large number of ICF categories were deemed to be relevant for people with gout. Only 29.7 % (19/64) of the level 2 categories, deemed to be relevant by health professionals, had been assessed as relevant in at least 5 % of gout outcome studies. Conversely, 70 % (19/27) of level 2 ICF categories assessed in at least 5 % of outcome studies were deemed relevant by health professionals. These ICF codes, which are found relevant in both studies, should be considered as mandatory in further research to a validated and practical core set of ICF categories. Published gout outcomes research fails to evaluate many life areas that are thought relevant by health professionals.

Spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and asymptomatic hyperuricemia: comparison with healthy individuals with normal serum urate concentrations

BACKGROUND

To identify spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and people with asymptomatic hyperuricemia by comparing them to healthy individuals with normal serum urate concentrations.

METHODS

Eighty-seven participants were included: 24 with gout, 29 with asymptomatic hyperuricemia and 34 age- and sex-matched normouricemic control participants. Spatiotemporal parameters of gait were assessed during level barefoot walking using a GAITRite® walkway. Peak plantar pressure and pressure time integrals were recorded using a TekScan MatScan®. Results were adjusted for age and body mass index.

RESULTS

Compared to normouricemic control participants, participants with gout demonstrated increased step time (P = 0.022) and stance time (P = 0.022), and reduced velocity (P = 0.050). Participants with gout also walked with decreased peak pressure at the heel (P = 0.012) and hallux (P = 0.036) and increased peak pressure (P < 0.001) and pressure time integrals (P = 0.005) at the midfoot. Compared to normouricemic control participants, participants with asymptomatic hyperuricemia demonstrated increased support base (P = 0.002), double support time (P < 0.001) and cadence (P = 0.028) and reduced swing time (P = 0.019) and single support time (P = 0.020) as well as increased pressure at the midfoot (P = 0.013), first metatarsal (P = 0.015) and second metatarsal (P = 0.007).

CONCLUSION

During barefoot walking, people with gout walk slower with plantar pressure patterns suggestive of apropulsive and antalgic gait strategies. Individuals with asymptomatic hyperuricemia also demonstrate altered barefoot gait patterns when compared to normouricemic control participants. Clinicians may consider dynamic gait outcomes when assessing and managing foot and lower limb related pain and disability in individuals with gout and asymptomatic hyperuricemia.

Gout is associated with organic and psychogenic erectile dysfunction

BACKGROUND

Gout is a deposition disease with an inflammatory response that can increase the risk of cardiovascular disease. Gout is stressful for affected individuals, and can cause erectile dysfunction (ED). The objective of this study was to identify the association between gout and psychogenic ED (PED) and organic ED (OED).

METHOD

We analyzed 35,265 patients from the National Health Insurance Research Database who had been diagnosed with gout between 2000 and 2011. A total of 70,529 matched controls were included in the study as a comparison. Patients with a history of PED and OED occurring before the index date, aged less than 20 years, or with incomplete demographic information were excluded. Control patients were selected from the population of people without a history of gout, PED, or OED. The following risk factors for PED and OED were included as covariates in the multivariable models: age, comorbidities of coronary artery disease (CAD), peripheral arterial disease, chronic kidney disease (CKD), hypertension, diabetes, hyperlipidemia, depression and anxiety.

RESULT

Men with gout were more likely to have an increased risk (1.21 times) of ED than were those without gout. Patients with gout were 1.52 times more likely to develop OED and 1.18 times more likely to develop PED than patients in the control group. The risk of developing ED was greater for patients with comorbidities of CKD, diabetes, hyperlipidemia, depression and anxiety.

CONCLUSION

Gout is associated with organic and psychogenic ED. Clinical physicians should consider this association when treating patients with gout.