Background/Purpose: Gout is reported to impact 3.9% of the US adult population (Zhu. Arthritis Rheum 2011;63:3136-41). Treatment encompasses controlling acute attacks (flares) and, dependent on the degree of severity of joint involvement, long-term efforts to reduce urate levels and dissolve existing urate deposits, while preventing new crystal formation. Gout flares are often self-treated by patients, so it is hypothesized that the number of gout flares experienced is underreported to health care providers, leading to underestimation of the burden of gout. The aim of this study was to describe gout flares experienced and reported, unreported, and prevented per year by patients with gout in the United States.

Methods: A 2017 cross-sectional survey of US adults assessed health conditions, impact on health-related quality of life, and health care resource utilization. Participants aged ≥18 years were recruited using a random stratified sampling framework to ensure demographic composition representative of the US population. Participants with self-reported gout were asked to estimate the annual number of flares they experienced and reported to their physician, flares experienced and not reported, and flares prevented. Population level characteristics and outcomes are summarized using descriptive statistics.

Results: In 2017, 3.1% (n=372) of a representative sample of US adults (n=12,146) reported having gout. Patients with gout reported significantly lower physical health as measured with the Rand VR-12 Physical Component Subscale (41.1 vs 46.5; P<0.05). The total flare burden was 6.5 flares per year; 69.2% of flares were pretreated/prevented or suffered and not reported to any physician (Figure). On average, patients with gout told their physician they experienced 2 flares over the last 12 months. They reported another 1.3 flares experienced per year that they did not report to their physician and 3.2 flares per year that were alleviated with treatment of initial flare signs (eg, joint warmth and redness). Females were less likely to report all of their flares to their physician (32.4% of females vs 51.8% of males reported all flares; P<0.05). Younger patients were more likely to report all gout attacks to a physician (mean age 55.5 reporting all flares vs 63.1 years not reporting all flares; P<0.01). There was no difference in reporting flares by the number of comorbidities or use of a urate-lowering therapy.

Conclusion: Patients report only a third of their flares to physicians, resulting in suboptimal treatment of gout. Likewise, age and gender disparity in underreporting also reveals a missed window of opportunity that is essential to ensure optimal management in a large proportion of patients. Reliance on clinical documentation of physician-reported flares is insufficient to assess the true patient burden of gout.