Background/Purpose: Regular exercise programs were previously thought to be inappropriate in patients with rheumatic diseases because of the potential to exacerbate inflammation. However, while recent paradigm-shifting studies have demonstrated that moderate physical activity can suppress inflammatory burden in chronic disease states, the impact in patients with gout has not been studied extensively hitherto. Consequently, clinical practice guidelines for gout released by the ACR (2012) and the ACP (2017) do not even address exercise as an interventional strategy. In a mouse model of gout, we have recently demonstrated that regular low/moderate intensity exercise regimens can reduce localized MSU crystal-induced inflammation. Therefore, the objective of this study was to examine the correlation of physical activity levels with clinical data in gout patients.

Methods: During scheduled appointments, gout patients not experiencing a flare at the time of visit were recruited from our clinics and consented to participate in the study (N = 30). International physical activity questionnaires (IPAQ) were completed to access current levels of daily/weekly physical activity. Clinical data was collected during the patient visit, including BMI, age, years since diagnosis, flares per year, perceived pain at the time of visit and in the past 4 weeks, and C-reactive protein (CRP) levels. Results were analyzed with individual unpaired t-tests with Welch’s correction and one-way ANOVA without Gaussian distribution and multiple comparisons to analyze the mean rank of each data set with that of every other to obtain p-values. Statistical significance was determined to be p < 0.05.

Results: The IPAQ survey, which has been previously used in studies of rheumatologic diseases, separated the gout patients in this study into physically active (IPAQ > 1400; N = 16) and physically inactive cohorts (IPAQ < 1400; N = 14) (p < 0.001). Average age, BMI, or years since diagnosis did not significantly differ between cohorts. However, physically active gout patients had 7 fewer flares per year, which corresponded to a 12-fold reduction (p < 0.01). Furthermore, physical activity correlated with a 10-fold decrease in CRP levels by an average of 2 mg/L (p < 0.01). In addition, perceived pain at the time of visit and over the past 4-week period was down 4.6-fold (p < 0.01) and 2.8-fold (p < 0.05), respectively.

Conclusion: These epidemiological and clinical data suggest that increased physical activity is beneficial in patients with gout and should be explored further as a therapeutic intervention. Regular exercise may be efficacious during intervals between flares and could function as a flare prophylaxis. While rest and decreased movement will still be recommended to a patient experiencing a gout flare, further characterization of exercise therapy may lead to a standardized exercise regimen to be performed during times of clinical inactivity and serve as part of the treatment for flare prophylaxis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-physical-activity-in-gout-patients-correlates-with-better-prognosis-decreased-pain-and-suppressed-c-reactive-protein-levels/