Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Gout is the most prevalent arthritis and significantly impacts on function. Beside the influence of concurrent comorbidities, identifying disease-related prognostic factors may help to improve management and prevent disability. This study primarily aims to evaluate the independent association of disease-related factors with functional disability over time in patients with gout.
Methods: This is prospective analysis of a multicentre cohort study including a random sample of patients with prevalent clinically diagnosed gout from 30 rheumatology centres across Italy (KING Study, promoted by SIR, NCT01549210) recruited between June 2011 and January 2012. All patients underwent full clinical evaluation, including general health variables (socio-demographics, life-styles, comorbidities and treatments), and gout-related variables (diagnosis, duration, pattern of disease, previous and current treatment, VAS pain and patient global, joint examination, tophi burden and serum uric acid (sUA) levels). Primary outcome was defined as persistency of or worsening of functional disability (according to the following HAQ classes: absent= 0-0.5; mild= 0.5-1; moderate= 1-2; severe= 2-3). The relationship between predictors and outcomes was modelled using logistic models, and results presented as crude and adjusted odds ratios (OR) and 95%CI. Generalised linear models explored longitudinal association between gout-related variables and functional outcome. Missing data were imputed using switching regression on 10 datasets.
Results: A total of 446 patients were included in the analyses. M:F ratio was 9:1 M:F, mean (SD) age 63.9 (11.6) years and median (IQR) disease duration 3.8 (1.5-10.1) years; 92% fulfilled ACR preliminary classification criteria for gout, 19.9% had tophaceous gout; mean (SD) sUA level was 6.3(1.7), and 81% were on treatment with xantine-oxidase inhibitors (68% allopurinol and 13% febuxostat).
Factors associated with worse functional outcome after 12 months are reported in Table.
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|
12-month functional outcome |
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|
Gout-related variables |
Crude OR [95%CI] |
Adj OR [95%CI]µ |
Adj OR [95%CI]# |
|
Disease duration (>5yrs) |
2.13 (1.32-3.44) |
2.17 (1.31-3.57) |
1.94 (1.16-3.27) |
|
Number of attacks last year |
1.07 (1.01-1.14) |
1.08 (1.01-1.16) |
1.06 (0.99-1.14) |
|
Attacks last month |
2.44 (1.48-4.01) |
2.87 (1.70-4.87) |
2.75 (1.59-4.76) |
|
Presence of tophi |
2.06 (1.20-3.54) |
1.87 (1.06-3.29) |
1.62 (0.90-2.92) |
|
Number of swollen joints (66) |
1.31 (1.19-1.46) |
1.30 (1.17-1.44) |
1.26 (1.14-1.40) |
|
Number of tender joints (68) |
1.23 (1.15-1.32) |
1.22 (1.14-1.31) |
1.19 (1.11-1.27) |
|
Serum Uric Acid (>6mg/dl) |
1.67 (1.01-2.77) |
2.11 (1.22-3.63) |
1.95 (1.10-3.45) |
|
Urate lowering treatment |
1.06 (0.57-1.97) |
1.01 (0.52-1.94) |
0.84 (0.43-1.65) |
|
Current NSAID or colchicine |
3.02 (1.78-5.12) |
2.99 (1.72-5.18) |
2.88 (1.63-5.10) |
|
Previous steroid |
2.38 (1.43-3.96) |
2.20 (1.28-3.77) |
1.90 (1.08-3.37) |
|
µ adjusted for age and gender # adjusted for age, gender, comorbidities |
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Variations over time of the following gout-related variables associated with statistically significant variation on HAQ score: swollen and tender joint count, VAS pain and patient global, number of attacks. Tophi and sUA showed only a marginal association.
Conclusion: disease-specific variables independently impact on function over time, suggesting that stricter control of the disease may improve the excess of disability observed in gout.
Disclosure:
C. A. Scirè,
None;
M. Manara,
None;
G. Carrara,
None;
M. A. Cimmino,
None;
M. Govoni,
None;
F. Salaffi,
None;
L. Punzi,
None;
C. Montecucco,
None;
M. Matucci-Cerinic,
None;
G. Minisola,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-functional-disability-in-patients-with-gout-longitudinal-analysis-from-a-multicentre-observational-study-of-the-italian-society-for-rheumatology/