Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Tophaceous gout is a chronic inflammatory arthritis that causes debilitating acute attacks and associated with exponential resource utilization. Our objective was to define predictors of tophaceous gout in a prospective cohort.
Methods: 112 veterans with gout were recruited from rheumatology and primary care clinics at a single VA facility and followed for a total of 4 visits 3 months apart. Joint counts and presence of tophus was assessed by providers. HRQOL was evaluated with SF-36 v2, Health assessment questionnaire-disability index (HAQ-DI), and Gout Impact Scale (GIS) of GAQ2.0. Patient demographics, duration of gout, Charlson comorbidities (CCI), serum urate (sUA), and patient and physician rating of the severity of gout on a 0-10 scale were assessed. Comparisons were made using the student’s t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate, p-value < 0.5 was considered statistically significant. Age, race, physician severity score, functional class, disease duration, alcohol use, and number of comorbidities were considered as predictors of having tophaceous gout in univariate and multivariate logistic regression models.
Results: Patients diagnosed with tophaceous gout (N=35) were similar to patients without tophaceous gout (N=74) with respect to age, gender, race, alcohol use, duration of gout, polyarticular involvement, sUA and number of Charlson comorbidities, serum creatinine, and sUA (Table). Physician gout severity scores were significantly greater among patients with tophaceous gout; however, there was no difference in patient severity scores between groups. SF-36 scores indicated that the tophaceous group had worse physical functioning (p =0.04), bodily pain (p=0.07), total PCS scores (p=0.07), and gout concern overall domain of GIS (p=0.07). Physician severity score was the only significant predictor of outcomes identified after controlling for age, race, physician severity score, functional class, disease duration, alcohol use, and number of comorbidities.
Conclusion: Physicians rated tophaceous gout patients as having more severe disease. Surprisingly, conventional predictors of tophaceous gout such as disease duration, kidney disease, and sUA were similar in tophaceous and non-tophaceous groups. This may be reflective of the VA population that has a higher burden of urate even in the non-tophaceous patients.
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Table 1. Patient Characteristics, Non-Tophaceous and Tophaceous
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Total Cohort N=112
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Non-Tophaceous N=74
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Tophaceous N=35
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p-value
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Age (Years) |
Mean (SD) |
65.7 (11.2) |
65.5 (12.1) |
66.5 (9.8) |
0.68 α |
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Gender (Male) |
N (%) |
106 (97.3) |
72 (97.3) |
34 (97.1) |
0.99 β |
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Race |
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Caucasian |
N (%) |
76 (67.86) |
47(63.51) |
26 (74.29) |
0.29 β |
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African American |
N (%) |
17 (15.18) |
15 (20.27) |
2 (5.71) |
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Other |
N (%) |
19 (16.96) |
12 (16.22) |
7 (20.00) |
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Alcohol Use
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N (%) |
39 (35.1) |
27 (36.5) |
11 (32.4) |
0.75 ε |
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Duration of Gout
|
Mean (SD) |
13.9 (12.9) |
12.7 (12.3) |
15.7 (14.0) |
0.31 γ |
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Polyarticular Involvement (>3 joints)
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N (%) |
37 (36.3) |
22 (32.4) |
14 (45.2) |
0.22 ε |
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# of Comorbidities (CCI) |
Mean (SD) |
3.9 (2.5) |
3.6 (2.3) |
4.5 (2.6) |
0.12 γ |
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Physician Severity Score |
Mean (SD) |
3.0 (2.5) |
2.3 (2.1) |
4.4 (2.9) |
<0.0001 α |
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Patient Severity Score
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Mean (SD) |
6.0 (2.9) |
6.5 (3.4) |
0.44 α |
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Radiographic evidence of erosion or tophi
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N (%) |
35 (70.0) |
16 (53.3) |
19 (95.0) |
0.002 β |
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Serum Urate
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Mean (SD) |
7.5 (1.9) |
7.8 (2.0) |
7.1 (1.6) |
0.09 γ |
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Serum Creatinine
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Mean (SD) |
1.4 (0.9) |
1.5 (0.9) |
1.3 (0.5) |
0.60 γ |
α=T-test; β=Fisher Exact test; γ=Wilcoxon test;ε=Chi-square test
Disclosure:
P. Khanna,
NIH,
2;
C. Aquino-Beaton,
None;
J. A. Singh,
Takeda, Savient,
2,
Savient, Takeda, Ardea, Regeneron, Allergan,
5,
URL pharmaceuicals Novartis,
5;
E. Duffy,
None;
D. Elashoff,
None;
D. Khanna,
NIH,
2,
Scleroderma Foundation,
2.
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