Background/Purpose: It is unknown what factors contribute to patient and physician perceptions of gout disease activity, and how these perceptions align.  The aim of this study was to understand the clinical variables that contribute to the patient and physician perceptions of gout disease activity, and to understand reasons for discordant assessments of gout disease activity. 

Methods: Patients (n=223) with gout according to the 1977 ARA gout classification criteria and on allopurinol ≥300 mg daily attended a standardized gout assessment visit which recorded gout flare in the preceding 3 and 12 months, physical examination for tophus, laboratory tests and patient questionnaires. Study participants and physicians completed questionnaires rating their global assessment of gout disease activity, (numerical rating scale (NRS); 0=no activity, 10=extremely active).  Discordance in the global assessment of gout disease activity was defined as an absolute difference of >2 units between the patient and physician assessments (Desthieux et al, Arthritis Care Res 2016).  Data were analysed using linear and logistic regression models. 

Results:  The mean (SD) patient global assessment of gout disease activity was 2.08 (2.35), and physician global assessment of disease activity was 2.52 (2.58), P=0.01.  Gout flare in the last 12 months, presence of tophus, gout flare in the last 3 months and serum urate <0.36mmol/L were independent predictors of patient and physician assessments (Table).  Male sex also predicted physician global assessment of gout disease activity, but not patient assessment.  Discordant patient and physician scores for gout disease activity were present in 63 (28.3%) participants.  In logistic regression models, gout flare in the last 3 months predicted discordant gout disease activity scores >2 (patient assessed gout disease activity as more severe, n=23); odds ratio 2.8, P=0.021, whereas gout flare in the last 12 months predicted discordant gout disease activity scores <-2 (physician assessed gout disease activity as more severe, n=40); odds ratio 10.4, P<0.001. 

Conclusion:  For both patients and physicians, gout flares, tophus and serum urate control contribute to assessments of gout disease activity.  However, discordance between patients and physicians in their assessment of gout disease activity is not uncommon, with recent gout flares contributing to higher patient global assessments of disease activity, and distant flares contributing to higher physician global assessments of disease activity.