Background/Purpose : Gout is the most prominent clinical manifestation of hyperuricemia, and is the most common cause of inflammatory arthritis. The symptoms of gout (eg, intense joint pain, redness, heat, and swelling) can have a have a significant impact on patients’ ability to function, with subsequent decreases in quality of life and increases in healthcare-related costs. Clinicians routinely consider gout severity when making treatment decisions, but the clinical features they use to define severity have not been well characterized. Therefore, we examined patient- and disease-related attributes of clinician-assessed gout severity.

Methods: Data were assessed from a survey of US physicians and in-depth patient chart audits. Gout severity was measured using physician global assessment. Additionally, serum uric acid (sUA) levels, flares, organ/joint damage, tophi, sociodemographic factors, and physician type (eg, primary care, rheumatologist) were identified. Descriptive and multivariate (stepwise logistic regression) statistics described differences among patients with severe vs moderate and mild gout.

Results: A total of 1159 patient charts were abstracted (185 with severe gout, 681 with moderate gout, and 293 with mild gout; 81% male; 38% ≥61 years of age; 71% white). Patients with severe gout had gout for a longer period than those with moderate or mild disease (66 mo vs 43 mo vs 38 mo; P <0.01). Tophi were reported in almost 74% of patients with severe gout, 19% with moderate gout, but only 3% of patients with mild gout (P <0.01). Patients with severe gout reported an average of ~3 flares per year vs ~2 flares per year for those with moderate gout, and only ~1 flare per year for those with mild gout (P <0.01). There were no differences in most recent sUA levels (7.2 mg/dL severe vs 6.8 mg/dL mild and moderate; P =0.08) or the proportions of patients who reached sUA goal (39% vs 42% vs 40%; P =0.42) by gout severity. The percentage of patients using urate-lowering therapy (ULT) differed by disease severity: 91% with severe, 80% with moderate, and 49% with mild (P <0.01). A model predicting gout severity found that having tophi or a greater number of flares per year, being female or of low social economic status, and having chronic heart failure, diabetes, or osteoarthritis were significant predictors of severe disease.

Conclusion: In this analysis, physician-assessed gout severity was more dependent on gout-specific attributes (tophi and flares), gender, socioeconomic status, and comorbidities than sUA (which was not a good indicator of gout severity). The lack of difference in sUA levels by gout severity may, in part, be a result of more patients with severe gout reporting use of ULT. These results should help physicians identify patients with factors aside from high sUA, who may be at risk of more severe gout, and who may require more careful monitoring and intensive management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-patient-and-disease-factors-and-severity-of-gout-in-a-real-world-population/