Background/Purpose: The severity of gout is often associated with poor patient compliance and sub-optimal medical treatment. Our objective was to determine the prevalence, characteristics, and factors associated with disability at baseline visit and the effect of regular treatment in patients with gout.

Methods: We analyzed baseline, 6, 12 and 18-months follow-up data of patients with gout from GRESGO, a cohort of 445 consecutive patients with gout seen for the first time at the Rheumatology Department and treated according to published guidelines (urate lowering therapy, acute attacks prophylaxis, NSAID and glucocorticoids) including treatment for associated diseases. Variables included demographic, clinical, and biochemical data; HAQ and EuroQoL questionnaires as well as VAS for pain and health. According to the use of daily life aids, specifically wheel chairs or gait aids (walking frames, canes or crutches) at baseline visit, we made two subgroups: one in need of such aids (GD) and another without them (GNoD). This protocol was approved by the local IRB and patients signed and informed consent for their participation. Statistical analysis included t test, X2, and logistic regression.

Results: Most patients (97%) were males; the mean ages at onset and at baseline were 34.4 (12.7) years and 47.5 (12.7) years; disease duration was 13.1 (10.7) years; 68% had tophi. There were 89 patients (20%) in GD group: 26% required 2 or more gait aids, 48% canes, 10% wheel chairs and 15% other walking frames; and 356 (80%) in GNoD group. GD had lower educational and socioeconomic levels and more severe disease (table 1); although there were no differences in age 47.9 (12.3) VS 47.4 (12.9) and disease duration 14.8 (9.9) VS 12.7 (10.9), p=NS, the frequency of renal and heart diseases was higher in GDAt the six-month follow-up, the effect of proper treatment had improved the clinical condition of 57% of patients in GD; 18 still required daily life aids; and 25% were lost to follow-up. At the 18-months evaluation 36 (40%) patients still had adequate functioning.

As expected, patients in GD had also significantly more or higher frequency of tender, swollen, limited joints, tophi, HAQ, EUROQoL, lost laboral days/6 months and VAS for pain and health. Nine (2%) patients died during follow-up: 3 (3.37%) from GD and 6 (1.68%) from GNoD.

Conclusion: Disability occurred in 20% of gout patients attending a Rheumatology Department for the first time. These patients were low-socioeconomic level young men with very severe and active disease (> flares/hospitalizations, > tophi) and also associated renal and heart disease. And probably higher mortality.Proper treatment improves functioning in up two 40% of patients with disability in the baseline visit.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-regular-treatment-on-disability-in-a-cohort-of-patients-with-gout/