Tophi and Frequent Gout Flares Are Associated With Impairments to Quality of Life, Productivity, and Increased Healthcare Resource Use

Results From a Cross-Sectional Survey

Puja P Khanna; George Nuki; Thomas Bardin; Anne-Kathrin Tausche; Anna Forsythe; Amir Goren; Jeffrey Vietri; Dinesh Khanna


Health and Quality of Life Outcomes. 2012;10(117) 

In This Article


Gout affects 3.9% of the adult population in the US (8.3 million)[1] and over 1% of the adult population in Germany and the UK.[2] Gout has increased in prevalence worldwide[3,4] and it is the most common inflammatory arthritis in men.[5] Acute gout manifests when monosodium urate (MSU) crystallizes and deposits in joints, bursae or tendon sheaths, and provokes an inflammatory response that causes a typical gout flare. This flare is characterized by an acute onset (maximum within 24 hours) of a heavily inflamed and extremely painful mono- or oligoarthritis which often results in short-term sick leave.[6] Serum urate (sUA) concentration above the limit of solubility (>6.8 mg/dL/400 μmol/L) leads to crystal deposition which is a necessary precursor for this disease, though many with hyperuricemia will never develop gout.[7,8] Gout patients whose sUA is maintained below 6 mg/dL (360 μmol/L) over time can expect to remain flare free and this is a most important aspect of long-term management of gout.[9–12] Higher sUA levels predict more flares and development of tophi,[2,13–16] and maintaining lower sUA prevents the formation of new tophi and reduces the size of established ones.[17,18]

Gout patients frequently have a number of comorbidities, including obesity, hypertension, high serum lipid and cholesterol levels, kidney disease, diabetes, and cardiovascular disease.[2,7,19–21] Due to the rising incidence and prevalence of gout, greater scrutiny has been directed towards the impact of gout on health-related quality of life (HRQOL),[22,23] healthcare resource utilization, and work productivity, a task complicated by the presence of the other ailments.

Although there is an expanding literature on the humanistic and economic burden of gout, gaps remain. Much of the current literature linking gout to HRQOL either relies on data from US veterans,[24] patients at a small number of medical facilities,[20] or studies with small sample sizes,[22] while data on work productivity and activity impairment in gout is very sparse.

The objective of the present study was to better understand the burden associated with signs and symptoms of gout (namely, tophi and flares) in larger, more diverse, and more representative samples of patients across the US and EU than has been reported previously. The secondary objective was to distinguish the burden of symptoms directly attributable to gout from those associated with comorbid diseases. By highlighting the heterogeneity of disease burden within the gout-diagnosed population, examining the impact of both tophi and flares across samples of US and EU patients, this study adds breadth and specificity to current analyses of gout burden in the literature and can thus contribute to more effective disease management and improved patient outcomes.