Patient-Reported Outcomes Accurately Show Disease Burden in Gout
Patients’ reported perception of their gout symptoms may be a more responsive indicator of disease burden than quality-of-life instruments, according to a recent post hoc analysis of a randomized controlled trial.
A proposed benchmark for patient-acceptable symptom state (PASS) is the complete absence of flares over a 6-month period. Low disease activity (LDA) may be defined as no more than 1 flare within the same timeframe. The investigators sought to explore how flare-defined states correlate with patient-reported outcomes, to provide insights into the clinical utility of such targets.
Participants initiated allopurinol therapy, with half receiving low-dose colchicine for the first 6 months. The researchers collected patient-reported data about gout flares along with validated outcome measures, including the Health Assessment Questionnaire (HAQ), EuroQol 5-Dimension 3-Level (EQ-5D-3L), and the gout-specific Brief Illness Perception Questionnaire (BIPQ). These questionnaires were administered at intervals throughout the study.
During the final 6 months, after allopurinol dosages were stabilized, 38% of participants were classified as meeting the PASS criteria, 19% as LDA, and the remaining 43% as neither. While flare state bore no statistically significant relationship to either HAQ or EQ-5D-3L scores, 3 BIPQ domains—consequences, identity, and concern—showed significant deterioration as flare burden increased across the spectrum from PASS to non-LDA or non-PASS.
These findings suggest that scores on general physical function and overall quality of life may not sensitively detect differences in the frequency of flares, patients’ perceptions of the severity of gout and its impact on quality of life do correlate with flare frequency.
A majority of patients achieved either PASS or LDA by the second half of the study, reinforcing the usefulness of these targets in clinical practice after beginning urate-lowering therapy. The results underscore the importance of maintaining flare suppression as a cornerstone of effective gout management. By minimizing flare frequency, clinicians can improve both objective disease control as well as patients’ subjective experience of their condition.
Reference:
Stamp LK, Frampton C, Stewart S, et al. Relationship between gout flare states and patient-reported outcomes after allopurinol initiation. Arthritis Care Res. Published online January 2, 2025. https://doi.org/10.1002/acr.25494
