title: 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.
abstract: BACKGROUND
  The prevalence of gout is increasing, and most research on the associated burden has focused on serum urate (sUA) levels. The present study quantifies the impact of the presence of tophi and frequency of acute gout attacks on health-related quality of life (HRQOL), productivity, and healthcare resource utilization.
  
  
  METHODS
  Patients with self-reported gout (n=620; 338 in US and 282 across France, Germany, and UK) were contacted based on inclusion in the 2010 US and EU National Health and Wellness Surveys (Kantar Health) and the Lightspeed Research ailment panel. Respondents were categorized into mutually-exclusive groups based on number of gout flares experienced in the past 12 months (0/don't recall, 1-2, 3, 4-5, 6+), current presence of tophi (none, 1+, or not sure), and sUA level awareness (yes, no). HRQOL (SF-12v2), healthcare provider visits in the last 6 months, and work productivity and activity impairment (WPAI) were compared across groups.
  
  
  RESULTS
  Most patients were males, mean age of 61 years, who reported experiencing at least one acute gout flare in the past 12 months, and 12.3% (n=76) reported presence of tophi. Among the 27.7% (n=172) of patients who were aware of their sUA levels, higher sUA was associated with more flares and tophi. Decreased HRQOL was associated with more frequent flares and presence of tophi. In multivariable models predicting outcomes based on presence of tophi and number of flares, both flares (≥4) and tophi (≥1) were associated with HRQOL decrements on physical and mental component summary scores and health utilities (all p<0.05), after adjustment for age, gender, and time since diagnosis. Flares were also associated with greater activity impairment.
  
  
  CONCLUSIONS
  Impairments associated with gout flares and presence of tophi, across patients in the US and EU, underscore the importance of effective management of this potentially curable condition.
authors.affiliation: University of Michigan, MI, USA.
authors.forename: Puja P
authors.initials: PP
authors.lastname: Khanna
authors.forename: George
authors.initials: G
authors.lastname: Nuki
authors.forename: Thomas
authors.initials: T
authors.lastname: Bardin
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Tausche
authors.forename: Anna
authors.initials: A
authors.lastname: Forsythe
authors.forename: Amir
authors.initials: A
authors.lastname: Goren
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vietri
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004526:Efficiency; D005060:Europe / Q000453:epidemiology; D005260:Female; D006073:Gout / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D006295:Health Resources / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011788:Quality of Life; D012008:Recurrence; D012044:Regression Analysis; D012216:Rheumatic Diseases / Q000191:economics / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014937:Work / Q000706:statistics & numerical data*