title: Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study.
abstract: OBJECTIVE
  To determine the prevalence of anxiety and depression in gout, examine associations between gout characteristics and these comorbidities and determine the role of allopurinol in any such relationships.
  
  
  METHODS
  As part of a prospective cohort study, a baseline questionnaire was sent to 1805 participants with gout aged≥18 years from UK primary care. Participants had a gout diagnosis or prescriptions for allopurinol or colchicine in their medical records 2 years prior to baseline. Prevalence of anxiety was defined using the Generalised Anxiety Disorder questionnaire and depression using the Patient Health Questionnaire. Logistic regression was used to examine any association between gout characteristics (12-month attack frequency, oligo/polyarticular gout and gout duration) and the presence of anxiety or depression. Crude and adjusted associations were reported as odds ratios (OR) and 95% confidence intervals (CI). Adjusted gout characteristics were stratified by allopurinol use.
  
  
  RESULTS
  One thousand one hundred and eighty-four participants responded to baseline (65.6%). Prevalence of anxiety and depression were 10.0% and 12.6% respectively. There was no association between gout characteristics and anxiety. However, there was an association between attack frequency and depression amongst those gout patients using allopurinol (2.87 [1.2 to 6.6]) and also between oligo/polyarticular gout and depression (2.01 [1.2 to 3.3]), irrespective of allopurinol use (2.09 [1.1 to 4.0]) or not (2.64 [1.0 to 6.8]).
  
  
  CONCLUSIONS
  Patients experiencing frequent gout attacks or attacks in multiple joints are likely to experience depressive symptoms, even when using allopurinol. Depression may influence medication adherence and participation in routine reviews, hence impacting adversely on gout management outcomes.
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom. Electronic address: j.a.prior@keele.ac.uk.
authors.forename: James Andrew
authors.initials: JA
authors.lastname: Prior
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Chandratre
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom.
authors.forename: Sara
authors.initials: S
authors.lastname: Muller
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Richardson
authors.affiliation: Research institute for primary care and health sciences, Keele university, ST5 5BG Staffordshire, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Roddy
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006073:Gout / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol
keywords: Allopurinol; Anxiety; Comorbidity; Depression; Gout; Primary care