Gout Worsens Its Comorbidities

October 30, 2017

Complaints about loss of self, loss of role identity, and lower quality of life dominate within this patient population.

Gout and the medications used for the treatment of gout worsen its comorbidities as well as patients’ perceptions of their quality of life.

Gout leads many patients to report a sense of body failure and a negative effect on social roles. Also, loss of identity-associated performance is progressive in patients who have gout.

The most common inflammatory arthritis, gout has been linked to obesity and the metabolic syndrome as well as associated comorbidities, such as heart disease, hypertension, diabetes, sleep apnea, and heart failure.

Jasvinder Singh at the University of Alabama at Birmingham pointed out that little is known about how gout affects the known comorbidities and their outcomes and that published qualitative research has focused on gout’s effect on quality of life and has under-represented women.

Dr Singh sought to shed light using a trajectory model developed by Corbin and Strauss to form a qualitative description of the effect gout has on comorbidities.

He presented his findings in a recent Arthritis Research & Therapy article.

The study

A nominal group study was conducted by looking at 45 patients with gout in 9 nominal groups. The trajectory model assessed body (organ system and function), biographical time (explicit narrative that gives meaning and purpose to a person’s life), and conceptions of self (role identity, social identity). The 3 components were reported as answers to the question, “How does gout or its treatment affect your other conditions and their treatment?”

The results

The effects of gout or gout treatment on comorbidities and their management included the following:

• Three groups rated the interaction of gout medications with medications for other medical conditions as a top concern.

• Seven groups rated gout’s effect in worsening medical comorbidities, including hospitalizations, as a high concern.

• Three groups cited worsening anxiety and depression as a top concern.

• Three groups considered changes in diet as a primary concern.

• Three groups cited new disease diagnosis on top of gout as a concern.

• Two groups named irreversible joint damage as a top concern.

• Four groups listed weight gain and inability to exercise as a problem.

• Three groups cited misdiagnosis of their gout as another problem.

The effects of gout or its treatment on daily life included the following:

• Six groups cited the negative effect of gout on daily life and activities, including the ability to work and social activities, as a concern.

• All 9 groups cited medication adverse effects as a problem.

• One group cited weight loss as a negative effect on quality of life.

• Three groups cited high cost as a concern.

There were no observable differences between men and women on the impact of gout on their lives.

Implications for physicians

• Complaints with regard to loss of self, loss of role identity, and lower quality of life dominate within the gout population.

• Although treatment of gout and its symptoms is important, physicians should not discount patients’ perceptions and the effect of gout on their comorbid conditions.

• Physicians should, as a routine, ask patients how gout affects their lives and validate their concerns.

• How physicians can change these comorbid interactions is unclear.

Disclosures:

The Division of Rheumatology at the University of Alabama at Birmingham provided funding.

References:

Singh JA. “Gout and comorbidity: a nominal group study of people with gout.” Arthritis Res Ther. 2017 Sep 15;19(1):204. doi: 10.1186/s13075-017-1416-1418.