Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Health Related Quality of Life (HRQOL) in Tophaceous vs. Non-Tophaceous Gout.

Khanna2,  Puja, Persselin3,  Jay, Hays1,  Ron, Furst1,  Daniel, Paulus1,  Harold, Maranian1,  Paul, Khanna1,  Dinesh

UCLA
UCLA and West LA VA
West LA VA

Objective:

Gout is a chronic disorder of uric acid metabolism resulting in acute painful episodes of arthritis. Tophaceous gout is associated with greater number of attacks, more erosive disease, inadequate pain control, and results in joint destruction when untreated. We assessed the impact of chronic tophaceous gout on HRQOL in an ongoing, prospective, 1-year observational study.

Methods:

71 patients with tophaceous and non-tophaceous gout were recruited at VA and University Hospitals. Tophi were assessed by a physician and HRQOL was assessed at baseline using SF-36 v2, HAQ-DI and a disease-specific Gout Impact Scale (GIS). Health utilities were elicited using computerized software, U-Maker ® in structured interviews. Direct preference-based measures to evaluate disutility of gout included health rating scale (RS, 0–100), time tradeoff (TTO, 0.0–1.0), and standard gamble (SG, 0.0–1.0). Disutility was assessed by subtracting preference scores for current health states with gout from those for current health without gout. Patients were questioned on how much money they would be willing to pay out of pocket as a one time payment to cure their gout permanently. Patients were also asked to list their comorbidities and rank them from most to least concerning.

Results:

Non-tophaceous were similar to tophaceous subjects in age (68 years), number of flares (3 per year), disease duration (12.4 years), Charlson comorbidity index (3.0), and serum urate levels (7.1 mg/dl, p> 0.05). Patients with tophi had greater evidence of radiographic damage (p< 0.05), worse HAQ-DI score (P=0.06) and rated their gout as more severe (p=0.0008). The 2 groups did not differ in SF-36 and GIS scores. However, tophaceous subjects assigned greater disutility to their gout on RS (12.4 vs. 7.4) and (SG 0.07 vs. 0.009), were willing to pay a significantly higher dollar amount out of pocket for a cure (p=0.04), and had worse functional capacity to perform usual activities of daily living (p=0.008) compared to the non-tophaceous. Gout was ranked as the top most health concern in 25% with tophaceous gout compared to 17% with non-tophaceous gout.

Conclusion:

Although the patients with chronic tophaceous and non-tophaceous gout were comparable in demographics, the tophaceous group had worse functional disability, assigned higher disutility to gout, and was willing to pay more for a cure. SF-36 and GIS were not able to discriminate between 2 groups. Our data quantifies the decrement in quality of life of patients with tophaceous gout and their willingness to pay for treatment of a debilitating and disabling disease. Our finindgs have implications for decision and cost-effectiveness analyses.

Demographics & Clinical characteristicsAll (N=71)Nontophaceous (N=45)Tophaceous (N=26)
Severity of Gout scale 0–103.0 (2.9)2.1 (2.3)4.7 (3.2)*
Health Status:   
1. SF-36 a) PCS37.1 (9.6)37.6 (9.4)36.2 (10.1)
  b) MCS47.2 (13.5)48.2 (12.1)45.4 (15.7)
2. HAQ-DI (0–3)0.9 (0.7)0.7 (0.6)1.1 (0.8)*
3. GAQ: Gout Concern Overall65.4 (25.8)62.8 (25.6)70.0 (25.9)
  Gout Medications Side Effects53.9 (25.1)55.0 (25.2)51.9 (25.4)
  Unmet Gout Treatment Need44.5 (19.7)43.9 (21.0)45.5 (17.5)
  Well Being During Attack58.0 (27.5)57.9 (25.3)58.2 (31.5)
  Gout Concern During Attack55.1 (25.6)54.9 (22.1)55.5 (31.3)
Health Utilities:   
1. Rating Scale, (0–100)9.2 (17.9)7.4 (19.3)12.4 (15.0)
2. Time Tradeoff, (0.00–1.00)0.02 (0.11)0.02 (0.08)0.01 (0.16)
3. Standard gamble, (0.00–1.00)0.03 (0.12)0.01 (0.05)0.07 (0.19)*
Willingness to pay in $, median (IQR)400 (60, 1000)100 (30, 1000)500 (200, 3500)*
ACR Functional Class: III57 (81.4)40 (90.9)16 (85.4)*
  III IV13 (18.6)4 (9.1)9 (34.6)
* p<0.05 for comparison between tophaceous and non-tophaceous Gout

To cite this abstract, please use the following information:
Khanna, Puja, Persselin, Jay, Hays, Ron, Furst, Daniel, Paulus, Harold, Maranian, Paul, et al; Health Related Quality of Life (HRQOL) in Tophaceous vs. Non-Tophaceous Gout. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1365
DOI: 10.1002/art.29131

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