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.


Urate-Lowering Therapy in Chronic Gout Results in Clinically Important Improvements in Health-Related Quality of LifeSF-36 Is Responsive to Change in Chronic Gout.

Khanna2,  Puja, Perez-Ruiz1,  Fernando, Maranian2,  Paul, Khanna2,  Dinesh

Hospital de Cruces
UCLA

Purpose:

SF-36 is a validated outcome measure to assess generic health-related quality of life (HRQOL) in patients with gout. We assessed HRQOL in patients with gout in an academic outpatient rheumatology setting.

Methods:

SF-36 was administered at baseline, then at yearly intervals. Patients who had a gout flare within the past 1 month were excluded. We assessed statistical significance and the minimal clinically important differences (MCID) at the first and second year. Statistical significance was evaluated using paired t-test for changed scores of the SF-36 scales. MCID for SF-36 scales and summary scores was defined as improvement of >=5 points and >=2.5 points at 12 months, respectively. We assessed responsiveness to change (effect size) and interpreted it based on Cohen's criteria: 0.20–0.49 as small, 0.50–0.79 as moderate, and >=0.80 as large, and the predictors for improvement in the SF-36 scales and summary scores. We assessed improvement (defined as >=MCID) in 8 SF-36 scales and 2 summary scales. Independent variables included age, tophi (presence/absence), comorbidities (presence/absence), baseline joint involvement, baseline serum urate levels, change in serum urate level and number of flares from baseline to 12 months.

Results:

Of 99 subjects, 96 were male, mean age was 57.1 years, disease dur was 8.2 years, 47% had associated comorbidities, 40% had tophi, and 64% had evidence of radiographic damage. Data was available for 77 patients at 1 year and 36 patients at 2 years. Patients were treated with urate lowering therapy (ULT) including allopurinol (N=64), benzbromarone (N=4), or combination therapy (N=1); only 7 patients were on oral colchicine. Baseline mean (SD) serum urate level was 8.9 (1.36) mg/dl and mean numbers of flares were 4.7 (4.5) over the last year. Patients with presence of tophi, polyarticular disease, and radiographic damage had lower SF-36 scores compared to patients without it. Urate-lowering therapies were associated with reduction in serum uric acid to 5.46 (1.1), (-3.44 (1.73); p< 0.001) and number of flares (-4.00 (4.32); p<0.001) over 12 months; and associated with a statistically significant and clinically meaningful improvement in the SF-36 scales and summary scores at 12 months (Table). Reduction in flares independently predicted improvements in SF-36 scales (bodily pain, physical functioning, and role physical) at 1 year after adjusting for the covariates (p values= 0.001–0.06). Improvement in SF-36 scores was maintained at 2 years.

SF-36Baseline Mean (SD)1-Year Mean (SD)Effect Size#% achieving MCID
Physical function43.39 (11)48.44 (8.33)*0.4834
Role Physical43.68 (11.41)49.44 (10.41)*0.5036
Bodily Pain39.91 (11.23)52.12 (10.77)*1.0969
General Health43.04 (8.92)47.12 (9)*0.4938
Vitality50.74 (12.24)54.97 (11.2)*0.3141
Social functioning45.5 (11.89)51.18 (8.82)*0.4053
Role emotional48.98 (11.04)51.69 (8.69)0.2022
Mental health49.73 (11.92)52.91 (10.51)0.2130
SF-36 PCS40.37 (9.45)48.48 (8.89)*0.9170
SF-36 MCS52.16 (10.8)54.15 (9.3)0.0838
* p<0.001

Conclusion:

In this real-life observational cohort, appropriate gout specific-therapy was associated with statistical and clinically meaningful improvements in the number of flares and HRQOL at 1 year then maintained at 2 years. SF-36 is responsive to change with treatment in gout over time. Our data shows that SF-36 is responsive to change in chronic gout.

To cite this abstract, please use the following information:
Khanna, Puja, Perez-Ruiz, Fernando, Maranian, Paul, Khanna, Dinesh; Urate-Lowering Therapy in Chronic Gout Results in Clinically Important Improvements in Health-Related Quality of LifeSF-36 Is Responsive to Change in Chronic Gout. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1572
DOI: 10.1002/art.29338

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