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
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.
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: 0.200.49 as small, 0.500.79 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.
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= 0.0010.06). Improvement in SF-36 scores was maintained at 2 years.
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