Relationship Between Gout Flare States and Patient-Reported Outcomes After Allopurinol Initiation

Abstract

Objective: Gout flares are the most important clinical feature of the disease. A hypothetical maximum flare occurrence in the preceding six months has been suggested to be no flares for a patient-acceptable symptom state (PASS) and only one flare for low disease activity (LDA). The aim of this analysis was to determine the relationship between gout flare states (PASS, LDA, and not in LDA or PASS [non-LDA/PASS]) and patient-reported outcomes. Methods: Post hoc analyses of variance were undertaken using data from a 12-month randomized controlled trial involving 172 people with gout, which compared low-dose colchicine to placebo for the first 6 months while starting allopurinol with a further 6-month follow-up. Self-reported gout flares were collected monthly. Health Assessment Questionnaire (HAQ) and EuroQol 5-domain (EQ-5D-3L) were completed at 0, 3, 6, 9, and 12 months, and the gout-specific brief illness perception questionnaire (BIPQ) was collected at months 0, 6, and 12. Results: In the final six months of the study, 68 participants (38%) were classified as being in PASS, 34 (19%) as in LDA, and 77 (43%) as non-LDA/PASS. There was no association between gout flare states and EQ-5D-3L or HAQ. There was a statistically significant association between three of eight BIPQ items with increasing consequences, identity, and concern scores across the three states of PASS, LDA, and non-LDA/PASS. Conclusion: The majority of people were able to achieve gout flare PASS or LDA in the second six months after commencing allopurinol. As flare burden increases, so does the impact of gout on the patient. These findings highlight the importance of flare prevention in the management of gout.