Gout & Quality Life
Gout: Affects on Quality of Life
The pain of gout can be very debilitating. The sudden severe pain of gout can be disabling when it starts, as well as, frightening. With proper medical treatment, gout can be managed and sufferers can improve their quality of life.
Gout is a type of arthritis that is brought on by high levels of uric acid in the blood. Uric acid turns into crystals and is deposited in the joints and surrounding tissues. The onset causes excruciating pain. It can cause immobility, loss of range of motion and disability. It can also cause problems with other organs such as the heart and kidneys. Gout has been associated with heart attacks, metabolic syndrome, and diabetes and in some rare instances, death.
The statistics on gout show that cases are increasing. According to the U.S. Census Bureau in 2005, up to 6.1 million adults over the age of 20 have gout. Gout is becoming a major cause of disability, medical expenses and lost jobs in our society.
It is un-fortunate that a significant number of gout cases do not achieve control of symptoms and have disease progression. These cases are called “treatment-failure gout”. According to studies a large number of gout patients are undergoing treatment, but are insufficiently managed with the available gout treatments. Studies are ongoing into drug development and improvement of quality of care. Even with good medical care studies show an estimate of 100,000 to 300,000 US gout cases, are “treatment-failure gout”.
Both controlled gout and “treatment-failure” gout greatly affects the quality of life for sufferers. There have been recent studies done on the “Health-Related Quality of Life” (HRQOL) and the “Health Assessment Questionnaire-Disability Index (HAQ-DI) among gout sufferers. These studies have shown that gout sufferers have only mild disability with their disease, but failed to address “treatment-failure” gout.
The studies done defined “treatment-failure gout” as (1) crystal proven with symptoms for at least 2 years; (2) unresponsive to urate-lowering treatments, shown by uric acid levels over 6.0mg/dl. The study showed improvement after 4 months treatment (86%), but less response after the end of a year at (47%).
A cross-sectional analysis on baseline data showed that people around age 59-75 years had a lower level of function with treatment-failure gout. The HAQ-DI score also indicated that there was moderate disability with treatment-failure gout, but overall the levels of disability were actually quite significant. The study showed that there is room for major improvements in gout care.
The studies have also shown a higher incidence of musculoskeletal disability when there is a presence of tophi (nodules caused by uric acid crystals). In addition, the amount of flares and painful swollen joints were also a factor in determining level of disability and are associated with worse outcomes. The one thing researchers were unable to find was a connection between Serum Uric Acid levels (SUA) and the level of HRQOL or quality of life with gout. So, they found that more important is the overall outcome of the disease and not the level of SUA in the blood. It showed it is equally important to strive for improvement in quality of life for gout sufferers, in addition to, reducing uric acid levels. Studies on gout related medications only target lowering SUA levels and could use more research in improving symptoms, as well.
Gout that is of the “treatment-failure” type also has a higher incidence of related conditions in other areas of the body. This group showed more signs of heart issues and metabolic syndrome. For these gout patients quality of life was greatly reduced in comparison to those who had controlled gout. Yet, there is no data to prove the association at this time. The studies are challenging due to the disease being intermittent with patients having periods of good health in between flares. Studies have shown helpful in developing two new drugs, febuxostat and pegloticase. These are new drugs for lowering uric acid. The HRQOL has been shown to be a useful tool in clinical research.
In the future, the HRQOL needs to be used in a way to evaluate the whole picture of gout outcomes. Its use should focus on disease effects, treatment outcomes, limitations and aging factors in the patient population. The use of this tool will aid the medical community in optimizing gout management and improving quality of life for all gout patients.
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