Underestimation of the Burden of Gout

OBJECTIVES: To assess reporting rates of gout flares and the associated burden in a sample of US adults.

METHODS: Data were collected via an on-line survey of US adults ≥18 years using a random stratified sampling framework representative of the US adult population. Participants with gout completed questions about treatments, serum urate (sUA) lab values, severity, satisfaction with control and number of gout flares. All participants completed the Veterans RAND 12-Item© (VR-12), Generalized Anxiety Disorder 7-item (GAD-7), and Physician Health Questionnaire 9-item (PHQ-9). Data were summarized using descriptive statistics. Multivariable-adjusted logistic regression analysis examined factors predictive of reporting vs. not reporting gout flares to a physician.

RESULTS: 933 participants met study criteria for having gout. Those with gout tended to be older (58.3 [SD 13.3] years vs. 45.4 [SD 16.1] years; p<0.001), male (76.3% vs. 46.9%; p<0.001), White (80.5% vs. 76.8%; p=0.01), and married or living with a partner (58.9% vs. 52.8%; p<0.001) than those without gout (n=30,146). The total gout flare burden for those with gout was 6.6 gout flares per year. Nearly 72% of gout flares were either not reported to physicians or pretreated/prevented. Characteristics of those less likely to report gout flares included being younger, less educated, lower Charlson Comorbidity Index (CCI) score, not being diagnosed with gout by their doctor, and not taking a urate lowering therapy (ULT) to control their gout.

CONCLUSIONS: This study confirmed that gout flares are common in US adults with gout and found that the majority of gout flares are not reported resulting in under estimation of the burden of gout. The under reporting of flares highlights estimates of the burden of gout are likely too conservative. Reliance on clinical documentation of physician-reported gout flares and/or not asking patients about unreported flares directly is insufficient to assess the true patient burden of gout.