Photo Credit: Jittawit.21

A recent study in ACR Open Rheumatology identified which patients were most likely to underreport experiencing or self-treating their gout flares.

A recent study published in ACR Open Rheumatology identified which patients were most likely to underreport gout flares.

Gout can have a profound impact on patient QOL. Flares are linked to significant pain, impaired functionality, and reduced productivity.

The authors wrote that gout flares are particularly common in untreated patients and those experiencing fluctuating serum urate levels due to dietary factors, alcohol consumption, or medications. Despite its clinical importance, the burden of gout flares remains inadequately reported and understood.

To address these gaps, the researchers conducted a comprehensive survey to examine the frequency, reporting, and prevention of gout flares in the United States.

“To our knowledge, no previous studies have assessed both types of gout flares, those self-treated early by the patient and prevented or minimized and those more symptomatic gout flares that require the administration of a prescription drug and/or a health care visit,” wrote Jasvinder A. Singh, MD, and colleagues. “Understanding which patients are most likely to underreport flares identifies an opportunity to ensure optimal management in a large proportion of patients.”

Significant Gaps Identified

The researchers used 2017-2019 data from the Acumen Health Research Institute to identify 31,079 participants. Of these, 933 people reported having gout, with 66% experiencing a flare in the previous year. The average age of participants with gout was 58.3 years, and the majority were male and White.

Compared with people without gout, those with the condition had a lower physical health QOL but better mental health scores. The researchers assessed depression and anxiety levels, noting that patients with gout reported moderate mental health impacts.

On average, participants had 6.6 gout flares per year, but only 1.9 flares per year were reported to physicians, revealing a significant degree of underreporting. Nearly 72% of all gout flares were either not reported or prevented through self-treatment.

Factors Linked to Underreporting

Younger patients, those with lower education levels, and people not using urate-lowering therapies were less likely to report flares. Additionally, patients who reported fewer flares tended to have lower mental health scores and were more likely to experience anxiety and depression.

The researchers identified several predictors for underreporting gout flares. Patients with longer disease durations and higher BMI were less likely to report flares, whereas those on urate-lowering therapies were more likely to do so. In addition, the researchers observed that gout flares were frequently self-treated, with patients using medications like NSAIDs or glucocorticoids to prevent symptoms. Tophi was also associated with an increased likelihood of self-treatment.

The researchers emphasized that underreporting gout flares limits clinicians’ ability to assess disease burden and optimize treatment strategies accurately. They suggested combining patient-reported outcomes with health record data could offer a more comprehensive understanding of gout’s impact.

“Those least likely to pretreat and not report gout flares are younger patients, are more likely to be women, experience greater disease severity, and are more likely to have comorbid depression or anxiety. These findings have direct clinical relevance and indicate that flare history during regular follow-up clinic visits is needed, with a focus on these patient subpopulations but in general for all people with gout,” Dr. Singh and colleagues said.