Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study

Ting Fu, Haixia Cao, Rulan Yin, Lijuan Zhang, Qiuxiang Zhang, Liren Li, Zhifeng Gu, Ting Fu, Haixia Cao, Rulan Yin, Lijuan Zhang, Qiuxiang Zhang, Liren Li, Zhifeng Gu

Abstract

Background: Gout is a painful, inflammatory disease that may cause decreased function and health-related quality of life (HRQoL). Limited study did not take the influence of gout characteristics and anxiety on HRQoL into consideration and there are no studies associated with functional disability in individuals with gout from China. This study aims to investigate the related factors of functional disability and HRQoL in gout patients recruited from China.

Methods: A total of 226 consecutive gout patients and 232 age- and gender-matched healthy individuals were involved in the study. A series of questionnaires (the Short Form 36 health survey, the Patient Health Questionnaire, the Generalized Anxiety Disorder questionnaire, the 10 cm Visual Analog Scale, and the Health Assessment Questionnaire-Disability Index) were applied. Blood samples were taken to examine the level of serum uric acid. Independent samples t-tests, Chi square tests, U test, Spearman rank correlation, logistic regression modeling, and linear regression were used to analyze the data.

Results: After adjusted demographic variables, individuals with gout have poorer HRQoL compared to healthy controls. Univariate tests presented that patients with functional disability had longer disease duration, more frequent flares/last year, more severe total pain, more number of tophi, higher degree of depression and anxiety, with a trend toward diabetes, the treatment of colchicine and corticosteroids use, compared to patients without functional disability. Meanwhile, place of residence, hypertension, DM, disease duration, cardiovascular disease, number of flares/last year, total pain, more number of tophi, presence of tender joints, depression, anxiety, currently using colchicine and corticosteroids were correlated significantly with HRQoL. Additionally, multiple regression analysis identified severe pain, depression, and colchicine use as predictors of functional disability. Cardiovascular disease, total pain, number of flares/last year, presence of tender joints, depression, anxiety, colchicine and corticosteroids use contributed to low HRQoL.

Conclusions: After adjusted demographic variables, gout subjects have poorer HRQoL compared to healthy controls. Chinese gout population experiencing poor HRQoL and functional disability were likely to suffer from gout-related features and psychological problems. The results underscore the need of effective interventions including psychological nursing and appropriate treatment approaches to reduce their functional disability and improve their HRQoL.

Keywords: Anxiety; Depression; Functional disability; Gout; Health-related quality of life.

Conflict of interest statement

Authors’ information

Ting Fu, MM, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China. Haixia Cao, MM, Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China. Rulan Yin, MM, School of Nursing, Nantong University, Nantong, Jiangsu, P.R. China. Lijuan Zhang, MM, School of Nursing, Nantong University, Nantong, Jiangsu, P.R. China. Qiuxiang Zhang, MM, School of Nursing, Nantong University, Nantong, Jiangsu, P.R. China. Liren Li, MD, School of Nursing, Nantong University, Nantong, Jiangsu, P.R. China. Zhifeng Gu, PhD, MD, Research Center of Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China; Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Affiliated Hospital of Nantong University, and written informed consents were obtained from all individual participants in accordance with the 1964 Helsinki declaration.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74(4):661–667. doi: 10.1136/annrheumdis-2013-204463.
    1. Smith EU, Diaz-Torne C, Perez-Ruiz F, March LM. Epidemiology of gout: an update. Best Pract Res Clin Rheumatol. 2010;24(6):811–827. doi: 10.1016/j.berh.2010.10.004.
    1. Roddy E, Choi HK. Epidemiology of gout. Rheum Dis Clin N Am. 2014;40(2):155–175. doi: 10.1016/j.rdc.2014.01.001.
    1. Scire CA, Manara M, Cimmino MA, Govoni M, Salaffi F, Punzi L, Monti MC, Carrara G, Montecucco C, Matucci-Cerinic M, et al. Gout impacts on function and health-related quality of life beyond associated risk factors and medical conditions: results from the KING observational study of the Italian Society for Rheumatology (SIR) Arthritis research & therapy. 2013;15(5):R101. doi: 10.1186/ar4281.
    1. Changchien TC, Yen YC, Lin CL, Lin MC, Liang JA, Kao CH. High risk of depressive disorders in patients with gout: a Nationwide population-based cohort study. Medicine. 2015;94(52):e2401. doi: 10.1097/MD.0000000000002401.
    1. Branco JC, Rodrigues AM, Gouveia N, Eusebio M, Ramiro S, Machado PM, da Costa LP, Mourao AF, Silva I, Laires P, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt- a national health survey. RMD open. 2016;2(1):e000166. doi: 10.1136/rmdopen-2015-000166.
    1. Hirsch JD, Terkeltaub R, Khanna D, Singh J, Sarkin A, Shieh M, Kavanaugh A, Lee SJ. Gout disease-specific quality of life and the association with gout characteristics. Patient Relat Outcome Meas. 2010;2010:1–8. doi: 10.2147/PROM.S8310.
    1. Singh JA, Strand V. Gout is associated with more comorbidities, poorer health-related quality of life and higher healthcare utilisation in US veterans. Ann Rheum Dis. 2008;67(9):1310–1316. doi: 10.1136/ard.2007.081604.
    1. Becker MA, Schumacher HR, Benjamin KL, Gorevic P, Greenwald M, Fessel J, Edwards L, Kawata AK, Frank L, Waltrip R, et al. Quality of life and disability in patients with treatment-failure gout. J Rheumatol. 2009;36(5):1041–1048. doi: 10.3899/jrheum.071229.
    1. Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology. 2017;56(1):103–112. doi: 10.1093/rheumatology/kew356.
    1. Khanna PP, Nuki G, Bardin T, Tausche AK, Forsythe A, Goren A, Vietri J, Khanna D. Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: results from a cross-sectional survey. Health Qual Life Outcomes. 2012;10:117. doi: 10.1186/1477-7525-10-117.
    1. Lee SJ, Hirsch JD, Terkeltaub R, Khanna D, Singh JA, Sarkin A, Kavanaugh A. Perceptions of disease and health-related quality of life among patients with gout. Rheumatology. 2009;48(5):582–586. doi: 10.1093/rheumatology/kep047.
    1. Lopez Lopez CO, Lugo EF, Alvarez-Hernandez E, Pelaez-Ballestas I, Burgos-Vargas R, Vazquez-Mellado J. Severe tophaceous gout and disability: changes in the past 15 years. Clin Rheumatol. 2017;36(1):199–204. doi: 10.1007/s10067-016-3381-z.
    1. Prior JA, Mallen CD, Chandratre P, Muller S, Richardson J, Roddy E. Gout characteristics associate with depression, but not anxiety, in primary care: baseline findings from a prospective cohort study. Joint Bone Spine. 2016;83(5):553–558. doi: 10.1016/j.jbspin.2015.10.008.
    1. Mewes R, Rief W, Kenn K, Ried J, Stenzel N. Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD) Psychol Health. 2016;31(4):470–486. doi: 10.1080/08870446.2015.1111369.
    1. Wan SW, He HG, Mak A, Lahiri M, Luo N, Cheung PP, Wang W. Health-related quality of life and its predictors among patients with rheumatoid arthritis. Appl Nurs Res. 2016;30:176–183. doi: 10.1016/j.apnr.2015.07.004.
    1. Chandratre P, Mallen C, Richardson J, Rome K, Bailey J, Gill R, Hider S, Mason J, Mayson Z, Muller S, et al. Prospective observational cohort study of health related quality of life (HRQOL), chronic foot problems and their determinants in gout: a research protocol. BMC Musculoskelet Disord. 2012;13:219. doi: 10.1186/1471-2474-13-219.
    1. Liu R, Han C, Wu D, Xia X, Gu J, Guan H, Shan Z, Teng W. Prevalence of hyperuricemia and gout in mainland China from 2000 to 2014: a systematic review and meta-analysis. Biomed Res Int. 2015;2015:762820.
    1. Bao KJ, Liu Y, Zhou LN, Chen B, Endocrinology DO, Hospital S. Health-related quality of life and influencing factors in patients with chronic gouty arthritis. Hainan Medical Journal. 2016;27(23):3930-932.
    1. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, TF Y. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895–900. doi: 10.1002/art.1780200320.
    1. Alvarez-Hernandez E, Pelaez-Ballestas I, Vazquez-Mellado J, Teran-Estrada L, Bernard-Medina AG, Espinoza J, Aceves-Avila FJ, Goycochea-Robles MV, Garza M, Ventura L, et al. Validation of the health assessment questionnaire disability index in patients with gout. Arthritis Rheum. 2008;59(5):665–669. doi: 10.1002/art.23575.
    1. Taylor WJ, Colvine K, Gregory K, Collis J, McQueen FM, Dalbeth N. The health assessment questionnaire disability index is a valid measure of physical function in gout. Clin Exp Rheumatol. 2008;26(4):620–626.
    1. Koh ET, Seow A, Pong LY, Koh WH, Chan L, Howe HS, Lim TH, Low CK. Cross cultural adaptation and validation of the Chinese health assessment questionnaire for use in rheumatoid arthritis. J Rheumatol. 1998;25(9):1705–1708.
    1. Singh JA, Taylor WJ, Simon LS, Khanna PP, Stamp LK, McQueen FM, Neogi T, Gaffo AL, Becker MA, MacDonald PA, et al. Patient-reported outcomes in chronic gout: a report from OMERACT 10. J Rheumatol. 2011;38(7):1452–1457. doi: 10.3899/jrheum.110271.
    1. Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis. 2010;69(1):48–53. doi: 10.1136/ard.2008.102053.
    1. He X, Li C, Jie Q, Cui H. Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients. Shanghai Arch Psychiatry. 2010;22:200–203.
    1. Bian CD, Xiao-Yan HE, Qian J, Wen-Yuan WU, Chun-Bo LI. The reliability and validity of a modified patient health questionnaire for screening depressive syndrome in general hospital outpatients. Shanghai Arch Psychiatry. 2009;30:1360–1140.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Emery P, Kavanaugh A, Bao Y, Ganguli A, Mulani P. Comprehensive disease control (CDC): what does achieving CDC mean for patients with rheumatoid arthritis? Ann Rheum Dis. 2015;74(12):2165–2174. doi: 10.1136/annrheumdis-2014-205302.
    1. Li L, Wang HM, Shen Y. Chinese SF-36 health survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health. 2003;57(4):259–263. doi: 10.1136/jech.57.4.259.
    1. Spaetgens B, Tran-Duy A, Wijnands JM, van der Linden S, Boonen A. Health and Utilities in Patients with Gout under the Care of a Rheumatologist. Arthritis Care Res (Hoboken). 2015;67(8):1128–1136. doi: 10.1002/acr.22551.
    1. Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. "You want to get on with the rest of your life": a qualitative study of health-related quality of life in gout. Clin Rheumatol. 2016;35(5):1197–1205. doi: 10.1007/s10067-015-3039-2.
    1. Gregg EW, Mangione CM, Cauley JA, Thompson TJ, Schwartz AV, Ensrud KE, Nevitt MC. Diabetes and incidence of functional disability in older women. Diabetes Care. 2002;25(1):61–67. doi: 10.2337/diacare.25.1.61.
    1. Zagozdzon P, Kolarzyk E, Marcinkowski JT. Quality of life and rural place of residence in polish women - population based study. Ann Agric Environ Med. 2011;18(2):429–432.
    1. Lahana E, Pappa E, Niakas D. The impact of ethnicity, place of residence and socioeconomic status on health-related quality of life: results from a Greek health survey. Int J Public Health. 2010;55(5):391–400. doi: 10.1007/s00038-010-0171-2.
    1. Roddy E, Zhang W, Doherty M. Is gout associated with reduced quality of life? A case-control study. Rheumatology. 2007;46(9):1441–1444. doi: 10.1093/rheumatology/kem150.
    1. Hsu NW, Tsao HM, Chen HC, Chou P. Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke-preliminary report of the Yilan study: a population-based community health survey. PLoS One. 2014;9(9):e107609. doi: 10.1371/journal.pone.0107609.
    1. EQ W, Forsythe A, Guerin A, AP Y, Latremouille-Viau D, Tsaneva M. Comorbidity burden, healthcare resource utilization, and costs in chronic gout patients refractory to conventional urate-lowering therapy. Am J Ther. 2012;19(6):e157–e166. doi: 10.1097/MJT.0b013e31820543c5.
    1. EQ W, Patel PA, Mody RR, AP Y, Cahill KE, Tang J, Krishnan E. Frequency, risk, and cost of gout-related episodes among the elderly: does serum uric acid level matter? J Rheumatol. 2009;36(5):1032–1040. doi: 10.3899/jrheum.080487.
    1. Rome K, Stewart S, Vandal AC, Gow P, McNair P, Dalbeth N. The effects of commercially available footwear on foot pain and disability in people with gout: a pilot study. BMC Musculoskelet Disord. 2013;14:278. doi: 10.1186/1471-2474-14-278.
    1. Khanna PP, Gladue HS, Singh MK, FitzGerald JD, Bae S, Prakash S, Kaldas M, Gogia M, Berrocal V, Townsend W, et al. Treatment of acute gout: a systematic review. Semin Arthritis Rheum. 2014;44(1):31–38. doi: 10.1016/j.semarthrit.2014.02.003.
    1. Morris I, Varughese G, Mattingly P. Colchicine in acute gout. BMJ. 2003;327(7426):1275–1276. doi: 10.1136/bmj.327.7426.1275.
    1. Ciccarelli F, De Martinis M, Ginaldi L. Glucocorticoids in patients with rheumatic diseases: friends or enemies of bone? Curr Med Chem. 2015;22(5):596–603. doi: 10.2174/0929867321666141106125051.
    1. Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink A, Buttgereit F. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009;68(7):1119–1124. doi: 10.1136/ard.2008.092163.
    1. Derijk RH, Van LN, Klok MD, Zitman FG. Corticosteroid receptor-gene variants: modulators of the stress-response and implications for mental health. Eur J Pharmacol. 2008;585(2–3):492–501. doi: 10.1016/j.ejphar.2008.03.012.
    1. Shen B, Feng G, Tang W, Huang X, Yan H, He Y, Chen W, Da Z, Liu H, Gu Z. The quality of life in Chinese patients with systemic lupus erythematosus is associated with disease activity and psychiatric disorders: a path analysis. Clin Exp Rheumatol. 2014;32(1):101–107.
    1. Xu X, Shen B, Zhang A, Liu J, Da Z, Liu H, Gu Z. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis. Patient Prefer Adherence. 2016;10:879–885. doi: 10.2147/PPA.S119825.
    1. Kronisch C, McLernon DJ, Dale J, Paterson C, Ralston SH, Reid DM, Tierney A, Harvie J, McKay N, Wilson HE, et al. Brief report: predicting functional disability: one-year results from the Scottish early rheumatoid arthritis inception cohort. Arthritis Rheumatol. 2016;68(7):1596–1602. doi: 10.1002/art.39627.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere