Frequent Flares Linked to Poor Health Literacy in Patients with Gout


Patients with gout who had poor health literacy were more likely to experience ≥ 2 flares within the previous 12 months.

Frequent Flares Linked to Poor Health Literacy in Patients with Gout

Lorraine Watson, PhD

Credit: NIHR

A history of oligoarticular/polyarticular flares, as well as frequent flares, were linked to poor health literacy in a cohort of patients with gout, according to a study published in Rheumatology Advances in Practice.1

“These findings are relevant to primary care, where most people with gout are managed, and to clinicians communicating with people with gout in clinical consultations,” wrote a team of investigators led by Lorraine Watson, PhD, research fellow and dietitian at Keele University School of Medicine. “They highlight the importance of considering health literacy when providing information and education to support people with gout.”

Health literacy is defined as the “knowledge, motivation, and competencies of accessing, understanding, appraising, and applying health-related information within the healthcare, disease prevention, and health promotion setting.” This is crucial as previous research has demonstrated poor health literacy contributes to health inequalities, worse outcomes, lower access to preventative services, and negatively effects self-management behaviors.2

In the cross-sectional analysis, ivestigators recruited a cohort of adult patients with gout from a primary care setting in the United Kingdom to assess the impact of health literacy on gout. Eligible patients received a baseline questionnaire and follow-up questionnaires at months 6, 12, 24, 36, 48, and 60.

Poor health literacy was defined using the Single-Item Literacy Screener (SILS) and multiple logistic regression models identified any associations between health literacy and a variety of individual gout characteristics, including age at gout onset, history of oligoarticular or polyarticular flares, frequency of flares, serum urate level, and allopurinol use and dosage. These were adjusted for age, sex, education, and deprivation.

A cohort of 551 mostly male (90.4%, n = 498), White (98%, n = 534) patients with a mean age of 54.4 years were enrolled in the study. Of these patients, 30.1% (n = 163) experienced ≥ 2 flares within the previous 12 months. Approximately 1 out of 10 (9.4%, n = 51) patients were identified as having poor health literacy.

Poor health literacy was linked to having ≥ 2 flares within the last year (adjusted odds ratio [aOR] 4.10 [95% confidence interval (CI) 2.04, 8.19]) and a history of oligoarticular or polyarticular flares (OR 1.93 [95% CI 1.06, 3.55]). Patients with poor health literacy were less likely to have obtained further education, were more deprived, more likely to be female, had more comorbidities, and more likely to self-report poor health.

Investigators could not determine any associations between health literacy and allopurinol use (OR .88 [95% CI .46, 1.65]), allopurinol dose (OR 1.00 OR [95% CI 1.00, 1.00]), serum urate (OR 1.0 [95% CI 1.00, 1.00]), or the patient’s age at gout onset (OR .99 [95% CI .96, 1.01]).

Investigators noted the predominantly White patient population residing in a single geographical region may limit generalizability. Additionally, as gout flares were self-reported, there is a possibility subjects with poor health literacy may interpret flares differently than other patients. Although flare distribution and frequency were assessed, investigators did not evaluate the duration of flare, functional limitation, or pain intensity.
“Since health literacy is an important determinant of health outcomes, it is important to consider health literacy when providing information and education to people with gout,” investigators concluded. “Future studies should evaluate whether interventions to aid communication with people with lower levels of health literacy (such as ‘teach back’, encouraging patient questions and using simple language and pictures) improve clinical outcomes in patients with gout.”


  1. Watson L, Protheroe J, Mallen CD, Muller S, Roddy E. Health literacy and gout characteristics in a primary care cohort. Rheumatol Adv Pract. 2024;8(2):rkae034. Published 2024 Mar 6. doi:10.1093/rap/rkae034
  2. MacKey LM, Doody C, Werner EL, Fullen B. Self-management skills in chronic disease management: what role does health literacy have? Med Decis Making 2016;36:741–59.
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