Gout Clinical Update, July 28, 2011

The latest in clinical research into gout and related disorders.

Gout Patients Surveyed Regarding Their Knowledge of Gout

A new study, which describes an easy-to-read 10-item questionnaire that can identify important knowledge gaps in patients with gout, has concluded that it can be the first step in designing educational interventions to improve patient understanding and improve clinical care.

The objective of the study, which was published in the Journal of Clinical Rheumatology, was to develop and test a survey of gout patients regarding their level of disease-related knowledge in order to identify potential targets for patient education.

The researcher was headed by Li Yun Zhang, MD, of the division of rheumatology at The Second Hospital of Shanxi Medical University in Taiyuan, China, and included collaborators at the University of Pennsylvania Veterans Affairs (VA) Medical Center. Researchers developed a 10-item questionnaire with readability at a Flesch-Kincaid grade level of 4.6 and Flesch reading ease of 83.9%.

The questionnaire was primarily evaluated at the Veterans Affairs (VA) Medical Center in Philadelphia and at two other hospitals in China; demographic and questionnaire data by institution were evaluated using descriptive statistics, and significant differences were identified by χ and Fisher exact tests.

“Patient responses were displayed by each individual question and by the distribution of total scores. Kruskal-Wallis tests of significance were used for nonparametric or skewed data. Intraclass correlations (ICCs) were performed within the VA population to determine internal consistency of the individual questions. A high score was defined as greater than seven (the median value),” the researchers wrote in the study abstract.

“Total correct score for individual patients varied widely at each institution with a mean (SD) and median (interquartile range [IQR]) scores in all 3 hospitals of 6.15 (2.25) and 7 (5-8), respectively. The average numbers of correct responses for each institution were 4.38 (SD, 3.04) (median, 4 [IQR, 2-7]) at GZ; 7.05 (SD, 1.37) (median, 8 [IQR, 6-8]) at QD; 6.21 (SD, 1.74) (median, 7 [IQR, 6-7]) at VA; P = 0.0010. Two questions (Q4 and Q10) were identified as difficult to understand by patients and showed poor ICC (ICC = 0.0000, P > 0.5) at the VA,” according to the researchers’ conclusions.

“Questions that were more difficult to answer were (1) Q3: What inside the joint causes attacks of gout? (GZ, 28.6%; QD, 7.7%; VA, 72.4%; P = 0.000); (2) Q8: How long should patients continue with serum uric acid-lowering drugs? (GZ, 19.1%; QD, 10.3%; VA, 82.7%; P = 0.000); (3) Q6: The ideal serum uric acid to aim at during treatment? (GZ, 42.8%; QD, 89.7%; and VA, 17.2%; P = 0.000); and (4) Q5: Which drugs can lower serum uric acid? (GZ, 61.9%; QD, 89.7%; VA, 51.7%; P = 0.002).”

Reproducibility of Musculoskeletal Ultrasound for Determining Monosodium Urate Deposition: Concordance Between Readers

Musculoskeletal ultrasound is reliable for detecting monosodium urate deposition in femoral articular cartilage and first metatarsophalangeal joints in gout and asymptomatic hyperuricemia, according to a recent study published in Arthritis Care & Research.

Criteria for sonographic diagnosis of monosodium urate (MSU) crystal deposition have been developed, but the inter-reader reproducibility of this modality is not well-established. Researchers headed by Rennie Howard, MD, of the NYU Langone Medical Center/NYU Hospital for Joint Diseases, assessed agreement using a systematic approach.

Fifty male subjects ages 55-85 recruited during primary care visits to an urban VA hospital were assessed by musculoskeletal ultrasound (MSK-US) of the knees and 1(st) metatarsophalangeal (MTP) joints to evaluate for the “double contour” sign and tophi as evidence of MSU crystal deposition.

“Images were read by two blinded rheumatologists trained in MSK-US, and degree of concordance was determined for individual patients, total joints, femoral articular cartilage (FAC) and 1(st) MTP joints,” the researchers wrote in the study abstract.

Patients were further categorized into three diagnostic groups: gout, asymptomatic hyperuricemia (AH) (no gout, serum uric acid (UA) ≥ 6.9 mg/dL) and controls (no gout, UA ≤ 6.8 mg/dL), and reader concordance within these three groups was assessed.

“We observed almost perfect agreement between readers for: 1) individual patients (yes/no) (n=50, 100% agreement, kappa=1.000); 2) total joints (n=200, 99% agreement, kappa=0.942); 3) FAC (n=100, 99% agreement, kappa=0.942); and 4) 1(st) MTPs (n=100, 99% agreement, kappa=0.942). Furthermore, findings by side (right/left) and diagnostic group (gout, AH, control) showed substantial to almost perfect concordance for all measures,” the researchers concluded. MSU deposition was seen most commonly in gout patients, and deposition was also seen in some patients with asymptomatic hyperuricemia, but in only one control.

Sources

Gout Patients Surveyed Regarding Their Knowledge of Gout [Journal of Clinical Rheumatology]

Reproducibility of Musculoskeletal Ultrasound for Determining Monosodium Urate Deposition: Concordance Between Readers [Arthritis Care & Research]