Study Explores the Patient Perspective of Gout Remission

Patients described gout remission as having minimal or no gout symptoms, an absence of mental load, and freedom from dietary restrictions, while using multifaceted management strategies to ensure continued remission, according to a study published in Open Rheumatology.¹

Sarah Stewart, PhD

Credit: Australian Podiatry Conference 2023

A preliminary definition of gout remission criteria was first developed by a group of rheumatologists and researchers in 2016. According to the criteria, remission is defined as the absence of gout flares and tophi, gout-related to pain <2 on a 0 – 10-point scale, a serum urate <.36 mmol/l (<6 mg/dl), and a patient global assessment of disease activity <2 on a 0 – 10-point scale.²

“Although derived from the Outcome Measures in Rheumatology (OMERACT) core outcome domains, the preliminary criteria were developed from a rheumatologist-only perspective of remission,” wrote Sarah Stewart, PhD, associated with Auckland University of Technology, Auckland, New Zealand, and colleagues. “This is an important limitation to note because patient views about remission may not necessarily align with those of rheumatologists… Understanding how remission is experienced by patients will contribute to further refinement of gout remission criteria.”

Investigators conducted semi-structured interviews to explore the patient experience of gout remission and preliminary remission criteria in a group of patients recruited through gout databases and the Clinical Research Centre at the University of Auckland in New Zealand. Eligible patients had a gout diagnosis based on the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria, did not experience a flare within the preceding 6 months, and were receiving urate-lowering medication. Interviews were recorded and transcribed, and data were evaluated using a reflexive thematic approach.

A total of 20 patients with gout were participated in the interviews, of which 17 were male, the median age was 63 years, and disease duration ranged from 2 – 54 years. Most (95%) of patients considered themselves to be in gout remission and 80% fulfilled the preliminary remission criteria.

After analyzing the data, 4 key themes were identified regarding the patient-specific experience of remission: 1) minimal or no symptoms of gout, including absence of pain due to gout flare and smaller or no tophi; 2) the absence of dietary restrictions; 3) a lack of worry and awareness about their gout; and 4) management strategies designed to maintain remission, such as receiving urate-lowering therapy.

Good physical function, defined as perform daily activities, participate in sports, and attend social commitments without experiencing pain, was also reported under the minimal gout symptom theme. Patients noted the importance of having the confidence to consume foods and beverages previously deemed dietary triggers when their gout was active and believed it to be a sign of successful treatment.

Regarding the multifaceted management approaches, patients strongly contributed their continued success to urate-lowering treatments, but also noted fitness, including walking, cycling, and going to the gym, and healthy eating as important aspects of sustaining remission.

Although patients believed the preliminary remission criteria represented all relevant domains, they stated the pain and patient global assessment domains may overlap with the gout flares domain. Additionally, patients reported 12 months to be a more suitable time frame, as opposed to 6 months, to define remission.

Investigators noted including participants with a variety of demographic and clinical characteristics as a strength of the study. However, the long disease duration of some of the participants may have led to recall bias when comparing remission to when their gout was active. Another limitation is a possible lack of generalizability to other patients with gout, as this patient population was comprised of volunteers and those who participated in previous gout research.

References

1. ^{Tabi-Amponsah AD, Stewart S, Hosie G, Horne A, Dalbeth N. The Patient Experience of Gout Remission: A Qualitative Study [published online ahead of print, 2023 Jul 3]. ACR Open Rheumatol. 2023;10.1002/acr2.11579. doi:10.1002/acr2.11579}
2. ^{De Lautour H, Taylor WJ, Adebajo A, et al. Development of preliminary remission criteria for gout using Delphi and 1000Minds consensus exercises. Arthritis Care Res (Hoboken) 2016; 68: 667–72}