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Gout Aware Newsletter, Issue #001 -- teaser here
July 31, 2015
Welcome to the latest edition of the Gout Aware newsletter. Featuring all the latest gouty news from around the world.
Gout Limits Function of Lower Extremities in Older Adults
Older adults with gout and hyperuricemia are more likely to have worse lower extremity function than their peers, but their upper body function appears to be similar, a study has shown.
Lower extremity function is especially poor in patients with gout who are older, who have a higher body mass index, who are of black race, and who have a history of stroke, diabetes, and osteoarthritis, Bridget Teevan Burke, MS, MPH, from the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and colleagues report in an article published online July 2 in Arthritis Care & Research.
To assess the relationship between physical function and gout and hyperuricemia, the investigators conducted a cross-sectional analysis comprising 5819 individuals from the ongoing, prospective Atherosclerosis Risk in Communities (ARIC) study who had self-reported gout status, hyperuricemia data, and available physical function measurements. The physical function measures include the Short Physical Performance Battery (SPPB), grip strength assessment, and a 4-m walking test.
Of the 5819 participants, 10% reported a history of gout, and 21% had hyperuricemia. The physical function analysis showed that participants with gout performed worse than those without gout on the SPPB. The prevalence odds of a 1-unit increase in their SPPB score were 0.77, and they were 1.18 times more likely to have a poor SPPB score, the authors report.
Although the association between gout and SPPB score was not different between men and women, the association between gout and poor SPPB performance was greater in men, the authors observe.
With respect to walking speed, patients with gout had slower walking speeds and were 1.19 times more likely to have poor walking speed than those without gout, and the association between gout and poor walking speed was greater in men, the authors report.
There was no difference in grip strength by history of gout overall and by sex, according to the analysis.
As with gout, patients with hyperuricemia had worse SPPB scores and walking speeds, but no difference was observed by grip strength, the authors write.
The investigators analyzed the data for predictors of poor physical function. Among older adults with gout, the likelihood of poor SPPB score increased with every 5-year increase in age (prevalence ratio [PR], 1.27; 95% confidence interval [CI], 1.16 - 1.39), as well as for every 5 kg/m2 increase in BMI (PR, 1.10; 95% CI, 1.02 - 1.19). Poor SPPB score was also more alike for subjects who were black (PR, 1.35; 95% CI, 1.09 - 1.66), current smokers (PR, 1.45; 95% CI, 1.04 - 2.04), and those with a history of stroke (PR, 1.47; 95% CI, 1.06 - 2.04), diabetes (PR, 1.54; 95% CI, 1.27 - 1.88), and osteoarthritis (PR, 1.60; 95% CI, 1.25 - 2.03), the authors report, noting that similar factors for poor walking speed were identified.
Sensitivity analyses showed that the association between hyperuricemia and physical function was similar among participants with and without a history of using gout medication, and that disease duration was not associated with physical function performance.
Although the researchers expected that older adults with gout and hyperuricemia were likely to have worse physical function overall, "We were surprised to see that these associations were limited to lower extremity function," according to principal investigator Mara McAdams DeMarco, PhD, assistant professor, Department of Epidemiology, Department of Surgery, Johns Hopkins. "However, this makes sense, given that the most common localizations of affected joints are in the lower extremity. Patients with gout are most likely to be first affected by lower extremity joints."
Although previous research has focused on irreversible joint damage resulting from gout, "our study suggests that prior to the onset of joint damage, those with gout are at risk of poor physical function," Dr DeMarco told Medscape Medical News. "This deficit in lower extremity physical function is associated with increased risk of mortality in older adults."
The findings also have relevance to clinical practice, Dr DeMarco noted. "Physicians can recognize these high-risk subgroups of older adults with gout in their clinical population and potentially counsel the patients on the benefits of exercise to improve lower extremity physical function."
This study was jointly funded by the Arthritis National Research Foundation and the American Federation for Aging Research. The authors have disclosed no relevant financial relationships.
Arthritis Care Res. Published online, 2015. Abstract
South Shields woman died after taking lethal dose of gout medication
South Shields woman died after taking lethal dose of gout medication
By Sonia Sharma
Kerry Mullen's body was found at her home in Devonshire Street, South Shields on February 7 this year
After her death, her partner was initially arrested and questioned by police. But he was later released without charge after it was found there was no third-party involvement.
At an inquest in Hebburn, it was said that concerns had been raised after paramedics found a red mark around Miss Mullen’s neck.
Det Sgt David Wakefield told the hearing there had been a history of domestic violence between Miss Mullen and her partner. He added: “They had quite a volatile and violent relationship.
“Since December 2012, we had 30 separate reports of domestic violence. Both were alcoholics.”
He said that, from December onwards, the couple had been staying with two other friends and Miss Mullen occasionally returned to Devonshire Street.
Then, on February 7, her body was found at her home.
A post-mortem examination found there was no evidence of any trauma or violence. However, there was a fatal level of Colchicine in her system – a drug used to treat gout. The medication had been prescribed to her partner three days before her death.
Coroner Terence Carney said there was no evidence to suggest Miss Mullen had taken her own life and concluded she died accidentally.
He added: “It is my belief that, unfortunately, she has not appreciated what she was taking. This was an unintended event. The effects of Colchicine were not known to her.”
Measuring Quality of Life in Patients with GoutThe prevalence of gout in the United States continues to rise, with some estimates indicating that as many as 9 million adults suffer from the condition—close to 4% of the population. Quality of life for patients suffering from gout can be dismal, and patients with gout will generally need some form of urate-lowering therapy (ULT) on a long-term basis, according to American College of Rheumatology and European League Against Rheumatism guidelines. But will they stay on those medications? Despite the availability of effective and tolerable therapies, many gout patients do not achieve target serum urate levels, in part due to poor adherence to therapy. Studies have shown that patient satisfaction with treatment directly impacts whether or not they choose to adhere to their medication therapy. A recent study in Patient Preference and Adherence looked at patient satisfaction with treatment via a mail survey to a managed care population. (The study authors all have connections to Takeda pharmaceuticals, manufacturers of febuxostat, one of the leading ULTs.) Eligible patients were over the age of 18 with self-reported gout who filled more than one prescription for febuxostat and were not taking other ULTs. Patients were stratified by self-report of currently experiencing a gout attack or not to assess the discriminant ability of the questionnaires. The survey included the Treatment Satisfaction Questionnaire for Medication (TSQM) and gout-specific health-related quality of life (HRQoL) with the Gout Impact Scale (GIS). While the TSQM has been used in studies of other rheumatic diseases, the study authors believe this is the first time it has been used to evaluate treatment satisfaction among gout patients. - See more at: http://www.hcplive.com/medical-news/measuring-quality-of-life-for-patients-with-gout#sthash.c2SSuIb4.dpuf
The final analytic sample included 257 patients who were taking only febuxostat when they completed the survey.Treatment satisfaction was assessed by the TSQM version II. Patients were asked on the TSQM to rate their level of satisfaction with the ULT they were currently taking for gout. The TSQM has 11 items, scored from 0 to 100, with higher scores indicating better satisfaction. Patients with current gout attack (n=29, 11%) had worse scores than those without gout attack on most instrument scales. Mean differences between current attack and no current attack for the TSQM domains were: -20.6, effectiveness; -10.6, side effects; -12.1, global satisfaction (all P<.05); and -6.1, convenience. For the GIS, mean differences were: 30.5, gout overall concern; 14.6, gout medication side effects; 22.7, unmet gout treatment needs; 11.5, gout concern during attack (all P<.05); and 7.9, well-being during attack (NS). Correlations between several TSQM and GIS scales were moderate. According to the study authors, “There were several moderate correlations between the TSQM and GIS scales, supporting the relationship between treatment satisfaction and HRQoL. The moderate correlations between the GIS unmet gout treatment needs and TSQM global satisfaction (-0.50) and effectiveness (-0.40) scales suggest that both measures captured the degree to which patients believed that their medication was beneficial for their gout treatment. The correlation between the side effect scales of the GIS and TSQM was also moderate (-0.46), indicating consistent findings from both instruments.” Limitations of the study include the fact that almost all patients were taking febuxostat for at least 60 days, which may bias the results in favor of patients satisfied with treatment. The study also lacked a formal comparator group of patients taking a ULT other than febuxostat. - See more at: http://www.hcplive.com/medical-news/measuring-quality-of-life-for-patients-with-gout/P-2#sthash.c9oTzSEI.dpuf
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