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Predictors of activity limitation in people with gout: a prospective study

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Abstract

The objective of the study was to determine clinical factors associated with activity limitation and predictors of a change in activity limitation after 1 year in people with gout. Two hundred ninety-five participants with gout (disease duration < 10 years) attended a baseline assessment which included medical and disease-specific history, pain visual analog score and plain radiographs scored for erosion and narrowing. Activity limitation was assessed using the Health Assessment Questionnaire-II (HAQ-II). After 1 year, participants were invited to complete a further HAQ-II; follow-up questionnaires were available for 182 participants. Fully saturated and stepwise regression analyses were used to determine associations between baseline characteristics and HAQ-II at baseline and 1 year, and to determine predictors of worsening HAQ-II in those with normal baseline scores. Median (range) baseline HAQ-II was 0.20 (0–2.50) and 0.20 (0–2.80) after 1 year of follow-up. Pain score was the strongest independent predictor of baseline HAQ-II, followed by radiographic narrowing score, type 2 diabetes, swollen joint count, BMI, age and urate (model R2 = 0.51, P < 0.001). Baseline HAQ-II was the strongest predictor of change in HAQ-II at 1 year, followed by tender joint count (model R2 = 0.19, P < 0.001). Of those with HAQ-II scores of 0 at baseline (n = 59, 32% of those with follow-up data), most did not progress (n = 52, 88%); however, baseline pain score, type 2 diabetes and flare frequency were significant predictors of worsening HAQ-II in this group (R2 = 0.34, P < 0.001). People with gout experience a wide range of activity limitation, and levels of activity limitation are, on average, stable over a 1-year period. Baseline pain scores are strongly associated with activity limitation and predict development of activity limitation in those with normal HAQ-II scores at baseline.

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Funding

This work was supported by the Arthritis New Zealand (R203), the University of Auckland Faculty Research Development Fund (9801/3623120) and the Henry Cotton Charitable Trust.

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Authors and Affiliations

  1. Health and Rehabilitation Research Institute, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand

    Sarah Stewart & Keith Rome

  2. Department of Radiology, Auckland District Health Board, Auckland, New Zealand

    Alastair Eason

  3. Department of Medicine, University of Auckland, Auckland, New Zealand

    Meaghan E. House, Anne Horne, Julie Knight & Nicola Dalbeth

  4. Radiology with Anatomy, University of Auckland, Auckland, New Zealand

    Anthony J. Doyle

  5. Department of Medicine, University of Otago, Wellington, New Zealand

    William J. Taylor

Authors
  1. Sarah Stewart
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  2. Keith Rome
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  3. Alastair Eason
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  4. Meaghan E. House
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  5. Anne Horne
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  6. Anthony J. Doyle
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  7. Julie Knight
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  8. William J. Taylor
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  9. Nicola Dalbeth
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Corresponding author

Correspondence to Sarah Stewart.

Ethics declarations

This study was approved by the New Zealand Multiregional Ethics Committee (MEC/06/10/114). All participants gave their informed consent prior to their inclusion in the study.

Conflicts of interest

ND has received consulting fees, grants or speaker fees from Takeda, Horizon, Menarini, AstraZeneca, Ardea, Pfizer and Cymbay outside of the submitted work. WJT has received consulting fees from AstraZeneca and Pfizer outside of the submitted work.

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Stewart, S., Rome, K., Eason, A. et al. Predictors of activity limitation in people with gout: a prospective study. Clin Rheumatol 37, 2213–2219 (2018). https://doi.org/10.1007/s10067-018-4110-6

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  • DOI: https://doi.org/10.1007/s10067-018-4110-6

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