The following article is a part of conference coverage from the American College of Rheumatology Convergence 2020, being held virtually from November 5 to 9, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2020.
Among patients with gout, high serum urate levels are associated with poorer health-related quality of life (HRQoL) outcomes, according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.
As limited data exist on the association of serum urate levels with functional limitations and HRQoL in gout, the objective of the current study was to determine the link between changes in serum urate levels with HRQoL.
Data were collected from 5 interventional clinical trials, including Combining Lesinurad With Allopurinol in Inadequate Responders (CLEAR1 and CLEAR2; n=1217; 12 months); Long-term Allopurinol Safety Study Evaluating Outcomes in Gout (LASSO; n=1735; 6 months); Lesinurad Monotherapy in Gout Subjects Intolerant to Xanthine Oxidase Inhibitors (LIGHT; n=214; 6 months; Combination Treatment Study in Subjects With Tophaceous Gout With Lesinurad and Febuxostat (CRYSTAL; n=330; 12 months). In each trial, levels of serum urate were assessed monthly and HRQoL measures were determined at baseline and every 3 months (LASSO trial only at baseline and 6 months).
The primary outcomes were physical component summary (PCS) and mental component summary (MCS) from Short-Form 36 data, Health Assessment Questionnaire Disability Index Score (HAQ-DI), Sheehan Disability Scale (SDS) score, Patient Global Assessment (PGA), and pain in the last week.
Higher current serum urate correlated with reduced PCS (beta, -0.334; 95% CI, -0.45 to -0.22) and MCS (beta, -0.240; 95% CI, -0.35 to -0.13), increased SDS (beta, 0.335; 95% CI, 0.23-0.44), PGA (beta, 0.792; 95% CI, 0.49-1.10), and pain (beta, 0.828; 95% CI, 0.38-1.28), but not with HAQ-DI Score.
Absolute change in serum urate levels in the preceding month correlated with all HRQoL measures in the first 6 months with initiation or change of urate-lowering therapy, including poorer HAQ-DI outcomes (beta, 0.013; 95% CI, 0.007-0.019), reduced PCS (beta, -0.120; 95% CI, -0.26 to -0.08) and MCS (beta, -0.345; 95% CI, -0.49 to -0.20), increased SDS (beta, 0.175; 95% CI, 0.04-0.31), PGA (beta, 0.500; 95% CI, 0.10-0.90), and pain (beta, 0.666; 95% CI, 0.17-1.17).
When absolute change in urate levels in the preceding month were stratified into increasing (n=4023) and decreasing (n=2910) levels, reduction in serum urate levels was associated with poorer outcomes in all HRQoL measures, including PCS (beta, -0.266; 95% CI, -0.47 to -0.07) and MCS (beta, -0.375; 95% CI, -0.57 to -0.18), HAQ-DI (beta, 0.019; 95% CI, 0.01-0.029), SDS (beta, 0.323; 95% CI, 0.14-0.51), PGA (beta, 0.954; 95% CI, 0.41-1.50), and pain (beta, 1.226; 95% CI, 0.56-1.89).
“This study provides further support for serum urate as central to disease pathophysiology and its impact on an individual’s health,” the study authors concluded.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
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Topless R, Merriman T, Noorbaloochi S, Singh J. Changes in serum urate, in the first 6-months of initiation or change of urate-lowering therapy, associate with immediate health-related quality of life outcomes in people with gout. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0600.