Becker Michael A, Schumacher H Ralph, Benjamin Katy L, Gorevic Peter, Greenwald Maria, Fessel Jeffrey, Edwards Lawrence, Kawata Ariane K, Frank Lori, Waltrip Royce, Maroli Allan, Huang Bill, Sundy John S
Division of Biological Sciences, Rheumatology Section, University of Chicago, Chicago, IL, USA.
J Rheumatol. 2009 May;36(5):1041-8. doi: 10.3899/jrheum.071229. Epub 2009 Mar 30.
The relationship between self-reported quality of life and disability and disease severity was evaluated in subjects with treatment-failure gout (n = 110) in a prospective, 52-week, observational study.
Subjects had symptomatic crystal-proven gout of at least 2 years' duration and intolerance or refractoriness to conventional urate-lowering therapy. Serum uric acid (sUA) concentration, swollen and tender joint counts, frequency and severity of gout flares, tophus assessments, comorbidities, and patient-reported outcomes data [Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire-Damage Index] were collected. Analyses included correlations of patient-reported outcomes with clinical variables and changes in clinical status.
Mean age of study subjects was 59 years. Mean scores on SF-36 physical functioning subscales were 34.2-46.8, analogous to persons aged >or= 75 years in the general population. Subjects with more severe gout at baseline had worse health-related quality of life (HRQOL) in all areas (p < 0.02 for all measures), compared to patients with mild-moderate disease. Number of flares reported in past year, number of tender joints, swollen joints, and tophi correlated significantly with some or all HRQOL and disability measures. sUA was not significantly correlated with any HRQOL or disability measure. Subjects with comorbidities experienced worse physical, but not mental, functioning.
Severe gout is associated with poor HRQOL and disability, especially for patients who experience more gout flares and have a greater number of involved joints. Subject perceptions of gout-related functioning and pain severity appear to be highly sensitive indicators of HRQOL and disability.
在一项为期52周的前瞻性观察性研究中，对110例治疗失败的痛风患者的自我报告生活质量与残疾及疾病严重程度之间的关系进行评估。
研究对象有症状性经晶体证实的痛风，病程至少2年，对传统降尿酸治疗不耐受或难治。收集血清尿酸（sUA）浓度、肿胀和压痛关节计数、痛风发作频率和严重程度、痛风石评估、合并症以及患者报告的结局数据[医学结局研究简表36（SF-36）、健康评估问卷损伤指数]。分析包括患者报告结局与临床变量的相关性以及临床状态的变化。
研究对象的平均年龄为59岁。SF-36身体功能分量表的平均得分在34.2至46.8之间，类似于普通人群中年龄≥75岁的人群。与轻中度疾病患者相比，基线时痛风更严重的患者在所有领域的健康相关生活质量（HRQOL）更差（所有测量指标p<0.02）。过去一年报告的发作次数、压痛关节数、肿胀关节数和痛风石与部分或所有HRQOL及残疾测量指标显著相关。sUA与任何HRQOL或残疾测量指标均无显著相关性。有合并症的患者身体功能较差，但心理功能无差异。
严重痛风与较差的HRQOL和残疾相关，尤其是对于痛风发作更频繁且受累关节数量更多的患者。患者对痛风相关功能和疼痛严重程度的认知似乎是HRQOL和残疾的高度敏感指标。
