Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK.
Rheumatology (Oxford). 2013 Nov;52(11):2031-40. doi: 10.1093/rheumatology/ket265. Epub 2013 Aug 11.
To identify the instruments that have been used to measure health-related quality of life (HRQOL) in gout and assess their clinimetric properties, determine the distribution of HRQOL in gout and identify factors associated with poor HRQOL.
Medline, CINAHL, EMBASE and PsycINFO were searched from inception to October 2012. Search terms pertained to gout, health or functional status, clinimetric properties and HRQOL. Study data extraction and quality assessment were performed by two independent reviewers.
From 474 identified studies, 22 met the inclusion criteria. Health Assessment Questionnaire Disability Index (HAQ-DI) and Short Form 36 (SF-36) were most frequently used and highest rated due to robust construct and concurrent validity, despite high floor and ceiling effects. The Gout Impact Scale had good content validity. Gout had a greater impact on physical HRQOL compared to other domains. Both gout-specific features (attack frequency and intensity, intercritical pain and number of joints involved) and comorbid disease were associated with poor HRQOL. Evidence for objective features such as tophi and serum uric acid was less robust. Limitations of existing studies include cross-sectional design, recruitment from specialist clinic settings and frequent use of generic instruments.
Most studies have used the generic HAQ-DI and SF-36. Gout-specific characteristics and comorbidities contribute to poor HRQOL. There is a need for a cohort study in primary care (where most patients with gout are treated) to determine which factors predict changes in HRQOL over time. This will enable those at risk of deterioration to be identified and better targeted for treatment.
确定用于测量痛风患者健康相关生活质量（HRQOL）的工具，并评估其临床计量学特性，确定痛风患者 HRQOL 的分布情况，并确定与 HRQOL 较差相关的因素。
从建库到 2012 年 10 月，检索 Medline、CINAHL、EMBASE 和 PsycINFO。检索词涉及痛风、健康或功能状态、临床计量学特性和 HRQOL。由两名独立评审员进行研究数据提取和质量评估。
从 474 项已确定的研究中，有 22 项符合纳入标准。由于具有良好的结构和同时效度，健康评估问卷残疾指数（HAQ-DI）和 36 项简短健康调查量表（SF-36）使用最频繁，评分也最高，但存在较高的地板效应和天花板效应。痛风影响量表具有良好的内容效度。与其他领域相比，痛风对身体 HRQOL 的影响更大。痛风的特定特征（发作频率和强度、间歇期疼痛和受累关节数）和合并症均与 HRQOL 较差相关。与客观特征（痛风石和血清尿酸）相关的证据则不那么充分。现有研究的局限性包括横断面设计、从专科诊所招募以及频繁使用通用工具。
大多数研究使用了通用的 HAQ-DI 和 SF-36。痛风的特定特征和合并症导致 HRQOL 较差。需要在初级保健（大多数痛风患者在此接受治疗）中开展队列研究，以确定哪些因素可以预测 HRQOL 随时间的变化。这将有助于识别那些有恶化风险的患者，并更好地针对这些患者进行治疗。
