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to ask about their feelings and the impact of gout on work productivity or social life
more than about their physical examination or laboratory fi nding, which physicians
might be more interested in [ 19 ]. Establishing a common understanding may be
important for meeting patients’ needs and for improving their satisfaction with
health care and adherence to treatment. PRO measurement also may be used to
monitor outcomes as a strategy for quality improvement or to reward presumed
superior care in clinical practice [ 18 ].
Third, as a chronic disease , gout has a widespread impact. It not only affects a
patient’s life and his/her work, but also the family, the society, and the health care
system [ 20 – 23 ]. Systematic reviews have demonstrated that gout has signifi cant
impact on the activities of daily living and HRQOL [ 24 , 25 ]. Patients with gout suf-
fer from severe pain, dependency, work disability, dietary restrictions, and social
isolation [ 18 ]. This impact may differ by race/ethnicity and gender [ 23 ]. For exam-
ple, compared to Caucasians with gout, African-Americans are more likely to report
dietary restrictions due to gout, associated emotional burden, severe pain during
gout fl ares, the need for canes/crutches during fl ares, and gout bringing their day to
a halt [ 23 ]. Whether some of these differences may be partially attributable to lower
adherence to urate-lowering therapy (ULT) in African-Americans is unclear [ 26 ].
Gout increases the dependency on family members for daily activities of life dur-
ing the gout fl ares , but also due to the disability associated with chronic gout [ 23 ,
27 ]. Gout is associated with signifi cantly higher number of days absent from work
compared to those without gout in United States [ 28 ]. Also, the overall productivity
at work is affected by gout. Employees with gout processed 3.5 % fewer units of
work per hour compared to employees without gout [ 29 ]. Gout also leads to signifi -
cant burden on the health care system. This burden is attributed to increase in the
number of hospitalizations and cost of care. As per a U.S. Bone and Joint Decade
report, gout and other crystal arthropathies accounted for 1.5 % of the 1.17 million
nonfederal, short stay hospitalizations in 2007 [ 30 ]. Gout led to 2.3 million ambula-
tory care visits annually from 2001 to 2005 in the USA [ 31 ]. Using data from the
Medical Expenditure Panel Survey (MEPS) a nationally representative survey of the
US civilian, non-institutionalized population, the estimated all-cause annual cost of
gout in the USA was $31.8 billion or $11,663 per person, using 2011 infl ation
adjusted dollars. Another study estimated that the estimated cost attributable to gout
was 24 % of all-cause gout expenditures ($7.7 billion) [ 31 ]. Thus, in addition to
associated personal and family suffering, gout is associated with signifi cant societal
and health care burden.
Lastly, PROs have been shown to have higher sensitivity to effects of treatment
compared to physician reported measures in clinical trials [ 32 ]. PROs differ from
physician reported outcomes in terms of disease/symptom presence, symptom fre-
quency, and symptom severity, and therefore may lead to discordant reports [ 33 ].
For example, fatigue and symptom severity reporting were moderately discordant
between physicians and patients [ 34 , 35 ]. For conditions that are associated with
pain, disability, and HRQOL defi cits, such as gout, the best assessments for these
outcomes are likely PROMs, rather than physician reported measures.
J. Singh and N. Shah