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anti-infl ammatory drugs (NSAIDs) in the treatment of acute gout for reducing pain
severity; (2) topical ice in combination with oral prednisolone and colchicine is a
better modality than prednisolone and colchicine for the treatment of acute gout,
since it is associated with greater VAS pain; (3) subcutaneous anakinra and intra-
muscular ketorolac were associated with statistically signifi cant reductions in VAS
pain scores in patients with acute gout; (4) rilonacept was associated with statisti-
cally signifi cant reductions in VAS pain in patients with chronic gout compared to
placebo whereas pain scores did not signifi cantly differ by allopurinol use in chronic
gouty arthritis patients; and (5) biweekly pegloticase was associated with greater
VAS pain reduction in chronic gout patients compared to monthly pegloticase.
PROMs for Functional Limitation
Health Assessment Questionnaire-Disability Index (HAQ-DI)
HAQ-DI is a commonly used functional assessment in rheumatic conditions. Each
item on HAQ-DI is scored from 0 to 3, with 0 being “no diffi culty” to 3 being
“unable to do [ 57 ].”
Validation Data for HAQ-DI in Chronic Gout
Construct Validity: HAQ-DI score was associated with disease characteristics such
as tender joints, swollen joints, joints with limited mobility, and presence of tophi
[ 20 ]. In a multicenter cohort study, data were collected at baseline and 6 months
later for patients with gout. HAQ had high negative correlation (−0.69) with SF-36
physical functioning and bodily pain subscales, but low negative correlation with
SF-36 mental health subscale (−0.23) [ 20 ]. The mean (±SD) HAQ-DI score was
0.59 ± 0.77 and the mean difference between HAQ-DI at baseline and at 6 months
was 0.31 ± 0.58, the effect size being 0.62 [ 20 ]. The HAQ-DI improvements in
patients with chronic gout on various treatment regimens are described in the fol-
lowing paragraph.
In another study, patients with chronic refractory gout were allocated to one of
the three intervention groups: pegloticase biweekly, pegloticase monthly, and pla-
cebo. At 25 weeks, the proportion of patients with HAQ-DI greater than or equal to
a minimum clinically important difference of ≥10 points on 100 mm-VAS was
45 %, 48 %, and 16 %, respectively [ 9 ], a difference that was statistically signifi cant
between pegloticase biweekly and placebo ( p < 0.003) and pegloticase monthly and
placebo ( p < 0.001).
J. Singh and N. Shah