Predictors of Patient and Physician Assessments of Gout Control

ObjectiveTo understand the clinical variables that contribute to the patient and physician assessments of gout control and which variables predict discordant assessments. MethodsPatients (n = 223) with gout taking allopurinol >= 300 mg daily attended a standardized gout assessment visit. Participants and physicians completed questionnaires rating their assessment of current gout control using a numerical rating scale (0 = not at all controlled, 10 = fully controlled). Discordance between patients' and physicians' scores was defined as an absolute difference of >2 units. ResultsThe mean +/- SD patient gout control score was 8.09 +/- 2.24, and the physician gout control score was 7.38 +/- 2.63 (P < 0.001 for comparison). Absence of gout flares in the last 12 months and in the last 3 months and serum urate at the treatment target (<6 mg/dl) were associated with higher patient and physician gout control scores. Absence of tophus also predicted higher physician, but not patient, gout control scores. Discordant scores for gout control were present in 50 participants (22.3%), mostly due to lower assessment of disease control by physicians. Gout flare in the preceding 3 months (odds ratio [OR] 5.9, P < 0.001) and tophus (OR 3.1, P = 0.007) predicted discordant disease-control assessments in which physicians scored lower gout control than patients. ConclusionFor both patients and physicians, absence of gout flares and serum urate levels at the treatment target predict assessment of gout control. However, discordance between patients and physicians in their assessment of disease control is not uncommon, with recent gout flares and tophus predicting lower scores by physicians than patients.