Experience of finding footwear and factors contributing to footwear choice in people with gout: a mixed methods study using a web-based survey.

BACKGROUND: Gout frequently affects the foot, particularly the first metatarsophalangeal joint. People with gout commonly wear ill-fitting footwear that lacks cushioning and support, which may further contribute to foot pain and disability. Footwear with good cushioning and motion control may be an effective non-pharmacological intervention. Currently, there is limited understanding about the footwear experience in people with gout. The aim was to understand footwear characteristics, experience of finding footwear, and factors contributing to footwear choice, in people with gout. METHODS: A web-based survey of people visiting a gout education website. Participants self-reported a diagnosis of gout. The 17-item survey included questions to elicit demographic and clinical characteristics, type of footwear worn, level of difficulty finding appropriate footwear, and factors contributing to choices about footwear. A mixed quantitative and qualitative methodology was used to report survey findings. RESULTS: Survey respondents (n = 83) were predominately White/Caucasian (84%), male (58%), and aged between 46 and 75 years-old (73%). Thirty-nine percent were newly diagnosed (< 12 months), 43% had gout for 1-10 years, and 19% had disease over 10 years. Gout flares in the feet were reported by 77 (93%) respondents, mostly in the big toe joint (73%). Seventy-six (92%) participants completed questions about footwear. Closed-in athletic shoes (88%), sturdy walking shoes (79%), and casual closed-in slip-on shoes (63%) were most frequently worn. Orthopaedic shoes were worn least often (16%). Comfort, fit, support, and ease to put on/take off were the features most often rated as important or very important when choosing footwear. Over half the respondents (64%) reported difficulty in finding footwear. Three categories, encompassing seven subcategories, were identified from the qualitative analysis to describe experiences of footwear. Categories included difficulty finding suitable shoes; impact of shoes on activity; and preferred footwear. CONCLUSIONS: People with gout need comfortable shoes that conform to the foot, have a wide opening, made from pliable materials with adjustable straps. The main barriers related to footwear include difficulty finding shoes that are wide enough, suitable for work and aesthetically pleasing. These findings provide clinicians with important insights into the priorities and needs of people with gout that should be considered when developing footwear interventions.

Rogue one: a story of tophaceous gout in the spine.

A 26-year-old man with history of extensive tophaceous gout presented to the referring facility with decreased bilateral lower extremity sensation and motor function that began acutely 1 week prior to admission and had progressed to urinary incontinence. The patient was admitted to the intensive care unit due to concern for sepsis secondary to epidural abscess. The patient was started on empiric vancomycin and cefepime. Neurosurgery did not recommend acute neurosurgical intervention given the lack of a compressive lesion. Aspiration of the paraspinal collection by interventional radiology subsequently showed crystals consistent with tophaceous gout. Given the high initial suspicion for gout and results of the paraspinal aspiration, the patient was started on prolonged steroid taper as well as allopurinol and colchicine. The patient eventually had partial neurological recovery with discharge to an inpatient rehabilitation facility for further physical therapy rehabilitation.

Health-related quality of life in gout: a systematic review.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Perceptions of disease and health-related quality of life among patients with gout.

OBJECTIVE: To assess the impact of gout on health-related quality of life (HRQoL) among patients in three large US cities. METHODS: Gout patients completed the Short Form-36 (SF-36) and a series of questions regarding their gout, comorbidities and demographics. Their physicians confirmed the gout diagnosis and evaluated the severity of patient's gout. The differences in mean norm-based SF-36 scores between the US norms and gout patients and between subgroups of gout patients were calculated. The relative weight and significance of gout-related characteristics associated with patients' HRQoL were also calculated. RESULTS: The majority of the patients were males with a mean age of 62.2 years and median disease duration of 13.8 years. Most were overweight/obese with several comorbidities. Half of the patients experienced three or more gout attacks per year with a typical gout attack involving five joints and lasting for at least 4 days. The Physical Component Summary (PCS) and Mental Component Summary (MCS) was significantly lower for gout patients (P < 0.002 and P < 0.001, respectively). Among gout patients, the mean PCS and MCS were lower for those with more frequent gout attacks and greater number of affected joints (P < 0.005 and P < 0.001, respectively). After adjusting for age, gender and comorbidities, the number of joints involved during a typical and the worst gout attack had the greatest impact on patient's PCS and MCS. CONCLUSION: Gout patients had clinically significant lower HRQoL than their age-matched US norm. Comorbidities and several additional gout-related factors significantly impacted the overall HRQoL.

Is gout associated with reduced quality of life? A case-control study.

OBJECTIVES: To compare quality of life (QOL) between gout cases and controls in a primary care population and to investigate whether impaired QOL in gout is secondary to co-morbid factors or to intrinsic factors related to gout itself. METHODS: A postal questionnaire was sent to all adults aged over 30 yrs registered with two general practices. The questionnaire assessed a history of gout (doctor diagnosed, or episodes suggestive of acute crystal synovitis) and medical and musculoskeletal co-morbidities. QOL was assessed using the WHOQoL-Bref instrument. Possible cases of gout attended for clinical assessment where the diagnosis was verified on clinical grounds. Overall QOL, satisfaction with health and QOL across four domains were compared between gout cases and controls and then entered into a linear regression model adjusting for gout, age, gender, body mass index and medical and musculoskeletal co-morbidities. RESULTS: Of 13 684 questionnaires mailed, 3082 completed questionnaires were returned (23%). From 289 suggested cases of gout, 137 cases were confirmed by clinical assessment. Compared with controls, cases had impaired overall QOL (15.67 vs 16.41, P = 0.003), satisfaction with health (13.16 vs 14.45, P < 0.001) and physical health-related QOL (14.08 vs 15.95, P < 0.001). On multi-variate analysis, gout remained associated with impaired physical health-related QOL (beta = -0.059, P = 0.001) but not overall QOL (beta = -0.024, P = 0.198) or satisfaction with health (beta = -0.028, P = 0.142). CONCLUSIONS: Gout associates with poor overall QOL mainly resulting from associated co-morbidity. Physical health-related QOL, however, remains impaired after adjustment for co-morbidities.

[Changes in the epidemiology, symptomatology and prognosis of gout]. / Veränderungen von Epidemiologie, Symptomatologie und Prognose der Gicht.

Hardly any other disorder in this century has been subject to such strong changes--referring to epidemiology and symptomatology--as was gout. These changes were all linked to fundamental social upheavals. In the past 4 decades effective medicamentous possibilities of treating hyperuricaemia and gout have been added. The clinical picture of gout is being obscured by many and partly indiscriminate beginnings of treatment of innocuous or symptomless hyperuricaemias that were found by accident on the occasion of a medical checkup; attacks of gout and classical gout-specific morphological degenerations have become rare in spite of a still increasing number of hyperuricaemias among the general population. For these reasons epidemiological inquiries about gout lack any solid foundation. It is rather appropriate to speak only of "potential" gout, of a constellation which--if untreated--would probably mean manifest gout sometime. Because of the numerous accompanying diseases which usually attack patients with gout and which mostly occur combined with other disorders (such as obesity, lesions of the liver and kidneys, high blood pressure, disorders of the lipoprotein and carbohydrate metabolism), those patients' life expectancy--if they are not treated--is limited anyway. Most of these accompanying diseases can contribute to the development of an early severe atherosclerosis the consequences of which do lead to the death of most of the untreated "cases". Today gout as an arthropathy can be considered to be overcome--punctual and correct medical treatment provided; also the numerous accompanying diseases are well treatable today.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in uric acid and blood lipids in patients with asymptomatic hyperuricemia treated with diet therapy in a rehabilitation procedure]. / Veränderungen der Harnsäure und der Blutfette bei Patienten mit asymptomatischer Hyperurikämie unter diätetischer Therapie während eines Rehabilitationsverfahrens.

More than 300 patients with asymptomatic hyperuricaemia had been included in lipometabolic analysis performed before and after 4 weeks of a special low-cholesterol, low-triglyceride and low-purine dietetic regimen. Remarkable in almost the entire hyperuricaemic population (96.7%) had been the presence of serum cholesterol levels of more than 200 mg/dl. Lipoprotein analysis showed that 87% of the patients had increased LDL- and 69% increased VLDL-levels; HDL-levels were pathologically lowered to below 40mg/dl in 41% of the group. After a four-week rehabilitation programme, all lipometabolic parameters and serum urate concentrations were found to have been significantly reduced by the special diet. The results therefore are impressive proof of the major health benefits of purposive nutritional behaviour.

[Rehabilitation of patients with gout during outpatient follow-up]. / Reabilitatsiia bol'nykh podagroi pri dispansernom nabliudenii.

The authors presented the results of a 5-year follow-up of 50 gout patients who had been regularly (no less than 3-4 times a year) examined in outpatient clinics. Dispensary examinations of the patients resulted in a decrease in the level of uric acid and in the number of exacerbations of gouty arthritis, the reduction of the sizes of tophi or their disappearance. Regular examination and ultrasonic investigation made it possible to prevent in some cases attacks of urolithiasis, and to reduce 4-fold a disability time-period and to preserve working capacity in 96% of the patients. The study showed that in most of the patients with essential hypertension and coronary heart disease arterial pressure got stable and the number of angina attacks was on a decrease. The data obtained indicated a high efficacy and appropriateness of combined rehabilitation activities in gout patients.

Bilateral total hip arthroplasty: a simultaneous procedure.

Fifty patients undergoing bilateral total hip replacement as a simultaneous procedure at the Indiana University Medical Center were compared with 50 patients undergoing unilateral total hip replacement. There was an increase in phlebitis and myositis ossificans in the patients undergoing bilateral total hip replacement and while their range of motion was less, there was no difference in mortality with one death in each group. The hospital time for patients in the bilateral group averaged 1 week longer than for those with unilateral hip replacement. The operating time and blood loss in patients of the bilateral group was approximately twice that of patients in the control group. There have been no infections as yet in the bilateral group. On the basis of these preliminary results, we can consider bilateral total hip arthroplasty feasible although it carries a slightly increased risk.