Background: Gout is a chronic, inflammatory joint disease, significantly effecting Health-Related Quality of Life. Patients with gout report pain, loss of mobility, reduced capacity for daily activities and dependency on others, as consequences of the disease [1]. Yet little is known about its impact on Health-Related Quality of Life (HRQoL), as measured with the utility instruments EQ-5D-5L and SF-6D [2]. Although effective treatments exist, gout is often undertreated. Treatment initiation with urate lowering therapy is likely to improve patient’s health related quality of life. EULAR recommends a treat to target strategy with urate lowering therapy dosed up until a target of uric acid of <6mg/dL (<360mmol/L) [3]. Studies investigating developments in HRQoL over time when following a treat to target treatment strategy are lacking in the published literature.

Objectives: In patients initiating a treat to target strategy, we wanted to measure patients’ health-related quality of life at regular intervals using the EQ-5D-5D and the SF-6D, describe developments in HRQoL over a period of five years and to compare the estimates from the two instruments.

Methods: In the prospective NOR-Gout study, 211 patients with confirmed gout were included to a treat to target strategy with urate lowering therapy with allopurinol or febuxostat. Patients were frequently tested and received monthly dose escalation until SUA was at target (<360 µmol/L or <300 µmol/L if tophi). Patients were assessed at baseline, at month 3, and 6, at year one, year two, with a final assessment at five years. At each of these visits, HRQoL was measured using the EQ-5D-5L and the SF-36, SF-36 was transformed to the preference based SF-6D. Utility values for the instruments were obtained using predefined algorithms. Intra-class correlation and Bland-Altman plot were used to evaluate the agreement between the instruments, summary scores were also compared.

Results: Included patients were predominately male (95%), with an average age of 56 years old. At baseline, 15% were prescribed treat-to-target urate lowering therapy with allopurinol. The percentage receiving prophylactic treatment increased to 100% after study initiation and the predetermined target of SUA (<360µmol/L), was met in 85% of patients after one year of follow up [4]. Patients improved in all domains of health, but mostly in pain and mobility for the EQ-5D and in pain and role limitations for the SF-6D (Table 1). The mean score for EQ-5D-5L and SF-6D increased over time, from a baseline of 0.81 and 0.71, respectively, to 0.88 and 0.81 at year five (Figure 1). The Intra-Class Correlation between EQ-5D-5L and SF-6D indicated moderate to low correlations between dimension of health included in the two instruments, whereas the Bland-Altman plot shows significant inconsistencies across higher and lower values. Summary scores from the two instruments are correlated, but significantly different.

Conclusion: Following a treat-to-target strategy, HRQoL values increased with 0.07 and 0.098 over a period of five years. Although no minimal clinical important difference has been established for these instruments, a value of 0.03 has been suggested. Compared to the size of improvements often seem in health economic evaluations, with a median incremental gain was 0.06 across all types of interventions and diseases [5], the improvements seen in these gout patients represents quite a large health gain. Findings endorse that treat-to-target ULT improves HRQoL.

REFERENCES: [1] Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol. 2011;17(1):1-6.

[2] Chandratre P, Roddy E, Clarson L, Richardson J, Hider SL, Mallen CD. Health-related quality of life in gout: a systematic review. Rheumatology (Oxford). 2013;52(11):2031-40.

[3] Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Lioté F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29-42.

[4] Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Perez-Ruiz F, et al. One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study. Arthritis Res Ther. 2022;24(1):88.

[5] Wisløff T, Hagen G, Hamidi V, Movik E, Klemp M, Olsen JA. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics. 2014;32(4):367-75.

Figure 1.

Developments in HTQoL over time

Acknowledgements: NIL.

Disclosure of Interests: Gunhild Hagen Pfizer 2015-2018, Lars Fridtjof Karoliussen: None declared, Joe Sexton: None declared, Espen A. Haavardsholm Novartis, AbbVie, Eli Lilly and Pfizer, Sella Aarrestad Provan: None declared, Hilde Hammer AbbVie, UCB, Novartis and Lilly, Till Uhlig: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.