Health outcomes associated with patient-perceived gout aetiology: a cross-sectional analysis of the GAPP Study baseline data

Abstract

Objectives: Current medical models of gout emphasise genetics and renal mechanisms in gout pathogenesis, in contrast to lay understanding that gout is caused by lifestyle factors. However, whether the perceived causative role of lifestyle factors contributes to sub-optimal health outcomes has not been substantiated quantitatively. This study examined the relationship between reported causes of gout and health outcomes.

Methods: As part of a larger randomised controlled trial (Trial Registration: ACTRN12616000455460), participants (n = 492) completed surveys at baseline in which they were asked to list three factors they believed caused their gout. Responses were grouped thematically and matched to participant serum urate (SU) levels, gout flare incidence, and self-reported urate-lowering therapy (ULT) adherence. Descriptive and regression analyses were performed, adjusted for age and sex.

Results: Most participants (63.4%) listed a lifestyle factor as the primary cause of their gout, most commonly diet (36.0%) or alcohol (14.4%). Fewer people reported physiological factors (28.3%), typically genetics (19.9%). Individuals who perceived gout to be primarily caused by lifestyle factors had higher concentrations of SU (β = 0.02; 95% CI: 0.01 to 0.04; p = 0.020) and lower odds of having target SU level of ≤ 0.36 mmol/L (OR = 0.64; 95% CI: 0.41 to 0.99; p = 0.043). Perceiving physiological factors as the primary cause of gout was associated with lower SU and higher odds of having target SU.

Conclusion: The perception that gout is caused by lifestyle excess remains prevalent among patients and may contribute to poor SU control. Patient education as to the physiological causes of gout may support management.

Trial registration: Australian New Zealand Clinical Trials Registry (Trial Registration: ACTRN12616000455460, Date registered: 7/04/2016). Key Points • The majority of gout patients continue to perceive gout as a disease of lifestyle excess. • Perceiving gout to be caused by lifestyle factors was associated with poorer health outcomes. • Perceiving gout to have a physiological aetiology was associated with better health outcomes.

Keywords: Gout; Illness perceptions; Medication adherence.