Objectives: To determine the proportion of people with gout who identify triggers of acute attacks; identify commonly reported triggers, and examine the disease and demographic features associated with self-reported triggers of acute gout.
Methods: Individuals with gout who participated in three community-based gout studies including one randomised controlled trial (n=516, to be published), one proof of concept (n=110) and one biomarker study (n=112) were sent a questionnaire enquiring about perceived triggers for acute gout attacks (1, 2). Binary logistic regressions were used to compute odds ratio and 95% confidence intervals to examine the association between having ≥1 self-reported triggers of acute gout and disease and demographic risk factors.
Results: 550 participants returned completed questionnaires. 214 (38.91%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45% respectively). Patients who had onset of gout before the age of 50 years were significantly more likely to identify at-least one trigger of acute gout (aOR (95%CI) 1.77 (1.15 - 2.72) after adjusting for their current age, sex, presence of tophi, body mass index, current serum uric acid and source of recruitment. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors.
Conclusion: Over 60% patients with gout do not identify any triggers that bring on their gout attacks. Patients with earlier onset of the disease (<50 years) are significantly more likely to identify triggers of acute attacks, of which alcohol was the commonest.
References: 1. Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2013 Jun;72(6):826-30. 2. Valdes AM, Manon-Jensen T, Abhishek A, Jenkins W, Siebuhr AS, Karsdal MA, et al. Intercritical circulating levels of neo-epitopes reflecting matrixmetalloprotease-driven degradation as markers of gout and frequent gout attacks. Rheumatology (Oxford). 2016 Sep;55(9):1642-6.