Foot pain, impairment and disability in patients with acute Gout; a prospective observational study
Purpose: Acute gout typically presents as an extremely painful intermittent arthritis affecting the foot. The impact of acute gout flares on musculoskeletal function is not well described. The aim of this study was to evaluate the impact of acute gout on foot pain, impairment and disability. Design: Prospective observational study. Methods: A total of 20 patients (17 males, 3 females, mean age of 54.4 years) were recruited from hospital wards and rheumatology outpatient clinics within Auckland and Counties-Manukau District Health Boards. Patients were recruited at the time of an acute flare (baseline visit) and then reassessed at a follow-up visit after the flare had resolved 6-8 weeks later. Clinical characteristics including tender joint count, swollen joint count, patient global assessment, C-reactive protein and serum urate were assessed at both study visits. General and foot-specific outcome measures were used to assess pain, impairment, function and disability. These included the Health Assessment Questionnaire (HAQ-II), Foot Function Index, Lower Limb Tasks Questionnaire and the Leeds Foot Impact Scale. Data was analysed using paired t-tests. Results: At the baseline assessment, 14 (70%) of patients were suffering from acute flares affecting the foot. Acute flares were associated with high levels of pain, impairment and disability. All measures of pain, impairment, function and disability displayed improvement at the follow-up visit. Pain and disability scores did not return to normal levels after the resolution of the acute flares. Conclusion: Acute gout is associated with high levels of foot pain, impairment and disability. This suggests the management of gout needs to be improved, particularly foot related health.