Risk factors for loss to follow-up in patients with gout: A Korean prospective cohort study

Abstract

Objectives: Gout, a common form of inflammatory arthritis, is often managed with urate-lowering therapy, but many patients only adhere to treatment during gout attacks, resulting in poor follow-up and suboptimal management. This study aimed to identify characteristics associated with loss to follow-up (LTFU) and develop strategies for better patient management.

Methods: Data were analyzed from the Urate Lowering TheRApy in gout (ULTRA) registry, a prospective cohort of Korean gout patients recruited since September 2021. Patients aged 18 or older who met the 2015 ACR/EULAR classification criteria were included. Demographic data, clinical characteristics, lifestyle habits, comorbidities, and quality of life assessments using the Korean Gout Impact Scale (K-GIS) and EuroQol 5-Dimension (EQ-5D) were collected at baseline, six months, and annually. LTFU was defined as missing a clinic visit for more than a year. Logistic regression was used to determine factors associated with LTFU.

Results: Among 269 patients, 125 (46.5%) were classified as LTFU. Patients not lost to follow-up experienced more frequent gout attacks (P = 0.020) and expressed greater concerns about future flares (P = 0.034). In contrast, LTFU patients had higher levels of anxiety (P = 0.049), depressive symptoms (P = 0.009), impaired mobility (P = 0.002), and a higher EQ-5D score (P = 0.002). Logistic regression identified frequent gout attacks, concerns about attacks, anxiety, impaired mobility, and EQ-5D scores as significant predictors of LTFU.

Conclusion: Fewer gout attacks, heightened anxiety and depression, and lower quality of life were key factors associated with LTFU. Providing emotional support and comprehensive education may enhance follow-up and improve gout management.