About one-third of patients with gout may report a constant pain pattern rather than the traditional pattern of intermittent flares separated by pain-free periods.
Investigators analyzed baseline data from a prospective observational study of 90 adult patients with physician-diagnosed gout who were aged older than 20 years, had experienced at least two gout flares during the previous 6 months, and had completed clinical assessments and patient-reported outcome measures between June 2024 and April 2025. The participants selected one of four graphical representations describing their pain patterns during the previous 6 months, which investigators classified as intermittent or constant. The constant pain category included daily pain, constant background pain with flares, and severe constant background pain with intermittent relief. The investigators used multivariable logistic regression to identify factors independently associated with constant pain.
The investigators evaluated demographic and disease characteristics, serum urate concentrations, comorbidities, activity limitation, health-related quality of life, pain measures, physical activity, and sleep quality prior to identifying independent predictors of constant pain.
Overall, 34% (n = 31) of the participants reported a constant pain pattern, whereas 66% (n = 59) of them reported intermittent pain. In the adjusted analysis, younger age at gout onset, greater activity limitation, and current anxiety or depression remained independently associated with constant pain. The participants with greater activity limitation had nearly six times the odds of reporting constant pain, and those with anxiety or depression had more than nine times the odds. The model also demonstrated good discrimination between constant and intermittent pain patterns.
In univariable analyses, patients with constant pain had longer gout duration, higher serum urate concentrations, poorer health-related quality of life, greater overall pain, poorer patient global assessment scores, poorer sleep quality, and current sleep apnea compared with patients reporting intermittent pain. However, these factors were not independently associated with constant pain following multivariable adjustment. A sensitivity analysis excluding anxiety or depression because of the small number of affected participants yielded similar results for the remaining predictors.
The investigators noted that the graphical pain classifications describe the temporal pattern of pain rather than its underlying mechanism. They suggested that persistent pain may arise from multiple processes, including ongoing low-grade inflammation, structural joint damage, or altered pain processing. However, the study was not designed to determine the cause of persistent pain.
The study’s cross-sectional design precluded causal inference, and the relatively small number of patients with constant pain may have limited the precision of the findings. The participants were recruited because they had experienced recent recurrent flares, which may limit generalizability to patients with well-controlled gout. In addition, gout diagnoses were based on prior physician diagnosis rather than independent crystal confirmation, the graphical pain classification had not been validated specifically in gout, and the predominantly male study population may limit generalizability to female patients.
“Although most participants reported an intermittent pattern consistent with pain-free intercritical gout, these findings indicate that this model may not fully capture the pain experience of all [patients] with gout and supports the need for tailored, multimodal management approaches for those with more persistent pain,” wrote lead study author Sarah Stewart, PhD, of the Faculty of Environmental Sciences at the Auckland University of Technology in New Zealand, and colleagues.
The study was supported by the Health Research Council of New Zealand. Full disclosures of the study authors can be found in the study.
Source: ACR Open Rheumatology
