The association of gout flare resolution with physical activity and sleep: a prospective remote-monitoring study

This study aimed to determine whether gout flare resolution is associated with physical activity and sleep. These findings were intended to inform the future development of a definition for flare resolution.

Data from 81 participants with gout who experienced >1 flare during a 6-month prospective observational study were included. Daily activity (step count) and sleep (total sleep time and deep sleep percentage) were collected remotely using wrist-worn trackers. Daily flare occurrence was captured using smartphone diaries. Activity/sleep outcomes during each flare episode were compared to those during three resolution timeframes: T1: the first day following the flare; T2: the consecutive window immediately following the flare and equal in length to the flare; and T3: the consecutive window equal in length to the flare and immediately following a washout window (equal in length to the flare). Adjusted differences in medians between flare and resolution timeframes were estimated using linear quantile mixed models.

Daily step count was lower during flares compared with all resolution timeframes (all P<0.033). T3 provided the best overall model fit, suggesting that resolution is most clearly distinguished from the flare when using this timeframe. No significant differences between flare and resolution were observed for the sleep outcomes for any resolution timeframe.

Physical activity improves soon after flare cessation, with the clearest distinction between flare and resolution observed over a longer post-flare recovery period, whereas sleep metrics do not differentiate flare from resolution states. These findings support physical activity as a useful objective domain for gout flare resolution.