Table 1 Top ranked seven concerns* among African American and Caucasian men

African American men (n = 5)

Impact of flare on social life

‘Affects my social life - Going to dinner, church, movies, etcʼ

10

‘I don’t want to be around anybody during the attackʼ

Pain during and after the flare and its impact

‘…(flare causes)…extreme painʼ

9

‘Crying while I am in painʼ

‘It makes me emotional and mean when I have an attackʼ

Limitation of recreational activities

‘Things that I like are taken away (music)ʼ

6

‘I can’t go (places…) with my brothersʼ

‘Affects my hobbies - fishing, hunting, biking, playing music, riding motorcycle, runningʼ

Work productivity

‘Hopefully your boss understandsʼ

6

‘Relationships are hard at work tooʼ

‘Caused me to take off from (or ability to do) my job.ʼ

Unpredictability of flare that brings a normal day to a halt

‘Brings normal day to a haltʼ

5

‘Stopping the desire to do anythingʼ

‘Comes unexpectedʼ

‘Don’t even want someone breathing around meʼ

Dietary restrictions and modification

‘What do different foods contribute to gout?ʼ

5

‘Staying away from fish, shellfish, steaks, & peasʼ

‘Affects foods I can enjoyʼ

‘Always have to watch what I eat - staying disciplinedʼ

Feeling of loss of youth

‘I was diagnosed in my 20s… feel old…

5

‘Causes me to feel “old” before my timeʼ

African American men (n = 9)

Severe pain and disability during an attack

‘When I have an attack it shuts down my whole life. I can't function. I will stay in the bed three to four days while I wait for it to passʼ

36

‘Have to have wheel chair close to me during an attackʼ

‘I have to keep my crutches by the bed so that I can get to the bathroomʼ

‘You will do anything to get reliefʼ

‘I miss going to church and other functionsʼ

Swelling and tenderness in acute flare

‘My toe ankle and knee they really swell up.ʼ

16

‘…tenderness in the acute phaseʼ

Affects sleep

‘Limits my ability to have a good night sleepʼ

16

‘You just can't sleepʼ

Dietary restrictions and modification

‘Affects what I can eatʼ

14

‘Can’t have a few drinks without a flareʼ

‘Can't eat red meat, even though I love itʼ

Need for daily medication

‘…have got to take medication every dayʼ

11

‘I have to take additional medications to stay wellʼ

‘It’s inconvenientʼ

‘It’s just another drug when you add that to our other medicationsʼ

‘I also have to take a pain medicationʼ

At-home productivity and dependency on family members and others

‘It disables me. I need help with my socks or just walking around the houseʼ

9

‘I can't use lawn mowerʼ

‘Need help from family and othersʼ

‘During a flare up I need help just to get me to the doctorʼ

‘One time the fire department had to find a way to get me out of the bed, into a wheelchair, into the back of a truck then to the hospital… It took a whole lot of help to get to the doctor that dayʼ

‘I can't do anything someone will have to bring me food, help me in and out of the bed; hop to the bathroom during an attackʼ

Affect on family life and sexual function

‘I can’t go to my grandson’s gameʼ

9

‘I can't do the things I like to do with my wifeʼ

‘My relationships are affected… I don't want anyone around me to touch meʼ

African-American men (n = 9)

Dietary restrictions and modification

‘Made me change my dietʼ

24

‘I had to change the food that I ateʼ

‘I can’t eat seasoned food; I did not like that at allʼ

‘No seafood, shell fish, red meat and fried foodsʼ

‘Watch what you drink - no alcoholʼ

‘Can’t have sodas or drink orange juiceʼ

‘Can’t have peanuts, pecans and tomatoesʼ

Problem with daily activities

‘Hard to move aroundʼ

18

‘Very hard to move around during a flare. It stays with me for a while, several daysʼ

‘Could not stand and it would hurt if the cover was touching itʼ

‘Have to be careful what you can doʼ

‘No activity outsideʼ

‘It's aggravating, not being able to do anythingʼ

‘All you want is the pain to go awayʼ

‘Gout affects my drivingʼ

‘During the flare there is a problem going to the restroomʼ

‘I couldn't drive my truck if my gout was flaring. I had to learn to shift with my left foot. My diet, activities and everything had to change because I could not do it like I used toʼ

Sexual difficulties

‘Problem with having sex during the flare. When you are in pain… the love goesʼ

14

‘You don't want to do anything when you are in pain. Our old lady doesn't understandʼ

Problem with shoes/footwear

‘I wore a wider shoeʼ

14

‘I had to get shoes 2 sizes largerʼ

‘Needed hard leather shoes and loose fitting shoesʼ

‘Get out of the fancy shoes and wear some soft shoesʼ

‘I wear sandalsʼ

Joint swelling

‘Affects my joints - I have swellingʼ

12

‘I will have small swelling in my feetʼ

Life-changing impact

‘Made my life change in a lot of waysʼ

9

‘My whole life changed. I had to accept a lot of things that I did not want toʼ

‘Pain made me change in a lot of ways with my friends family and the people that I am normally around. It will have an impact on the way your carry yourselfʼ

Severe pain during flare

‘Can’t have anything touching it a sheet, clothes… nothing.ʼ

9

‘…when it flares up you can't sleepʼ

‘I have to sleep a certain way to avoid painʼ

‘I have to sleep in a chairʼ

Emotional impact

‘Can’t play with painʼ

7

‘Makes me irritatedʼ

Caucasian men (n = 5)

Problem with daily activities and at-home productivity

‘Gout affects my physical abilitiesʼ

17

‘I can't garden or do yard work anymore. Can't do vegetable gardeningʼ

‘Work around the house is impossible when I have a harsh gout attackʼ

‘…(during flare)… My sink is full of dishesʼ

‘Standing is a devil (during flare).ʼ

‘My inability to walk and move around totally limits my life (to go to the bathroom, eat do anything)ʼ

Impact on family life and sexual function

‘Affects your sex lifeʼ

10

‘My life with family has sufferedʼ

Work productivity

‘My work output suffersʼ

8

‘I get paid on commission. My average has dropped over the years due to goutʼ

‘Affects my job. A limitation to the jobʼ

‘The medication (narcotics) has made it difficult to workʼ

Long-term medication side-effects

‘Affects your personality usually due to the medication that you are taking (steroids)ʼ

7

‘I worry about the long term affects the drugs have on my healthʼ

‘The side affects that I have or could get from the medication or the diseaseʼ

‘My joints are deteriorated due to me continuing to move during a flare upʼ

‘Because I have one kidney my pain reliving drugs are even more limited“

Impact on comorbidity management

‘How it (gout) interacts with my other health issuesʼ

6

‘Raises blood pressureʼ

‘That's my problem - I do not know how it is affecting my other problems. I ask my doctor all the timeʼ

Dependency on family members

‘I don't like to be waited on… they should not have to bear that burdenʼ

5

‘I have to have help when I am having a severe attackʼ

‘Concern over being dependent on my wife and family because of my limitationsʼ

Makes traveling very tricky

5

Caucasian men (n = 7)

Intense pain

‘Gout leads to severe painʼ

24

‘Attack in the unusual placesʼ

‘Unable to live the active life tat I liveʼ

Gout stops certain activities

‘Limited movementʼ

18

‘….couldn’t walkʼ

‘Inability to exercise, have family interactionsʼ

‘..(had to) reduce daily activitiesʼ

‘Limitation of mobilityʼ

Not predictable

‘Don’t you wish you knewʼ

18

‘Can not plan activities in town and out of townʼ

‘Out of town, can not get medical attention quick for an attackʼ

Need for daily medication

‘Take medication everyday and buy itʼ

12

‘If you travel you are stuck with themʼ

‘…(problem) having to take daily medicationsʼ

Expenses of medications and doctor visits

‘I have group health insurance and my condition has impact on othersʼ

8

‘Limitation of disposable incomeʼ

‘….emergency room visits are expensiveʼ

Lack of healthiness

‘….contributes to the sense of lack of healthinessʼ

6

Possible drug interactions

‘Lot of unexplained symptoms, wondering if they might be due to side effects of allopurinolʼ

6

‘We are getting older and need to worry about theseʼ

‘What about it’s effect on medications for other diseasesʼ

Caucasian men (n = 3)

Severe pain

‘Pain was so much, I could hardly walkʼ

11

‘I broke my leg an year ago, I swear gout hurt worse than my fractureʼ

‘I broke my ankle, not even comparable to acute gout attack (gout was worse)ʼ

‘Pain from gout was worse than neck fusion symptomsʼ

‘I can feel the pain with every heartbeatʼ

Physical limitation

‘Limits my ability to play sports, family events and excursions, vacation, home improvement and choresʼ

12

‘Limits sporting events during the attackʼ

‘Could hike, if it weren’t thereʼ

‘Has long-term impact on hobbiesʼ

‘I had to give up sports I played my whole lifeʼ

‘Had to so “no” a lotʼ

‘Had an attack during vacation. I couldn’t do things and make me think of polioʼ

Emotional impact

‘Puts emotional strain in relationships, marriage and familyʼ

7

‘People have heard about it, but don’t know what it isʼ

‘It led to my divorceʼ

My wife said in her journal “… seems that he wants to be in pain to avoid doing things with meʼ

‘My family and wife know very well what gout isʼ

Limits work ability

‘Limits my ability to workʼ

6

‘Delay, reschedule or ask coworkers (ask for help)ʼ

‘Traveling is difficultʼ

‘Can’t driveʼ

‘….had to get cherry juice and spend a night in a hotelʼ

Need to take daily medication

‘Have to take medication dailyʼ

4

‘Not easy to fill and refill, especially when travelingʼ

‘I don’t like taking medications every dayʼ

‘Allopurinol if a miracle drugʼ

Awareness of joint disease

‘Constantly cautious of joint sensitivityʼ

4

‘Anytime I feel something it constantly reminds me of my attacksʼ

Finding fellow people with gout

‘Bond with people who know how it feelsʼ

1

‘Becoming part of social interactionʼ

‘Every friend of mine knows I have goutʼ