Thursday, 17 Aug 2017

You are here

Mortality in Gout Increased

Two current articles in the Journal of Rheumatology address issues surrounding mortality risk among those with new and established gout.

Vincent et al assessed predictors of mortality in patients with a recent onset of gout (disease duration < 10 years). They analyzed 295 patients with a mean followup duration of 5.1 years, during which time there were 43 deaths (14.6%).

Factors independently associated with an increased mortality risk included: older age (HR > 9.3 for those over 80 yrs.); Māori or Pacific ethnicity (HR 2.48); loop diuretic use (HR 3.99); elevated serum creatinine and the tophi (HR 2.85).  Amongst these only subcutaneous tophi was the only baseline variable independently associated with both CV death and all cause death.

A gout disease duration < 10 years has an increased risk of death. Subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.

Kang and Korean investigators also analyzed mortality risk in terms of gender and serum urate (SUA) levels. (Citation source: http://buff.ly/2omFieW

During 12.3 years of followup there was 27,490 deaths, amounting to 6.9% of men and 3.1% of women died.

The bimodal (U shaped) association between SUA levels in men and mortality was not seen in women. Thus a significant interaction of gender was seen with the SUA-mortality association.

Thus a higher mortality rate was seen with very low SUA levels (SUA ≤ 4.0 mg/dl, adjusted HR 1.413) and higher SUA levels in men (> 8.0 mg/dl, adjusted HR 1.140). Women failed to show any significant association between SUA and mortality.

Novel to this study was the observation that lower SUA (after correction) was an independent risk factor for all-cause mortality in men with normal kidney function.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Gouts' Increasing Hospitalizations and Poor Management

Numerous studies have shown that gout hospitalizations have increased in the last decade. Also worrisome is a new studiy showing that patients admitted to the hospital are less likely to have received recommended urate-lowering treatment (ULT). (Abstract OP0262 - http://buff.ly/2roN7SF)

Mixed Results with Combination Therapy in Gout

Lesinurad, a selective URAT-1 inhibitor has been approved for coadministration with a urate-lowering therapy (ULT) in patients with gout for nearly a year. The CRYSTAL study was one of the studies that lead to FDA approval.

New BSR 2017 Gout Guidelines

The British Society for Rheumatology/British Health Professionals in Rheumatology first published a guideline for the management of gout in 2007. They have just updated and published their new guideline, largely because of new therapies, an increasing incidence of gout, low penetrance of urate lowering therapies, and the inability to achieve a target serum uric acid level.

The UnderManagement of Gout

Most physicians believe they understand and can manage gout. Yet, the number of gout patients has risen at an alarming rate and the introduction of 4 new drugs has done little to improve the care and outcomes of gout patients. Misuse, misunderstandings and missed opportunities abound in the wide world of gout.

EULAR Treat-to-Target Guidelines for Gout

Treat-to-target (T2T) works when they are pragmatic and conform well to daily practice.  

Gout is an ideal therapeutic area where T2T could be and should be applied.