Friday, 14 Jun 2019

You are here

Not All Hyperuricemia Leads to Gout

Dalbeth and colleagues studied 4 large prospective cohorts and found that rising levels of serum uric acid (SUA) leads to a non-linear increased risk of incident gout, but only half of those with SUA ≥10mg/dL developed clinically evident gout. 

Researchers analyzed four prospective cohorts (Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, and both the Original and Offspring cohorts of the Framingham Heart Study)  to assess the correlation between baseline SUA and the risk of incident gout.

There were 18 889 gout-free participants followed for a mean 11.2  years of follow-up.

The cumulative 15 year incidence of new gout cases varied according to baseline SUA:

  • SUA 6 mg/dL = 1.1% (0.9 to 1.4) 
  • SUA ≥10 mg/dL = 49% (31 to 67)

The adjusted hazard ration for incident gout was:

  • SUA 6.0-6.9 mg/dL - HR 2.7
  • SUA 7.0-7.9 mg/dL  - HR  6.6
  • SUA 8.0-8.9 mg/dL  - HR 15
  • SUA  9.0-9.9 mg/dL - HR 30
  • SUA ≥10 mg/dL - HR  64.

While hyperuricemia plays a significant role in causing gout, there are other factors, over time that along with prolonged hyperuricemia are necessary to lead to gout.

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

Add new comment

More Like This

Updated 2018 EULAR Recommendations for the Diagnosis of Gout

The first EULAR recommendations for the diagnosis of gout were published in 2006. A task force was formed and following a systematic review, they voted unanimously for changes in all items of the 2006 recommendations.

Excess Non-CV Mortality Persists in Gout

Patients with gout not only have a well-recognized increased risk of dying from cardiovascular (CV) disease, but also have higher all-cause mortality and die prematurely from other diseases, a Swedish study indicated.

Despite Gout Numbers and Flares, Allopurinol is Underutilized

A population-based survey from South Australia shows that gout flares are common in the community and have a significant effect on health-related quality of life (HRQoL), yet there is significant undertreatment of gout, even in those on current allopurinol.

Coexistent Gout Increases Risk in Rheumatoid Arthritis

It his often said that gout and rheumatoid arthritis (RA) cannot coexist and where confusion exists, a good history and testing for serum urate (SUA) and rheumatoid factor (RF) can usually clarify the dominant disorders. A recent study shows that hyperuricemia and gout are uncommon in RA, but when present shows an increased risk of comorbidities and cardiovascular (CV) mortality.

Less Structural Damage with T2T in Gout

A two‐year randomized clinical trial has demonstrated that allopurinol dose escalation to a target serum urate (SU) results in less bone erosion, structural damage and urate crystal deposition in patients with gout.