Coexistent Gout and Rheumatoid Arthritis Save

While it is often said there is a negative association between gout and rheumatoid arthritis (RA), cases of coexistent disorders are uncommonly seen. 

A longitudinal RA study was categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline serum UA levels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses.

Analysis of 1,999 RA patients in the Veterans Administration RA registry identified 341 (17%) with hyperuricemia (serum Uric acid >6.8 mg/dl) and 121 (6.1%) who carried a diagnosis of gout.  These prevalences are similar to general population prevalence for hyperuricemia and gout.

RA patients with gout were more likely to be on sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs.

The presence of moderate hyperuricemia (serum UA >6.8 to ≤8 mg/dl) was associated with an increased risk of CVD-related mortality (hazard ratio 1.56 [95% confidence interval 1.11-2.21]). Hyperuricemia was not associated with an increase in all-cause mortality.

These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity.