Management of Acute and Recurrent #Gout: A Clinical Practice #Guideline From the American College of Physicians

http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college

-ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout.
-ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout.
-ACP recommends against initiating long-term urate–lowering therapy in most patients after a first gout attack or in patients with infrequent attacks.

#Gout and subsequent #erectile dysfunction: a population-based cohort study from England
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461678/

An association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England.

Overall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184–202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24–1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27–2.08). Similar findings were also observed for severe ED warranting pharmacological intervention.

Conclusions
We have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

Is #gout a risk equivalent to diabetes for #stroke and myocardial #infarction? A retrospective claims database study
https://link.springer.com/article/10.1186/s13075-017-1427-5

Gout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear. Our objective in the present study was to assess whether gout is as strong a risk factor as diabetes mellitus (DM) for incident MI and incident stroke The incidence of acute MI was lowest in patients with neither gout nor DM, followed by patients with gout alone, DM alone, and both. Among men >80 years of age, the respective rates/1000 person-years were 14.6, 25.4, 27.7, and 37.4. Similar trends were noted for stroke and in women. Compared with DM only, gout was associated with a significantly lower adjusted HR of incident MI (HR 0.81, 95% CI 0.76–0.87) but a similar risk of stroke (HR 1.02, 95% CI 0.95–1.10). Compared with patients with DM only, patients with both gout and DM had higher HRs for incident MI and stroke (respectively, HR 1.35, 95% CI 1.25–1.47; HR 1.42, 95% CI 1.29–1.56).

Conclusions

Gout is a risk equivalent to DM for incident stroke but not for incident MI. Having both gout and DM confers incremental risk compared with DM alone for both incident MI and stroke

Relationship between serum #urate concentration and clinically evident incident #gout: an individual participant data analysis

http://ard.bmj.com/content/early/2018/02/28/annrheumdis-2017-212288


This analysis included 18 889 participants who were gout-free at baseline, with mean (SD) 11.2 (4.2) years and 212 363 total patient-years of follow-up. The cumulative incidence at each time point varied according to baseline serum urate concentrations, with 15-year cumulative incidence (95% CI) ranging from 1.1% (0.9 to 1.4) for <6 mg/dL to 49% (31 to 67) for ≥10 mg/dL. Compared with baseline serum urate <6 mg/dL, the adjusted HR for baseline serum urate 6.0–6.9 mg/dL was 2.7, for 7.0–7.9 mg/dL was 6.6, for 8.0–8.9 mg/dL was 15, for 9.0–9.9 mg/dL was 30, and for ≥10 mg/dL was 64.

Conclusions Serum urate level is a strong non-linear concentration-dependent predictor of incident gout. Nonetheless, only about half of those with serum urate concentrations ≥10mg/dL develop clinically evident gout over 15 years, implying a role for prolonged hyperuricaemia and additional factors in the pathogenesis of gout

Impact of #diuretics on the urate lowering therapy in patients with #gout: analysis of an inception cohort

https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-018-1559-2

..Use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis.

Results
We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = − 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = − 0.47, p = 0.833). There was no association with febuxostat (beta = − 0.116, p = 0.514).

Conclusion
Diuretics do not appear to have a significant impact on managing gout.

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Obesity, #hypertension and diuretic use as risk factors for incident #gout: a systematic review and meta-analysis of cohort studies

https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-018-1612-1


..9923 articles were identified: 14 met the inclusion criteria, 11 of which contained data suitable for pooling in the meta-analysis. Four articles were identified for obesity, 10 for hypertension and six for diuretic use, with four, nine and three articles included respectively for each meta-analysis. Gout was 2.24 times more likely to occur in individuals with body mass index ≥ 30 kg/m2 (adjusted relative risk 2.24 (95% confidence interval) 1.76–2.86). Hypertensive individuals were 1.64 (1.34–2.01) and 2.11 (1.64–2.72) times more likely to develop gout as normotensive individuals (adjusted hazard ratio and relative risk respectively). Diuretic use was associated with almost 2.5 times the risk of developing gout compared to no diuretic use (adjusted relative risk 2.39 (1.57–3.65)).

Conclusions
Obesity, hypertension and diuretic use are risk factors for incident gout, each more than doubling the risk compared to those without these risk factors. Patients with these risk factors should be recognised by clinicians as being at greater risk of developing gout and provided with appropriate management and treatment options.

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#Gout and the Risk of Incident #Erectile Dysfunction: A Body Mass Index-matched Population-based Study

http://www.jrheum.org/content/early/2018/07/09/jrheum.170444


We identified 2290 new cases of ED among 38,438 patients with gout (mean age 63.6 yrs) and 8447 cases among 154,332 individuals in the comparison cohort over a 5-year median followup (11.9 vs 10.5 per 1000 person-years, respectively). Univariate (matched for age, entry time, and BMI) and multivariate HR for ED among patients with gout were 1.13 (95% CI 1.08–1.19) and 1.15 (95% CI 1.09–1.21), respectively. In our sensitivity analysis, by restricting gout cases to those receiving anti-gout treatment (n = 27,718), the magnitude of relative risk was stronger than the primary analysis (multivariate HR 1.31, 95% CI 1.23–1.39).

Conclusion This population-based study suggests that gout is associated with an increased risk of developing ED, supporting a possible role for hyperuricemia and inflammation as independent risk factors for ED.

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Incident #gout and chronic #kidney Disease: healthcare utilization and survival

https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-019-0060-0

The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD).

Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01–2.71; HR55+ years = 1.50; 95% CI 1.37–1.65).

Conclusions
The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age..

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Important food sources of #fructose-containing sugars and incident #gout: a systematic review and meta-analysis of prospective cohort studies

https://bmjopen.bmj.com/content/9/5/e024171

Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.

Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).

Conclusion There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.

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Important food sources of #fructose-containing sugars and incident #gout: a systematic review and meta-analysis of prospective cohort studies

https://bmjopen.bmj.com/content/9/5/e024171

Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.

Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).

Conclusion There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.

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Cause‐Specific #Mortality in #Gout: Novel Findings of Elevated Risk of Non‐Cardiovascular Related Deaths

https://onlinelibrary.wiley.com/doi/abs/10.1002/art.41008

Persons with gout had higher prevalence of chronic kidney disease, metabolic and CV comorbidities. Gout was associated with 17% increased hazard of all‐cause mortality (HR 1.17, 95% confidence interval 1.14‐1.21) overall, and 23% (HR 1.23, 1.17‐1.30) in women and 15% (HR 1.15, 1.10‐1.19) in men. In terms of cause‐specific mortality, the strongest associations were seen for the relation of gout to risk of death due to renal disease (HR of 1.78, 1.34‐2.35), diseases of digestive system (HR 1.56, 1.34‐1.83), CV diseases (HR 1.27, 1.22‐1.33), infections (HR 1.20, 1.06‐1.35), dementia (HR 0.83, 0.72‐0.97).

Conclusions
Several non‐CV causes of mortality are increased in persons with gout, highlighting the need for improved management of comorbidities

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Assessing the Risk for #Gout With Sodium–Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Population-Based Cohort Study

Hyperuricemia is common in patients with type 2 diabetes mellitus and is known to cause gout. Sodium–glucose cotransporter-2 (#SGLT2) inhibitors prevent glucose reabsorption and lower serum uric acid levels..

..The gout incidence rate was lower among patients prescribed an SGLT2 inhibitor (4.9 events per 1000 person-years) than those prescribed a GLP1 agonist (7.8 events per 1000 person-years), with an HR of 0.64 (95% CI, 0.57 to 0.72) and a rate difference of −2.9 (CI, −3.6 to −2.1) per 1000 person-years.

Limitation:
Unmeasured confounding, missing data (namely incomplete laboratory data), and low baseline risk for gout.

Conclusion:
Adults with type 2 diabetes prescribed an SGLT2 inhibitor had a lower rate of gout than those prescribed a GLP1 agonist. Sodium–glucose cotransporter-2 inhibitors may reduce the risk for gout among adults with type 2 diabetes mellitus, although future studies are necessary to confirm this observation.

https://bit.ly/3a7MsMe

Serum CA72-4 is specifically elevated in #gout patients and predicts flares
https://2medical.news/2020/03/02/serum-ca72-4-is-specifically-elevated-in-gout-patients-and-predicts-flares/

..CA72-4 was highly expressed in patients with gouty arthritis [median (interquartile range) 4.55 (1.56, 32.64) U/ml] compared with hyperuricaemia patients [1.47 (0.87, 3.29) U/ml], healthy subjects [1.59 (0.99, 3.39) U/ml] and other arthritis patients [septic arthritis, 1.38 (0.99, 2.66) U/ml; RA, 1.58 (0.95, 3.37) U/ml; SpA, 1.56 (0.98, 2.85) U/ml; OA, 1.54 (0.94, 3.34) U/ml; P < 0.001, respectively]. Gout patients with frequent flares (twice or more …

#Gout risk in adults with pre-#diabetes initiating metformin

https://2medical.news/2024/06/07/gout-risk-in-adults-with-pre-diabetes-initiating-metformin/