Newly Diagnosed Gout Is Associated with Increased Mortality
Gouty arthritis results from the precipitation of monosodium urate crystals in the tissues, usually intra-articular and periarticular, resulting most frequently in recurrent acute arthritis. Cardiovascular disease is common among gout patients but not the only cause of increased mortality in this group.
A recent prospective observational study (Vincent ZL et al.) aims at determining mortality rates and predictors of death at baseline in people with a recent onset of gout.
Methods and patients
For the study purposes, people with newly diagnosed gout disease, with duration less than 10 years, were recruited from primary and secondary care settings. Comprehensive clinical assessment was accomplished at baseline. Participants were prospectively followed for at least 1 year. Data about death was systematically collected from primary and secondary health records. Standardized mortality ratios (SMR) were calculated and risk factors for mortality were analyzed using Cox proportional hazard regression models.
Results
- A total number of 295 patients were included and were followed for a period of 5.1 (1.6) years.
- 14.6% had died at the time of censorship (SMR 1.96, 95% CI 1.44-2.62).
- In the reduced Cox proportional hazards model, the following factors were independently associated with an increased risk of death from all causes: older age (70-80 yrs: HR 9.96, 95% CI 3.30-30.03; 80-91 yrs: HR 9.39, 95% CI 2.68-32.89), Maori or Pacific ethnicity (HR 2.48, 95% CI 1.17-5.29), loop diuretic use (HR 3.99, 95% CI 2.15-7.40), serum creatinine (per 10 mcmol/l change; HR 1.04, 95% CI 1.00-1.07), and the presence of subcutaneous tophi (HR 2.85, 95% CI 1.49-5.44).
- The presence of subcutaneous tophi was the only baseline variable independently associated with both cardiovascular (CV) cause of death (HR 3.13, 95% CI 1.38-7.10) and non-CV cause of death (HR 3.48, 95% CI 1.25-9.63).
Conclusion
People with gout disease duration < 10 years have an increased risk of death. The presence of subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.
Why is this important?
Gout is one of the most prevalent forms of inflammatory arthritis and is associated with impaired quality of life and increased mortality risk. Newly diagnosed gout makes no exception.