Background/Purpose:

While gout is the most common form of inflammatory arthritis, there are relatively few studies on the influence of sex with regard to disease presentation and comorbidities as well as flare and hospitalization rates among patients with gouty arthritis. Possible determinants of these outcomes in patients with gouty arthritis based upon sex were evaluated using a population-based cohort.

Methods:

The individual medical records of all patients with a potential diagnosis of gout in a geographically defined area were retrospectively reviewed using a resource insuring complete capture. All individuals with a possible diagnosis of incident gout in 2009-2010 were identified. Incident cases had to fulfill at least 1 of 3 criteria: the 1977 American College of Rheumatology proposed criteria for gout, the Rome or New York criteria. All identified cases were followed up through their records for 5 years after incident gout attack, death or migration, whichever came first. Clinical characteristics were compared using chi-square and rank sum tests. Person-year methods were used to estimate and compare flare and hospitalization rates over time.

Results:

A total of 271 patients (196 males; 72%) with incident gout in 2009-2010 were identified. Females had significantly higher mean (SD) age at diagnosis 66.3 (15.7) years compared to males 57.6 (16.9) years (p<0.001). Although the mean (SD) body mass index (BMI) for females 32.1 (8.9) did not differ from males 32.0(5.8) (p=0.48), more females were morbidly obese (BMI ≥40 kg/m²) than males (25% vs 8%; p<0.001). Podagra was less common in females than males (51%vs 62%), but this did not reach statistical significance (p=0.10). Females had significantly more chronic kidney disease stage 3/4 (36% vs 20%; p=0.006) while hypertension, diabetes and heart disease were non- significantly increased in females compared to males.

During a median of 4.7 years of follow up, 127 males and 31 females experienced at least one gout flare with no significant difference in the number of involved joints. Males reported a total of 323 flares with a rate of 3.97 person-years (py), higher than the 74 flares experienced by females with a rate of 2.28 per 10 py (rate ratio: 1.73; 95% confidence interval [CI]: 1.36-2.25). This difference persisted after adjustment for multiple flares per person (hazard ratio: 1.51; 95% CI: 1.14-2.00).

In the follow up period, 69 male patients and 41 female patients were hospitalized. Males were hospitalized 169 times for a rate of 2.08 per 10 py which is less than the reported 137 hospitalizations for females with a rate of 4.22 per 10 py (rate ratio: 0.49; 95% CI: 0.39 -0.62). However, this difference was no longer significant after accounting for the older age of the females

Conclusion:

Female patients with gout are older at incidence than males and tend to have more associated common co-morbidities, particularly chronic kidney disease. Podagra is less common in females than males. Female patients tend to have fewer flares as compared to males. Adjusted for age, there was no difference in hospitalization rates between males and females.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sex-differences-in-gout-patients-epidemiology-flares-and-hospitalization-data-in-a-population-based-cohort/