Background/Purpose:

This cohort study aimed to investigate the risk of total joint (hip/knee) replacement (TJR, THR and TKR) among patients with incident gout at initial diagnosis and subsequent periods. Furthermore, we estimate the exposure dose of urate-lowering treatment (ULT) on the TJR risk by using a nested case-control study.

Methods:

An incident gout cohort during 1995 to 2009 was retrieved from the UK Clinical Practice Research Datalink (CPRD) and were age-, sex and general practice-matched in a 1:4 ratio to controls. Multivariate odds ratios (ORs) for TJR at diagnosis and hazard ratios (HRs) for TJR after diagnosis were estimated adjusting for age, gender, Charlson comorbidity index, BMI level, smoking status, alcohol consumption and comorbidities. Adjusted ORs derived from conditional logistic regression were used to estimate the association between cumulative defined daily dose (cDDD) of urate-lowering treatment and TJR using a nested case-control design.

Results:

There were 40,160 incident gout patients diagnosed during study period and matched to 160,640 controls. Gout was associated with adjusted ORs (95% CIs) of 1.34 (1.15–1.57) for THR and 1.24 (1.02–1.51) for TKR at diagnosis. The incidence of both were higher in gout patients compared with their corresponding controls (3.72 vs 2.47 cases/1000 person-years for THR and 3.57 vs 2.31 cases/1000 person-years for TKR). Multivariate HRs (95% CIs) were 1.22 (1.10–1.35) for THR, 1.09 (0.99–1.21) for TKR and 1.14 (1.06-1.23) for TJR. Using a nested case-control study with gout cohort, ORs (95% CI) for TJR was 1.00 (0.83–1.20) for 1–180 cDDD of ULT, 1.03 (0.80–1.33) for 180–364 cDDD and 1.09 (0.94–1.27) for >365 cDDD compared with non-ULT user.

Conclusion:

Gout was associated with a higher risk of TJR at diagnosis and the risk continue to rise afterwards. TJR risk was not modified by ULT use after gout diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/urate-lowering-treatment-and-risk-of-total-joint-replacement-in-patients-with-incident-gout-a-population-based-cohort-and-nested-case-control-study/