Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Even though there are a few cases in the literature reporting co-existence of gout and rheumatoid arthritis (RA), it has been a long time popular belief that gout does not occur in patients with RA. We aimed to assess the occurrence, clinical presentation, and possible risk factors for gout in patients with RA.
Methods: We retrospectively reviewed a population-based incidence cohort of patients who fulfilled 1987 ACR criteria for RA in 1980-2007. All subjects were longitudinally followed through their complete community medical records until death, migration, or April 2012. Gout was defined using the physician diagnosis, along with typical monosodium urate crystal positivity in synovial fluid or the 1977 ARA clinical criteria for gout. We excluded the patients with pseudogout, hyperuricemia without gout, septic arthritis, traumatic arthritis, and RA initially misdiagnosed as having gout. Cumulative incidence of gout in RA adjusted for the competing risk of death was estimated. Cox models were used to assess risk factors for gout in RA.
Results: The study population included 813 patients, 537 (66%) were rheumatoid factor positive; 33% had rheumatoid nodules, and 53% had erosive joint disease. During 9771 total person-years of follow-up (mean 12.0 years per RA patient), 22 patients developed gout by clinical criteria. The great toe was the most common site of gout (12 of 22 patients). The 25 year cumulative incidence of gout diagnosed by clinical criteria was 5.3%. Typical intracellular monosodium urate crystals were present in 9 of 22 patients with acute gout; all had developed gout after the RA incidence date. The 25 year cumulative incidence of gout diagnosed by clinical criteria including presence of urate crystals is 1.3%. The prevalence of gout in RA on Jan 1, 2008 was 1.9% (11 of 582 patients) as opposed to expected prevalence of 5.2% (or 30 patients) based on National Health and Nutrition Examination Survey (NHANES) data using age and sex specific prevalence rates.
Risk factors for gout in RA were: older age (hazard ratio [HR] 1.5 per 10 year increase; p = 0.04), male sex (HR 3.18; p = 0.03) and obesity (HR 3.5; p = 0.03). The presence of erosive RA joint disease reduced the risk of gout (HR 0.24; p = 0.03). Gout has become more common in patients diagnosed with RA in recent years (1995-2007) than in previous years (1980-1994; HR 5.6; p = 0.007).
Conclusion: Gout does occur in patients with RA though at a lower rate than in the general population, with a minimum/maximum cumulative incidence of 1.3/5.3%. Risk factors for gout in RA generally mirror those in the general population.
Disclosure:
A. Jebakumar,
None;
C. S. Crowson,
None;
P. D. Udayakumar,
None;
E. L. Matteson,
Centocor, Inc./Johnson and Johnson,
2,
Genentech and Biogen IDEC Inc.,
2,
Hoffmann-La Roche, Inc.,
2,
Human Genome Sciences, Inc.,
2,
Pfizer Inc,
2,
Novartis Pharmaceutical Corporation,
2,
Roche Pharmaceuticals,
2,
UCB Group,
2,
Centocor, Inc.,
5,
Horizon Pharma,
5,
Novartis Pharmaceutical Corporation,
5.
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