Background/Purpose:

Historically, the published literature have suggested that smoking tobacco is associated with lower serum urate concentrations. However, whether smoking impacts the risk for incident gout or not has not been addressed in detail. Our aim was to test this hypothesis and assess if any such link is merely a reflection of the inverse relationship between smoking and obesity.

Methods:

The analysis was based on Framingham heart study (FHS) visits 1 to 26, covering 52 years from 1948 to 2000. Gout was defined by presence of any of the following:  self-report, physician diagnosis, gout medication use, and radiographic changes. Smoking was defined as any usage of tobacco. Hypertension was defined by presence of any of the following: systolic blood pressure >= 140 mm Hg or diastolic blood pressure >= 90 mm Hg or usage of anti-hypertensive medications. Diabetes were defined according to FHS official review. BMI was obtained from FHS raw data. Statistical analyses were performed using Cox proportional hazard regression models in STATA, where the dependent variable was the time from a patient first enrolled to his incident gout. All covariates that entered the multivariable models (smoking, sex, age, BMI, hypertension, diabetes, kidney disease and alcohol use) were treated as time varying in the regression models. Missing values were addressed by multiple imputations.

Results:

There were 5079 participants that were included, among whom 3703 used tobacco. At the baseline the proportion of men was 45.17%. Overall there were 414 incident cases of gout during the follow up. The incidence rate per thousand person-years of gout in the smoking group was 2.55 and in the non-smoking group was 4.57. The unadjusted and age adjusted hazard ratio of smoking were 0.75 (95% confidence interval 0.58-0.99) and 0.73 (0.55-0.96) respectively. In multivariable Cox models, smoking was associated with a hazard ratio of 0.65 (0.44-0.96). The results were not different when men and women were analyzed differently.

Conclusion: Smoking was associated with lower risk for gout and this association was not confounded by obesity or other risk factors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/smoking-and-the-risk-for-incident-gouty-arthritis/