Background/Purpose: Although gout has historically been thought to be a rare in patients with SLE, recent case series suggest that the incidence of gout in SLE may be greater than previously thought.  Here we report a retrospective analysis of a large lupus cohort to determine the prevalence and risk factors for gout in an outpatient population.

Methods: Patients from the University of Michigan lupus cohort who met criteria for acute gout were identified by either the 1977 ACR or the 1968 New York gout criteria.  All patients met 4 ACR criteria for a diagnosis of lupus and were seen in the outpatient rheumatology clinic between 1997 and 2014.  Characteristics of the patients identified as having gout, including age, race sex, uric acid levels, medication use, and lupus activity were recorded and compared to the 827 remaining patients in the cohort without a diagnosis of gout..

Results: 27 of 856 lupus cohort patients were identified as having gout, including six with crystal-proven gout.  Of these 27, 8 were male, 10 were black, 15 white and 2 were of Asian ancestry and the average age at the time of presentation with gout symptoms was 55 years.  The average BMI was 33.5 +/- 6.8.  All patients were hyperuicemic with an average uric acid level of10.8 +/- 2.3.  Compared to the cohort as a whole, a significant number (12/27 patients) were treated with a loop diuretic (p=0.001) and a significant number (6/27) were treated with a thiazide diuretic (p=0.01).  Reduced renal function, defined as CKD stage IIIa or worse was found in 17/27 (p=0.0001) patients.  25/27 were taking some dose of prednisone with an average of 6 mg, a minimum of 1 mg and a maximum of 13 mg.  A total of 6/27 patients had a history of kidney transplant and were being treated with cyclosporine.  C3 and C4 Complement levels were within the normal range for all 27 patients.

Conclusion: Gout was documented according to standard criteria  in 27/854  (3.2%) of patients in the lupus cohort. Most risk factors including age, male sex, and kidney transplant history were non modifiable. However there was a striking association between gout and the administration of a diuretic, either for edema ( 12/27 patients) or for other indications (6/27 patients), especially in the setting of impaired renal function. Lupus patients with a history of compromised renal function who are being treated with diuretics should be monitored closely for hyperuricemia and symptoms of gout.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-strong-association-between-gout-and-diuretic-use-among-lupus-patients/