Background/Purpose:

Gout is the most common inflammatory disease in the United States (US), affecting more than 4% of the population. Although uric acid (UA) can function as an antioxidant at low levels, high levels have been postulated to play an important role in the pathogenesis of cancer. Recent evidence has demonstrated that hyperuricemia is associated with excess cancer risk, cancer recurrence, and mortality. However, this may be confounded by common comorbidities such as alcoholism and obesity that likewise increase risk for malignancy.  The National Health and Nutrition Examination Survey (NHANES) provides a good basis to study these associations in the general US population.

Methods:

            11,262 individual from the general population between 2011-2014 were surveyed through the NHANES project using a combination of questionnaires, physical examinations and laboratory studies. Of all subjects, 403 had a diagnosis of gout and 825 had a diagnosis of cancer. Statistical modeling of disease associations were adjusted for age, gender, college education, and the presence of rheumatoid arthritis, smoking status, alcohol use, and BMI. All analyzes were performed using SAS software version 9.4 (Cary, North Carolina).

Results:

There was a significantly higher proportion of cancer diagnoses in gout patients (21% vs 7%; p< 0.001). Adjusted multivariate analysis showed that those with gout were 50% more likely to have a diagnosis of malignancy (Odds ratio [OR] = 1.54; 95%CI, 1.16-2.04, p=0.003). Interestingly, patients with rheumatoid arthritis also had a direct association with a diagnosis of cancer (OR 1.6, 95% CI 1.22-2.00, p=0.001), and this was independent of the association with gout. The most common cancer was prostate cancer (25%), followed by breast, cervix, and colon.

Conclusion:

Our study shows evidence of an independent association between gout and malignancy. Prostate cancer was the most common type of cancer this group. The association between gout and cancer warrants further investigation, as confirming these findings have the potential to modify screening practices in those with gout.