Background/Purpose: Understanding the risk factors for recurrent flares among established gout patients is directly relevant to clinical care; however, relevant data are scarce. A previous prospective study of 197 gout patients found that chronic risk factors such as age, sex, education level, obesity, gout disease duration, and the presence of hypertension, diabetes, renal disease, or congestive heart failure (CHF) were not significantly associated with the risk of recurrent gout, although some point estimates were suggestive of an association. We re-examined the same risk factors among 997 gout patients in an expanded follow-up study.

Methods: We conducted a cohort analysis of a prospective study designed to examine the associations of putative risk factors with recurrent gout attacks. Individuals with gout were recruited and followed up online for one year. Participants were asked to provide the following information regarding their gout attacks: date of gout attack onset, symptoms and signs, medications (including anti-gout medications), and exposure to potential risk factors at baseline and during the follow-up in relation to gout flares. We used Cox proportional hazard models to calculate hazard ratios for the risk of recurrent gout attacks related to age, sex, education level, body mass index, gout disease duration, and the presence of hypertension, diabetes, renal disease, and CHF at baseline.

Results: Among 997 gout patients (mean age, 53.6 years; 78.4% male), we documented 361 gout flares during a mean follow-up of 0.49 years. Overall, the annual incidence rate was 75 per 100 person-years (Table). Younger age (<60 years), disease duration (>1 year), and the presence of CHF were independently associated with a 45%, 71%, and 57% higher risk of gout flares, respectively (Table). Female sex, obesity, and diabetes tended to be associated with a higher risk of gout flares (Table), although not statistically significant.

Conclusion: This large prospective gout cohort study suggests that younger age, longer disease duration, and having CHF all confer a higher risk of gout flares, independent of other risk factors. While these associations may be due to higher serum urate levels and pools associated with these factors even among gout patients, it remains conceivable that these factors may contribute to the risk of flares independent of their urate level impact. Regardless, these data suggest a potential need for more aggressive therapy among patients with these risk factors.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/chronic-risk-factors-for-recurrent-gout-flares-among-established-gout-patients-a-prospective-cohort-analysis/