Background/Purpose: Hyperuricemia and untreated gout appears to be independent prognostic markers for poor all-cause and coronary heart disease mortality in patients with recent acute myocardial infarction. Moreover, gout attacks among patients with acute myocardial infarction are linked with short-term and long-term adverse non-fatal cardiac events. Similarly, serum uric acid levels correlate with morbidity and mortality of patients with congestive heart failure. However, the factors associated with gouty arthritis in patients presenting with acute cardiovascular events are not well known. Thus, we sought to study the demographic and clinical factors in patients with acute coronary syndromes and congestive heart failure who developed acute gout during hospitalization.

Methods: In-patient rheumatology consults of patients admitted to a cardiovascular hospital with either acute coronary syndromes (angina pectoris or myocardial infarction) or congestive heart failure between January 2006 and May 2015 were evaluated. Data on demographic parameters, type of medical insurance, primary diagnosis on admission, comorbidities, and pharmacologic treatment were compared between patients who developed acute gouty arthritis during hospitalization versus those who did not, using Chi-square test, Fisher’s Exact test and Student’s T test, as appropriate. Shapiro-Wilk test was used to assess normal distribution.

Results: A total of 189 patients admitted with acute cardiac events were consulted to the rheumatology service. Of those patients, 83 (43.9%) had acute gouty arthritis during the hospitalization. The mean (SD) age was similar between patients with and without acute gout [57.4 (15.0) vs. 58.7 (15.3) years, p=0.561]. Most patients with acute gout were men (92.8% vs. 33.0%, p < 0.001). Patients with acute gout were more likely to have chronic kidney disease (30.1% vs. 11.3%, p=0.001) and less likely to have systemic lupus erythematosus (0.0% vs. 14.2%, p < 0.001), rheumatoid arthritis (0.0% vs13.2%, p < 0.001), hypothyroidism (4.8% vs. 15.1%, p=0.023), and exposure to antiplatelet therapy (8.4 % vs. 27.4%, p=0.001) than those without acute gout. As expected, patients with acute gout had a previous history of gout (53.0% vs. 5.7%, p < 0.001) and were more commonly taking allopurinol (15.7% vs. 3.8%, p=0.005) and colchicine (19.3 % vs.1.9%, p < 0.001) at the moment of admission than those who did not present acute gout. However, of those with previous history of gout, only 30% were taking allopurinol at the moment of admission. No statistical differences (p > 0.05) were found for type of health insurance, arterial hypertension, diabetes mellitus, dyslipidemia, and exposure to diuretics and angiotensin receptor blockers.

Conclusion: Male gender, chronic kidney disease, and previous history of gout were associated with acute gout attack in this group of patients admitted with acute coronary syndromes and congestive heart failure. The awareness of these factors may help to recognize and manage patients promptly and prevent further complications in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-acute-gouty-arthritis-in-patients-hospitalized-with-acute-coronary-syndromes-and-congestive-heart-failure/