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Abstract Number: 1126

Gout and Chronic Pain in Older Adults: A Medicare Claims Study

Jasvinder A. Singh and John Cleveland, Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: gout and pain

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Session Information

Date: Monday, October 22, 2018

Session Title: Epidemiology and Public Health Poster II: Gout, Ankylosing Spondylitis, Osteoarthritis, Osteoporosis, Pain, and Function

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: To assess if gout is associated with a higher risk of incident chronic pain in older adults, 65 years or older.

Methods: This study used the 2006-2012 Medicare claims data. We used multivariable-adjusted Cox regression analyses to examine the association of pre-existing diagnosis of gout with incident (new) diagnosis of chronic pain, adjusting for demographics, medical comorbidity and use of common medications for cardiovascular disease and gout. Sensitivity analyses substituted Charlson-Romano score with a categorical variable or each Charlson-Romano comorbidity. Gout was identified by the presence of two claims for gout at least 4 weeks apart, with International Classification of Diseases, ninth revision, common modification (ICD-9-CM) code of 274.xx. Study outcome was was incident (new) chronic pain, with an absence of this diagnosis in the baseline period of ³1 year, that occurred in patients with or without pre-existing gout diagnosis that preceded the diagnosis of chronic pain. We identified chronic pain by the occurrence of at least two claims 4-weeks apart containing any of the following ICD-9-CM codes [12]. 307.80, 307.89, 338.0, 338.2, 338.4, 719.41, 719.45 – 719.47, 719.49, 720.0, 720.2, 720.9, 721.0 – 721.4, 721.6, 721.8, 721.9, 722, 723.0, 723.1, 723.3 – 723.9, 724.0 – 724.6, 724.70, 724.79, 724.8, 724.9, 729.0 – 729.2, 729.4, 729.5. This approach has been shown to be valid, with positive predictive value of 95%, sensitivity of 70% and specificity of 99%. We used multivariable-adjusted Cox proportional hazard models to assess the association of gout with incident GCA, adjusting for potential confounders/covariates including demographics (age, race, gender), comorbidities (Charlson-Romano comorbidity index), and medications commonly used for cardiac diseases (statins, beta-blockers, diuretics, and angiotensin converting enzyme (ACE)-inhibitors) and gout (allopurinol and febuxostat; Model 1).  

Results: There were 1,321,521 eligible people, of whom 424,518 developed incident chronic pain. Crude incidence rates of chronic pain were as follow: gout, 158.1 per 1,000 person-years and no gout, 64.5 per 1,000 person-years. In multivariable-adjusted Cox regression analyses, gout was associated with higher hazard ratio of chronic pain, 2.02 (95% CI, 1.98, 2.05), confirmed in sensitivity analyses 1.96 (95% CI, 1.93, 1.99) (model 2) and 1.77 (95% CI, 1.74, 1.80) (model 3).

No meaningful differences were found by gender and race in subgroup analyses; slightly lower hazard of gout with chronic pain was seen in oldest people (Table 1).

Conclusion: Gout was associated with a doubling of the risk of chronic pain. Efforts must be made to optimize gout control and gout inflammation, so that long-term sequalae of gout, including chronic pain can be avoided and when present, treated early and appropriately. 

 

Table 1. Association of gout with chronic pain, in pre-defined subgroup analyses, by age, gender, and race

 

Multivariable-adjusted (Model 1)

Multivariable-adjusted

(Model 1)

Multivariable-adjusted

(Model 1)

 

HR (95% CI)

P-value

HR (95% CI)

P-value

HR (95% CI)

P-value

Black

White

Other race

Gout

2.27 (2.17, 2.38)

<0.0001

1.97 (1.94, 2.01)

<0.0001

2.19 (2.04, 2.34)

<0.0001

 

Female

Male

 

 

Gout

1.95 (1.90, 2.00)

<0.0001

2.04 (2.00, 2.08)

<0.0001

 

 

 

65-75 years

75-85 years

>85 years

Gout

2.20 (2.15, 2.25)

<0.0001

1.86 (1.81, 1.91)

<0.0001

1.75 (1.67, 1.85)

<0.0001

Race*Gout p-value <0.0001;

Sex*gout p-value <0.0001;

Age*gout p-value <0.0001;

HR, Hazard ratio; CI, confidence interval;

Hazard ratios that are significant with p-value <0.05 are in bold

 


Disclosure: J. A. Singh, Takeda, Savient, 2,Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan pharmaceuticals, WebMD, UBM LLC, Medscape , Fidia pharmaceuticals and the American College of Rheumatology, 5; J. Cleveland, None.

To cite this abstract in AMA style:

Singh JA, Cleveland J. Gout and Chronic Pain in Older Adults: A Medicare Claims Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/gout-and-chronic-pain-in-older-adults-a-medicare-claims-study/. Accessed April 11, 2021.
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