Background/Purpose: Although gout is a prevalent disease, the coexistence of rheumatoid arthritis (RA) and gout has been considered unusual. Only several case reports describing the coexistence of the two conditions have been previously published, and large-scale population-based studies on the association between them are scarce. This study aimed to evaluate the association between RA and subsequent gout risk in South Korea.

Methods: This retrospective cohort study included 29,223 patients with RA and a comparison group of 146,115 individuals matched 1:5 for age, sex and index data. Data were from the Korean National Health Insurance Service database. Participants were enrolled from 2010 to 2017 and followed up until 2020. Seropositive RA (SPRA) was defined by the International Classification of Diseases 10^th revision (ICD-10) code M05, prescription of disease-modifying anti-rheumatic drugs (DMARD), and enrollment in a special copayment reduction program. Seronegative RA (SNRA) was defined by the ICD-10 code M06 and prescription of any DMARD. We only included those participants who had undergone health screening within 2 years before index data to obtain covariate information. Participants who had previously been diagnosed with gout or were diagnosed with gout within 1 year after the index data were excluded to minimized surveillance bias. The primary endpoint was the newly diagnosed gout, defined using the ICD-10 code of gout (M10).

Results: A total of 18,552 gout cases (12,441/146,115 [8.5%] in controls and 6,111/29,223 [20.9%] in RA) were reported during a mean follow-up of 5.4 years after 1 year lag period. Patients with RA had a 2.7-fold higher risk of gout compared with controls (adjusted hazard ratio [aHR] 2.74, 95% confidence interval [CI] 2.65-2.82). Increased risk of gout was found in both patients with SNRA and SPRA compared with controls (aHR 2.8, CI 2.71-2.91 in SPRA; aHR 2.57, CI 2.45-2.71 in SNRA). Compared to patients with SNRA, those with SPRA demonstrate a heightened risk (aHR 1.07, CI 1.01-1.13), though the difference was marginal. A significant interaction was observed between RA and covariates (sex, age, drinking status, and comorbid conditions such as diabetes mellitus, hypertension, obesity, hyperlipidemia and chronic kidney disease) with the risk of gout (P for interaction< 0.05).

Conclusion: Contrary to common perceptions, the nationwide cohort study found that both SPRA and SNRA was linked to a higher risk of gout.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/heightened-gout-risk-in-patients-with-rheumatoid-arthritis-a-national-cohort-study/