Background/Purpose: Gout is associated with non-alcoholic fatty liver disease (NAFLD), but neither the frequency nor severity of NAFLD in gout is well described. Elastography is a well-established ultrasonic method to evaluate both steatosis and fibrosis in the liver but has not been applied to evaluate gout patients.

Methods: We employed the FibroScan, a validated transient elastography method, to evaluate patients with advanced gout at one center from 11/1/2016 – 11/12021. We assessed the Fibrosis score (kPA), which measures liver stiffness (E score), and the controlled attenuation parameter dB/m (CAP) score, which measures steatosis. In addition, we assessed the four-factor fibrosis (FIB-4) Index formula, which combines the patient’s age with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count.

Results: 47 gout patients (7 females, 14.9%; 40 males, 85.1%) were evauated. The mean age was 59.8 years) and the mean BMI was 30.95 kg/m2. Tophi were present in 11 (26.2% of those with recorded information). Disease duration ranged from 0-49 years. Comorbidities included: dyslipidemia (86.7%), diabetes (31.1%), hypertension (63.6%), CHF (12.8%), CAD (12.8%), chronic kidney disease (19.15%), known liver disease (33.3%) and current alcohol consumption (46.8%). 53.7% (n=29) had hyperuricemia (SU >6.8 mg/dL) and 54.4% had elevations of either ALT or AST.

Hepatic steatosis (CAP >238 dB/m) was found in 40 (85.1%), but was not significantly different in males or females (p=0.37) or those with CHF (p=0.87), CAD (p=0.94), hypertension (p=0.17), diabetes (p=0.68), dyslipidemia (p=0.59) or the presence of known liver diseases (p=0.37). CAP was correlated with BMI (r=0.53, p=0.0001) but not age, serum urate, glucose, triglycerides, ALT, AST, FIB-4, or Fibrosis scores. By Fibroscan, 9 (19.1%) had evidence of fibrosis (E score >7), including one with moderate and 8 with severe fibrosis (cirrhosis). Moderate or severe fibrosis was significantly associated with age (p=0.03), known liver disease (p=0.003), but not ancestry, gender, BMI, triglycerides, HDL, glucose, gout duration, CHF, CAD, hypertension, dyslipidemia, or diabetes. Serum urate was comparable in those with or without moderate or severe fibrosis (p=0.24). The Fib-4 score was significantly greater in those with severe or moderate fibrosis (3.77) versus those with no or mild fibrosis (1.59, p=0.0045). There was a significant correlation between the Fibrosis score and FIB-4 score (r2=0.24, p=0.0009), but not between the Fibrosis score and ALT (p=0.44) or AST(p=0.41).

Conclusion: Hepatic steatosis and fibrosis are common in patients with gout, but not associated with typical gout co-morbidities. Screening for NAFLD with elastography should establish the actual frequency of NAFLD in gout and provide a means to manage this co-morbidity more effectively.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hepatic-steatosis-and-fibrosis-in-patients-with-gout-detected-by-elastography/