Methods: We studied gout, hyperuricemia, and function in 5,819 older adults (age>65) using the Atherosclerosis Risk in Communities cohort, a prospective US population-based cohort study of middle-aged adults enrolled between 1987-1989 with ongoing annual follow-up through 2012. Differences in lower (Short Physical Performance Battery (SPPB) and 4 meter walk test, measured in 2011-2013) and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated: adjusted ordinal logistic regression for SPPB and modified Poisson regression for 4 meter walk test and grip strength. The risk of poor physical function (lowest quartile of grip strength, lowest quartile of SPPB and highest quartile of 4 meter walk test) was estimated using modified Poison regression. Characteristics of gout participants with poor physical function were identified using modified Poisson regression.

Results: There were 595 (10.2%; women: 7.1% and men: 14.6%) participants with gout and 1,242 (21.3%; women: 16.2% and men: 28.4%) with hyperuricemia. There was no difference in grip strength by history of gout (mean difference = -0.29, 95% CI: -0.90, 0.32; P=0.36) nor risk of poor grip strength by history of gout (RR=1.07, 95% CI: 0.95-1.21; P=0.27). Participants with gout had 0.70-times (95% CI: 0.60, 0.82; P<0.001) the odds of 1-unit increase in the SPPB score, such that those with gout had worse performance on the SPPB and participants with gout were 1.28-times (95% CI: 1.15-1.42; P<0.001) more likely to have poor SPPB performance. Participants with gout had slower 4 meter walk test by history of gout (mean difference = 0.23, 95% CI: 0.12, 0.33; P<0.001) and were at 1.24-fold (95% CI: 1.10-1.41; P=0.001) increased risk of poor 4 meter walk test performance. Results were similar when comparing grip strength, SPPB and 4 meter walk test by hyperuricemia (Table). Among participants with gout, older participants (for every 5 year increase in age, RR=1.42, 95% CI: 1.28, 1.59), black participants (RR=1.58, 95% CI: 1.25, 2.00), participants with higher BMI (for every 5 kg/m² increase in BMI, RR=1.18, 95% CI: 1.07, 1.29), and participants who were current smokers (RR=1.65, 95% CI: 1.14, 2.38) were at highest risk of poor 4 meter walk time; similar results were observed for poor SPPB score.

Conclusion: Older adults with gout and hyperuricemia are more likely to have poor lower but not upper body function. Additionally, we identified a group of gout participants with high risk of poor lower extremity function, namely, older age, men, with higher BMIs, and current smokers.