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Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study
David J Hunter1, Michael York, Christine E Chaisson
1Boston University Clinical Epidemiology Research and Training Unit, Arthritis Center, the Department of Medicine at Boston Medical Center, Boston, Massachusetts 02118, USA. djhunter@bu.edu
Insights
Recent use of diuretics, including thiazide and loop types, significantly increases the risk of recurrent gout attacks. This finding highlights a key modifiable risk factor for gout management.
Area of Science:
- Rheumatology
- Pharmacology
- Epidemiology
Background:
- Gout is a common inflammatory arthritis characterized by recurrent attacks.
- Certain medications, such as diuretics, are suspected triggers for gout flares.
- Understanding these triggers is crucial for effective gout management.
Purpose of the Study:
- To investigate the association between thiazide and loop diuretic use and recurrent gout attacks.
- To identify diuretics as potential modifiable risk factors in patients with gout.
Main Methods:
- An internet-based case-crossover study design was employed.
- 197 participants with a recent gout attack provided data on diuretic use during attack (hazard) and non-attack (control) periods.
- Conditional logistic regression adjusted for alcohol and purine intake was used to analyze the risk.
Main Results:
- Recent use of any diuretic within 48 hours of an attack was associated with a 3.6-fold increased odds of recurrent gout.
- Thiazide diuretic use showed an odds ratio of 3.2 for recurrent gout attacks.
- Loop diuretic use demonstrated an odds ratio of 3.8 for recurrent gout attacks.
Conclusions:
- Recent diuretic use is a significant risk factor for recurrent gouty arthritis.
- Both thiazide and loop diuretics are associated with an increased risk of gout attacks.
- Diuretic therapy represents an important, modifiable risk factor in managing patients with gout.
Objective:
To assess several putative risk factors, including thiazide and loop diuretics use, thought to trigger recurrent gout attacks.
Methods:
We conducted an internet-based case-crossover study involving subjects who had a gout attack within the past year. Patients were recruited online and asked to provide access to medical records. Data were obtained on specific diuretic use on each day over the 2-day period prior to an acute gout attack (hazard period) and on each day of 2 days during the intercritical period (control period). We examined the relation of all diuretic use and use of specific diuretics, i.e., thiazide and loop, to the risk of recurrent gout attacks using a conditional logistic regression model adjusting for alcohol consumption and purine intake.
Results:
One hundred ninety-seven subjects completed both control and hazard period questionnaires. Participants were predominantly male (80%) and over half had a college education. The median time between onset of gout attack and logging on to the website was 2 days. Adjusting for alcohol consumption and purine intake, the odds ratio (OR) for recurrent gout attacks from all diuretic use over the last 48 h was 3.6 (95% confidence interval 1.4-9.7). OR of recurrent gout attacks were 3.2 and 3.8 for use of thiazide and loop, respectively.
Conclusion:
Recent use of diuretics is associated with a significantly increased risk for recurrent gouty arthritis. The increased risk of gout attacks from either thiazide or possibly loop diuretic therapies represents an important modifiable risk factor in patients with gout.
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