Comorbidities in patients with gout prior to and following diagnosis: case-control study
Chang-Fu Kuo1, Matthew J Grainge2, Christian Mallen3
1Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Patients with gout have more health issues at diagnosis and face an increasing risk of developing new conditions afterward. This highlights the broad impact of gout on overall health beyond joint pain.
Area of Science:
- Rheumatology
- Epidemiology
- Internal Medicine
Background:
- Gout is a complex inflammatory arthritis with known associations with metabolic and cardiovascular diseases.
- The full spectrum of comorbidities and their progression in gout patients remains incompletely understood.
Purpose of the Study:
- To quantify the burden of pre-existing comorbidities in patients diagnosed with gout.
- To assess the risk of developing new comorbidities after a gout diagnosis.
Main Methods:
- A large cohort study utilizing the UK Clinical Practice Research Data-link, including 39,111 patients with incident gout and matched controls.
- Comorbidity risk was evaluated before and after gout diagnosis using logistic regression (ORs) and Cox proportional hazards models (HRs), adjusted for multiple covariates.
Main Results:
- Gout patients exhibited significantly higher comorbidity burdens at diagnosis (Charlson index ORs ranging from 1.39 to 2.51).
- Increased risks for incident comorbidities were observed in gout patients across cardiovascular, genitourinary, metabolic, musculoskeletal, and other systems.
- Gout diagnosis was associated with a 41% increased risk of developing any comorbidity (HR 1.41) and a 13% increased risk of all-cause mortality (HR 1.13).
Conclusions:
- The majority of gout patients present with significant pre-existing health issues at diagnosis.
- Gout patients face a progressively higher risk of developing new comorbidities, indicating a broad and expanding health impact.
- The findings underscore the need for comprehensive management strategies addressing the wide-ranging comorbidities associated with gout.
Objectives:
To determine the burden of comorbidities in patients with gout at diagnosis and the risk of developing new comorbidities post diagnosis.
Methods:
There were 39 111 patients with incident gout and 39 111 matched controls identified from the UK Clinical Practice Research Data-link. The risk of comorbidity before (ORs) and after the diagnosis of gout (HRs) were estimated, adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption.
Results:
Gout was associated with adjusted ORs (95% CIs) of 1.39 (1.34 to 1.45), 1.89 (1.76 to 2.03) and 2.51 (2.19 to 2.86) for the Charlson index of 1-2, 3-4 and ≥5, respectively. Cardiovascular and genitourinary diseases, in addition to hyperlipidaemia, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, osteoarthritis and depression, were associated with a higher risk for gout. Gout was also associated with an adjusted HR (95% CI) of 1.41 (1.34 to 1.48) for having a Charlson index ≥1. Median time to first comorbidity was 43 months in cases and 111 months in controls. Risks for incident comorbidity were higher in cardiovascular, genitourinary, metabolic/endocrine and musculoskeletal diseases, in addition to liver diseases, hemiplegia, depression, anaemia and psoriasis in patients with gout. After additionally adjusting for all comorbidities at diagnosis, gout was associated with a HR (95% CI) for all-cause mortality of 1.13 (1.08 to 1.18; p<0.001).
Conclusions:
The majority of patients with gout have worse pre-existing health status at diagnosis and the risk of incident comorbidity continues to rise following diagnosis. The range of associated comorbidities is broader than previously recognised and merits further evaluation.
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