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Association of Serum Uric Acid and Disease Duration With Frequent Gout Attacks: A Case-Control Study
Abhishek Abhishek1, Ana M Valdes2, Weiya Zhang2
1University of Nottingham, Nottingham, UK. Abhishek.abhishek@nottingham.ac.uk.
Insights
Higher serum uric acid and longer disease duration are linked to frequent gout attacks. However, common factors poorly predict recurrent gout flares, indicating a need for further research into individual variations.
Area of Science:
- Rheumatology
- Gout Pathophysiology
- Clinical Epidemiology
Background:
- Gout is a common inflammatory arthritis characterized by recurrent acute attacks.
- Identifying patients at high risk for frequent gout attacks is crucial for effective management.
- Readily available demographic and disease factors are often used to assess gout severity.
Purpose of the Study:
- To determine if common disease and demographic factors are associated with frequent acute gout attacks.
- To evaluate the ability of these factors to identify patients at risk for recurrent gout attacks.
Main Methods:
- Analysis of data from 468 gout patients (excluding those on urate-lowering treatment).
- Logistic regression was used to assess associations between factors like age, BMI, disease duration, and serum uric acid (SUA) with >2 gout attacks in 12 months.
- Receiver operating characteristic (ROC) curves were employed to assess predictive ability.
Main Results:
- Disease duration and serum uric acid (SUA) were independently associated with frequent gout attacks (OR 1.36 and 1.27, respectively).
- These factors demonstrated poor performance in identifying patients with frequent attacks, with an Area Under the Curve (AUC) of 0.61.
- Adding other variables did not significantly improve the AUC (0.64).
Conclusions:
- Elevated SUA and longer disease duration are linked to increased gout attack frequency, likely due to greater crystal burden.
- These findings support early consideration of urate-lowering treatment (ULT) for gout patients with higher SUA.
- Readily available factors are insufficient for predicting frequent gout attacks, necessitating further research into underlying variations.
Objective:
To ascertain whether readily available disease and demographic factors associate with frequent acute attacks of gout, and to find out whether they can identify patients especially at risk of recurrent gout attacks.
Methods:
Data from 3 previous studies at Academic Rheumatology, University of Nottingham, UK, were used. Patients taking urate lowering treatment (ULT) were excluded, as it influences gout flare frequency. Logistic regression was used to examine the association between age, sex, body mass index (BMI), disease duration, cardiovascular comorbidities, tophi, serum uric acid (SUA), and >2 acute attacks of gout in the previous 12 months. Receiver operating curves were plotted to examine their ability in identifying patients with recurrent gout attacks.
Results:
A total of 468 gout patients (88.5% men, mean ± SD age 62.2 ± 11.3 years, BMI 29.8 ± 5.0 kg/m(2) ) were included. Disease duration and SUA associated independently with >2 acute attacks of gout in the previous 12 months (adjusted odds ratio 1.36 [95% confidence interval (95% CI) 1.08-1.72] and 1.27 [95% CI 1.10-1.46], respectively). However, these factors performed poorly in identifying patients with frequent gout attacks, with an area under the curve (AUC) of 0.61, and there was an insignificant increase in AUC on adding other variables (AUC 0.64).
Conclusion:
Higher SUA and longer disease duration associate independently with frequent gout attacks, presumably because of greater crystal load. This association supports early consideration of ULT for gout patients with higher SUA. However, as readily available disease and demographic factors perform poorly in identifying patients with frequent gout attacks, further research is required to ascertain the reasons underlying interpersonal variations in frequency of gout attacks.
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