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Urate-lowering treatment and risk of total joint replacement in patients with gout

Chang-Fu Kuo1,2, I-Jun Chou3, Lai-Chu See1,4,5

  • 1Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Rheumatology (Oxford, England)
|July 31, 2018
PubMed

Insights

Gout significantly increases the risk of total joint replacement (TJR). Current urate-lowering treatment (ULT) did not appear to reduce this elevated risk in patients with gout.

Area of Science:

  • Rheumatology
  • Epidemiology
  • Orthopedics

Background:

  • Gout is a common inflammatory arthritis.
  • Total joint replacement (TJR) is a common surgical procedure for end-stage joint disease.

Purpose of the Study:

  • To investigate if gout is an independent risk factor for TJR.
  • To determine if urate-lowering treatment (ULT) mitigates the risk of TJR in gout patients.

Main Methods:

  • Utilized Taiwan National Health Insurance and UK Clinical Practice Research Datalink databases.
  • Included 74,560 patients with gout in Taiwan and 34,505 in the UK, matched with controls.
  • Employed Cox proportional hazards models and conditional logistic regression to analyze TJR risk and ULT association.

Main Results:

  • Gout patients exhibited higher TJR prevalence and incidence compared to controls in both Taiwan and the UK.
  • Adjusted hazard ratios for TJR in gout patients were 1.56 (Taiwan) and 1.14 (UK).
  • No significant reduction in TJR risk was observed with increasing cumulative defined daily doses (cDDD) of ULT.

Conclusions:

  • Gout is confirmed as a significant independent risk factor for total joint replacement.
  • Current urate-lowering treatment strategies do not appear to reduce the heightened risk of TJR associated with gout.
Abstract

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