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The risk of polymyalgia rheumatica in older adults with gout: a Medicare claims study
Jasvinder A Singh1,2,3, John D Cleveland2
1Medicine Service, VA Medical Center, Birmingham.
Objective:
In the absence of previous studies, the objective was to assess whether gout is associated with a lower risk of PMR.
Methods:
We used the 5% Medicare sample to assess whether gout in adults 65 years or older increases the risk of incident PMR. The main multivariable-adjusted model included age, gender, race, Charlson-Romano co-morbidity score, the use of medications for cardiovascular diseases (statins, β-blockers, diuretics, angiotensin-converting enzyme inhibitors) and gout (allopurinol, febuxostat). Hazard ratios and 95% CI were calculated.
Results:
There were 11 744 cases of incident PMR, with crude incidence rates of PMR of 289/100 000 person-years in patients with gout and 109/100 000 person-years in patients without gout. People with incident PMR had a mean duration of gout of 2.2 years before PMR diagnosis (s.d., 1.6; median, 1.8; interquartile range, 0.8, 3.2). Multivariable-adjusted analyses showed that gout was associated with PMR with a hazard ratio of 2.45 (95% CI, 2.28, 2.64; P < 0.0001). Older age, female gender, White race and higher co-morbidity index were associated with a higher hazard of PMR. Sensitivity analyses that substituted continuous Charlson-Romano co-morbidity score with categorized score or individual co-morbidities (plus hypertension, hyperlipidaemia and coronary artery disease) confirmed the main findings with minimal attenuation of hazard ratio, 2.39 (95% CI, 2.22, 2.57; P < 0.0001) and 2.13 (95% CI, 1.98, 2.29; P < 0.0001), respectively.
Conclusion:
Contrary to our hypothesis, gout was associated with >2-fold higher risk of incident PMR in older adults. Studies should explore whether inflammation or hyperuricaemia is the underlying mechanism for this association.
Insights
Gout is surprisingly linked to a significantly higher risk of developing polymyalgia rheumatica (PMR) in older adults. This study found gout patients had over double the risk of incident PMR.
Area of Science:
- Rheumatology
- Epidemiology
- Geriatric Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition affecting older adults.
- The relationship between gout and PMR risk was previously unstudied.
Purpose of the Study:
- To investigate the association between gout and the risk of developing incident PMR in adults aged 65 and older.
Main Methods:
- Utilized a 5% Medicare sample to identify incident PMR cases.
- Multivariable-adjusted models accounted for age, gender, race, comorbidities, and cardiovascular/gout medications.
- Calculated hazard ratios (HR) and 95% confidence intervals (CI).
Main Results:
- Gout was associated with a >2-fold higher risk of incident PMR (HR 2.45, 95% CI 2.28-2.64).
- Crude incidence rates were 289/100,000 person-years for gout patients vs. 109/100,000 for non-gout patients.
- Sensitivity analyses confirmed the association, with HRs ranging from 2.13 to 2.39.
Conclusions:
- Gout is unexpectedly associated with an increased risk of incident PMR in older adults.
- Further research is needed to explore potential mechanisms, such as inflammation or hyperuricemia.
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