Gout flares following acute stroke: a single-center cohort and a systematic review/meta-analysis

With the global prevalence of hyperuricemia and gout rising, accumulating evidence has linked acute gout flares to a transient rise in major adverse cardiovascular events, including myocardial infarction and stroke. However, the reverse association, whether acute stroke is associated with an increased incidence of gout flares, has been inadequately investigated. The aim of this single-center cohort study, coupled with a systematic review and meta-analysis, was to evaluate the incidence and characteristics of gout flares in the early post-stroke period.

A systematic review and meta-analysis of published studies was conducted, incorporating data from a cohort of acute stroke patients admitted to a tertiary care stroke center. Eligible studies reported in-hospital gout flares among patients with acute ischemic or hemorrhagic stroke. Pooled estimates were calculated using random-effects models. The systematic review was pre-registered in PROSPERO (CRD420251061747).

We identified three studies (one involving only acute ischemic stroke, two including both ischemic and hemorrhagic stroke), encompassing a total of 13,722 acute stroke patients, including our institutional cohort. The pooled incidence of in-hospital gout flares was 4% (95% CI, 2-6%; I²=88.1%). The pooled mean time to flare onset was 6.3 days post-stroke (95% CI, 4.09-8.44; I²=96.6%), and 64% of flares involved the paretic limb (95% CI, 33-90%; I²=62.1%). Among flare patients, 85% were male (95% CI, 40-100%; I²=84.5%), 97% had ischemic stroke (95% CI, 94-99%; I²=0%), and 61% were newly diagnosed with gout or hyperuricemia during hospitalization (95% CI, 48-73%; I²=0%). In our cohort, 50% and 12.5% of flare patients presented with delirium and aphasia, respectively; all patients received colchicine treatment with complete symptom resolution.

Gout flares occur in one out of every 25 acute stroke patients, particularly in men presenting with acute ischemic stroke within the first week after symptom onset, and frequently involve the paretic limb. In over half of cases, the flare uncovers previously undiagnosed gout or hyperuricemia, emphasizing the need for systematic evaluation, particularly in patients with delirium or impaired communication, where diagnosis may be delayed. Early colchicine initiation warrants consideration given its anti-inflammatory effects and potential to reduce stroke recurrence.