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. 2018 Dec 1;57(12):2129-2139.
doi: 10.1093/rheumatology/key212.

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

Chang-Fu Kuo  1   2 , I-Jun Chou  3 , Lai-Chu See  1   4   5 , Jung-Sheng Chen  1 , Kuang-Hui Yu  1 , Shue-Fen Luo  1 , Ao-Ho Hsieh  1 , Weiya Zhang  2 , Michael Doherty  2
Affiliations

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

Chang-Fu Kuo et al. Rheumatology (Oxford). .

Abstract

Objectives: To examine whether gout is an independent risk factor for total joint replacement (TJR) and whether urate-lowering treatment (ULT) reduces this risk.

Methods: Using the Taiwan National Health Insurance database and the UK Clinical Practice Research Datalink, 74 560 Taiwan patients and 34 505 UK patients with incident gout were identified and age and sex matched to people without gout. Cox proportional hazards models and condition logistic regression were used to examine the risk of TJR in gout patients and the association between cumulative defined daily dose (cDDD) of ULT and TJR.

Results: The prevalence rates of TJR in the patients at the time of diagnosis of gout and in people without gout were 1.16% vs 0.82% in Taiwan and 2.61% vs 1.76% in the UK. After a gout diagnosis, the incidence of TJR was higher in the patients with gout compared with those without (3.23 vs 1.91 cases/1000 person-years in Taiwan and 6.87 vs 4.61 cases/1000 person-years in the UK), with adjusted HRs of 1.56 (95% CI 1.45, 1.68) in Taiwan and 1.14 (1.05, 1.22) in the UK. Compared with patients with gout with <28 cDDD ULT, the adjusted ORs for TJR were 0.89 (95% CI 0.77, 1.03) for 28-90 cDDD, 1.03 (0.85, 1.24) for 90-180 cDDD and 1.12 (0.94, 1.34) for >180 cDDD ULT in Taiwan. In the UK, the respective ORs were 1.09 (0.83, 1.42), 0.93 (0.68, 1.27) and 1.08 (0.94, 1.24).

Conclusion: This population-based study provides evidence from two nation populations that gout confers significant TJR risk, which was not reduced by current ULT.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Flow chart of the study population (A) Cohort study based on the Taiwan NHI database. (B) Cohort study based on the UK CPRD. (C) Nested case–control study based on the Taiwan NHI database. (D) Nested case–control study based on the UK CPRD.
<sc>Fig</sc>. 2
Fig. 2
The cumulative incidence of THR and TKR in patients with gout and without gout (A) THR in Taiwan. (B) TKR in Taiwan. (C) THR in the UK. (D) TKR in the UK.
See this image and copyright information in PMC

References

    1. Wortmann R. Crystal-induced Arthropathies: Gout, Pseudogout, and Apatite-associated Syndromes. Boca Raton, FL: CRC Press, 2006.
    1. Clarson LE, Chandratre P, Hider SL. et al. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol 2015;22:335–43. - PMC - PubMed
    1. Abbott RD, Brand FN, Kannel WB, Castelli WP.. Gout and coronary heart disease: the Framingham Study. J Clin Epidemiol 1988;41:237–42. - PubMed
    1. Choi HK, Curhan G.. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007;116:894–900. - PubMed
    1. Kuo CF, Yu KH, See LC. et al. Risk of myocardial infarction among patients with gout: a nationwide population-based study. Rheumatology 2013;52:111–7. - PubMed

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