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. 2024 Feb 6;331(5):417-424.
doi: 10.1001/jama.2023.26640.

Serum Urate and Recurrent Gout

Natalie McCormick  1   2   3   4 , Chio Yokose  1   2   3 , Gregory J Challener  3   5 , Amit D Joshi  6 , Sruthi Tanikella  1   2 , Hyon K Choi  1   2   3   4
Affiliations

Serum Urate and Recurrent Gout

Natalie McCormick et al. JAMA. .

Abstract

Importance: Approximately 12 million adults in the US have a history of gout, but whether serum urate levels can help predict recurrence is unclear.

Objective: To assess associations of a single serum urate measurement with subsequent risk of acute gout flares and subsequent risk of hospitalizations for gout among patients in the UK with a history of gout.

Design, setting, and participants: This retrospective study included patients with a history of gout identified from the UK between 2006 and 2010 who were followed up through Primary Care Linked Data medical record linkage until 2017 and through the Hospital Episode Statistics database until 2020.

Exposures: Serum urate levels at enrollment.

Main outcome and measure: Rate of recurrent acute gout, ascertained by hospitalization, outpatient, and prescription/procedure records, and adjusted rate ratios using negative binomial regressions.

Results: Among 3613 patients with gout (mean age, 60 years; 3104 [86%] men), 1773 gout flares occurred over a mean follow-up of 8.3 years. Of these, 1679 acute gout flares (95%) occurred in people with baseline serum urate greater than or equal to 6 mg/dL and 1731 (98%) occurred in people with baseline serum urate greater than or equal to 5 mg/dL. Rates of acute gout flares per 1000 person-years were 10.6 for participants with baseline urate levels less than 6 mg/dL, 40.1 for levels of 6.0 to 6.9 mg/dL, 82.0 for levels of 7.0 to 7.9 mg/dL, 101.3 for levels of 8.0 to 8.9 mg/dL, 125.3 for urate levels of 9.0 to 9.9 mg/dL, and 132.8 for levels greater than or equal to 10 mg/dL. Rate ratio of flares were 1.0, 3.37, 6.93, 8.67, 10.81, and 11.42, respectively, over 10 years (1.61 [1.54-1.68] per mg/dL). Rates of hospitalization per 1000 person-years during follow-up were 0.18 for those with baseline serum urate less than 6 mg/dL, 0.97 for serum urate of 6.0 to 6.9 mg/dL, 1.8 for serum urate of 7.0 to 7.9 mg/dL, 2.2 for serum urate of 8.0 to 8.9 mg/dL, 6.7 for serum urate of 9.0 to 9.9 mg/dL, and 9.7 for serum urate greater than or equal to 10 mg/dL. Rate ratios of hospitalization for gout, adjusting for age, sex, and race were 1.0, 4.70, 8.94, 10.37, 33.92, and 45.29, respectively (1.87 [1.57-2.23] per mg/dL).

Conclusions and relevance: In this retrospective study of patients with a history of gout, serum urate levels at baseline were associated with the risk of subsequent gout flares and rates of hospitalization for recurrent gout. These findings support using a baseline serum urate level to assess risk of recurrent gout over nearly 10 years of follow-up.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McCormick reported receiving grants from NIAMS K99-AR080243 Career Development Award during the conduct of the study. Dr Yokose is supported by the Rheumatology Research Foundation Scientist Development Award and reported receiving grants from National Institutes of Health (K23AR081425-01A1) and the National Institutes of Health Loan Repayment Program during the conduct of the study. Dr Joshi reported being an employee of and stockholder in Regeneron Pharmaceuticals outside the submitted work. Dr Choi reported receiving grants from Horizon and serving on a board or committee for LG Chem, Shanton, and ANI Pharmaceuticals outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort Development in Study of Recurrent Flares Among Patients With History of Gout
Figure 2.
Figure 2.. Rate and Rate Ratio (RR) for Recurrent Gout Flares According to Serum Urate Level and Follow-Up From Baseline
aAdjusted for age, sex, and race. bAdjusted for variables included in the primary model (age, sex, race) plus body mass index (continuous), smoking status, alcohol intake, coffee intake, red meat, fish, and poultry intake, current use of diuretic medications and urate-lowering therapy, and prevalent diabetes, cardiovascular disease, hypertension, and chronic kidney disease.
Figure 3.
Figure 3.. Rate and Rate Ratio (RR) for Recurrent Gout Flares per mg/dL and SD of Serum Urate Over 10 Years
aAdjusted for age, sex, and race.
Figure 4.
Figure 4.. Rate and Rate Ratios (RR) for Recurrent Gout Flares Requiring Hospitalization
See this image and copyright information in PMC

Comment in

References

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