Failure to Meet Optimal Urate Levels Increases Mortality Risk in Gout

Patients with gout who did not reach a serum uric acid level below 6 mg/dL had a 2.4-fold increased risk for death.

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

Patients with gout who fail to achieve a target serum uric acid (SUA) level below 6 mg/dL are at increased risk for death, investigators reported at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois.1

In a study of a prospective follow-up cohort of 1193 patients attending a gout clinic (92% men), Fernando Perez-Ruiz, MD, PhD, of Hospital Universitario Cruces in Spain, and colleagues found that an SUA level of 6 mg/dL or higher independently predicted a significant 2.4-fold increased risk for death compared with patients with a level below 6 mg/dL, after adjusting for age, sex, previous cardiovascular events, and baseline SUA level.

The cohort had a mean age of 60 years and mean disease duration of 6.8 years. The mean SUA at baseline was 9.1 mg/dL, and 16.3% of patients had SUA levels of 6 mg/dL or higher despite treatment. During a mean follow-up period of 48 months, 158 patients died (13%). Another 286 patients (24%) were lost to follow-up.

The overall crude mortality rate was 32.7 deaths per 1000 patient-years, and was significantly higher among patients with SUA levels of 6 mg/dL or higher than those with lower levels (80.9 vs 25.7 per 1000 person-years).

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“This new analysis shows that although a signal for developing severe gout remains, reaching serum urate therapeutic target is associated with lower mortality risk than being over target,” Dr Perez-Luiz said in an ACR press release.2 “Although we cannot exclude other variables not included in our database, such as control of comorbid conditions, our results encourage making any clinically acceptable effort to reach and maintain serum urate levels on target.”

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  1.  Perez-Ruiz F, Richette P, Stack A, et al. Failure to reach serum urate target is associated with elevated mortality in gout. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL.  Abstract 869.
  2. Gout patients who fail to reach optimal serum urate target have higher death risk [press release]. Chicago, Illinois: American College of Rheumatology. Published October 20, 2018. Accessed October 20, 2018.

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