Urate-Lowering Therapy May Not Mediate Arthroplasty Risk in Gout

xray knee prosthesis
xray knee prosthesis
Patients with gout have an increased risk for total joint replacement, which may not be reduced by urate-lowering treatment.

Patients with gout have a significant risk of requiring total joint replacement, and this risk may not be reduced by current urate-lowering treatment (ULT), according to the results of a population-based study published in Rheumatology.

The investigators sought to explore whether gout is an independent risk factor for TJR and whether the use of ULT lowers this risk. They used the Taiwan National Health Insurance database and the UK Clinical Practice Research Datalink for their review. A total of 74,560 patients with incident gout from Taiwan and 34,505 from the United Kingdom were identified and were age matched and gender matched with healthy controls.

Prevalence rates of TJR in patients with gout at the time of diagnosis vs those without gout were 1.16% vs 0.82% among participants from Taiwan and 2.61% vs 1.76% among participants from the United Kingdom. Following a diagnosis of gout, the incidence of TJR was higher among those with gout vs those without gout in both Taiwan (3.23 vs 1.91 cases per 100 person-years) and in the United Kingdom (6.87 vs 4.61 cases per 1000 person-years). The adjusted hazard ratio was 1.56 (95% CI, 1.45-1.68) in Taiwan and 1.14 (95% CI, 1.05-1.22) in the United Kingdom.

Compared with patients with gout with a cumulative defined daily dose (cDDD) <28 of ULT, the adjusted odds ratios for TJR in Taiwan were 0.89 (95% CI, 0.77-1.03) for 28 to 90 cDDD, 1.03 (95% CI, 0.85-1.24) for 91 to 180 cDDD, and 1.12 (95% CI, 0.94-1.34) for >180 cDDD. In the United Kingdom, the respective adjusted odds ratios were 1.09 (95% CI, 0.83-1.42), 0.93 (95% CI, 0.68-1.27), and 1.08 (95% CI, 0.94-1.24).

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The investigators concluded that the presence of gout is associated with a significant risk for TJR, which was not decreased by the use of current ULT. It is possible that earlier interventions and more optimal treat-to-target use of ULT may be required to reduce the risk for TJR in these patient populations.

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Kuo C-F, Chou I-J, See L-C, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout [published online July 27, 2018]. Rheumatology (Oxford). doi:10.1093/rheumatology/key212