Mortality Risk Doubles for Gout When Uric Acid Not Optimal

Marcia Frellick

October 24, 2018

Gurkirpal Singh, MD, from Stanford University in California, talks to Medscape Medical News about the challenges of treating gout. (Camera work by John Gress; video edit by John Rodriguez)

 

CHICAGO — Patients with gout who fail to achieve optimal levels of serum uric acid are at increased risk for premature mortality, new data show.

The risk is twice as high in patients with serum uric acid levels of 6 mg/dL or higher than in those with levels below 6 mg/dL, Fernando Pérez-Ruiz, MD, PhD, from Hospital Universitario Cruces in Vizcaya, Spain, reported during a news conference here at the American College of Rheumatology 2018 Annual Meeting.

For their prospective follow-up cohort study, Pérez-Ruiz and his colleagues assessed 1193 patients who attended a gout clinic and had at least one follow-up visit from 1992 to 2017.

Mortality was confirmed from medical records, families, and local death registries. Serum uric acid levels were monitored during follow-up and categorized as below 6 mg/dL or 6 mg/dL and higher.

Average age was 60 years, average disease duration was 6.8 years, the average number of flares in the previous year was three to four, and men made up 92% of the cohort.

For patients with serum uric acid levels of 6 mg/dL or higher, the hazard ratio was 2.39 (95% confidence interval, 1.64 - 3.50) after adjustment for age, sex, previous cardiovascular events, and baseline uric acid level.

Currently, there are two approaches to gout: treat flares unless severe gout develops, and treat to target.

These data support the need for renewed vigilance by physicians so that patients achieve the recommended target. Incremental progress is not adequate, said Pérez-Ruiz.

"We do that for diabetes, for hypertension, for hyperlipidemia, and I think it's time we do it with gout," he added.

That is a message Shraddha Jatwani, MD, a rheumatologist in Evansville, Indiana, said she will take back to her patients.

"We know it has to be less than 6 mg/dL to avoid the flare-ups, to avoid the long-term disability associated with gout, but if you're talking about mortality, that is taken more seriously by the patient," she explained.

This study will help physicians give a more direct message to patients on the necessity of taking their medication every day and adhering to diet recommendations, she told Medscape Medical News.

Patients with gout are often taking medications for several comorbidities, she pointed out, so they might discontinue gout medication after a flareup has been resolved.

Singh reports financial relationships with Allergan, Bioiberica, Crealta, Merz, Regeneron, Horizon, and Takeda. Pérez-Ruiz and some of his coauthors report receiving support from Amgen, Grünenthal, Menarini, the Asociación de Reumatólogos de Cruces, the Health Research Board, the Midwest Research and Education Foundation, and Astellas. Jatwani has disclosed no relevant financial relationships.

American College of Rheumatology (ACR) 2018 Annual Meeting: Abstract 869 Presented October 22, 2018.

Follow Medscape Rheumatology on Twitter @MedscapeRheum and Marcia Frellick @mfrellick

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