Photo Credit: Mykola Churpita

A study finds that risks for mortality, acute myocardial infarction, and end-stage renal disease are higher in tophaceous gout than nontophaceous gout.

A longitudinal cohort analysis suggests that risks for mortality, acute myocardial infarction (MI), and end-stage renal disease (ESRD) in patients with gout are higher in tophaceous than nontophaceous gout. In tophaceous gout, the mortality hazard was increased by 24% at 5 years.

A longitudinal cohort analysis, presented by Gregory Challener, MD, sought to investigate whether the overall increased mortality risk in patients with gout varies between the subgroups with or without tophi. Data for the multicentre study was collected from the US TriNetX Diamond network of claims records. Outcomes of mortality, acute MI, and ESRD were measured at years 1 and 5.

The tophaceous gout cohort included 73,569 patients, and the non-tophaceous gout cohort was 284,241. The mean age was about 67 years, more than 50% were men, around 70% had hypertension, just more than 25% had ischaemic heart disease, and between 27.3% and 28.5% had chronic kidney disease. Before matching, significant differences existed between the cohorts for diabetes, obesity, and medication. After matching, all standardized mean differences between the two now equally sized groups were less than 0.1.

At 1 year, the mortality risk for tophaceous gout versus nontophaceous gout within the 2 matched groups was 5.0% versus 4.3%, leading to an HR of 1.20 (95% CI, 1.15–1.26). After 5 years, the likelihood of mortality was 24% greater for patients with tophaceous gout (HR, 1.24; 95% CI, 1.20–1.27). Also, the chances for acute MI at 1 and 5 years were increased in the tophaceous gout group: HR,1.20 (95% CI, 1.10–1.31) and HR, 1.21 (95% CI, 1.15–1.28), respectively. Kidney impairment in terms of ESRD followed a similar pattern: HR, 1.12 with 95% CI, 1.02–1.24 (1 year), and HR, 1.16 with 95% CI, 1.09–1.25 (5 years).

Although this was a retrospective study, Dr. Challener pointed out that it had strengths in its large population, multicentricity, and propensity score matching. “This result suggests that it is important to identify patients with tophaceous gout and treat them aggressively, including with uricase treatment and those with an inadequate response on xanthine oxidase inhibitors,” Dr. Challener concluded.

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