Here are a few take home points about gout from Friday's Posters.
Have you ever worried about urate-lowering therapy (ULT) causing impairment in bone health and increased risk of fracture? I wasn't too worried, but now for the data… In FRI0690, there was no statistically significant increased risk of fracture with ULT in 31,781 patients with gout who were prescribed ULT (ICD code, health services data) vs 122,961 controls, who were followed for a mean of 10.8 yrs. It would be nice to see corresponding serum uric acid levels to make sure the ULT was being taken, treated to target, or some other drug compliance data. Looks reassuring though. #lemêmegoût
Cardiac events are feared outcomes in all of our patients, including those with gout. Whether or not the risk can be modified remains an open question. At FRI0692, the risk of ventricular arrhythmia (VA) in gout patients was assessed in light of recent reports of higher risk association in gout patients for atrial fibrillation. Incident VA was assessed in 28,755 new allopurinol starts in the USA (Medicare beneficiaries data). Compared to gout patients not using allopurinol, ULT was associated with a lower risk of VA (HR 0.82, 0.76-0.90) in multivariable adjustment analysis. Risk continued to drop with each additional year of allopurinol use. It may be time for prospective RCT data. #lifesaver?
This one is a bit of a teaser, and it has nothing to do with gout at all. Nonetheless, FRI0710 used dual energy CT (DECT) to detect MSU crystal accumulation in the SI joints of 186 ankylosing spondylitis (AS) patients (who did not have gout and had mean serum uric acid levels in the normal range). After multivariable risk adjustment, the volume of MSU crystals (not presence) independently increased the risk of SI joint damage (AOR 2.02, 1.14-3.56), and was associated with higher ASDAS and BASFI scores. While this might suggest a way of risk stratifying AS patients for damage, that would require quite a bit more prospective work. It also raises the hypothesis that MSU is somehow involved in the pathogenesis of bony damage in AS. #crystalosingspondylitis
Dr. Appleton completed the combined MD/PhD program at Western University in Canada and is now a rheumatologist and clinician scientist at St. Joseph’s Hospital in London, Canada. In addition to his rheumatology practice, Dr. Appleton oversees a translational biology research program in early osteoarthritis.View Full Bio