Gout and Premature Death Risk

People with Gout at Risk of Premature Death

A new study found that people with gout have a 25 percent greater likelihood of dying prematurely than people without gout. The findings also show that this increased mortality rate has not improved over the past 16 years, unlike the mortality rate for people with rheumatoid arthritis (RA).

Gout, which affects more than 4 percent of adults in the United States, is the most common form of inflammatory arthritis. It develops in some people who have high levels of uric acid in the blood. The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling. Gout is also associated with other illnesses, such as cardiovascular disease and metabolic syndrome.

The study, published online recently in Annals of the Rheumatic Diseases, looked at data available in The Health Improvement Network (THIN) – an electronic medical record database in the United Kingdom that includes information on more than 10 million people.

The researchers identified more than 103,000 people with gout from the database. Each person with gout was matched – based on age, sex and what calendar year they were entered into the database – with up to five people without gout (for a total of nearly 515,000 matched controls). The researchers then divided the participants into two groups based on the gout patients’ year of diagnosis, forming an early group (1999–2006) and a late group (2007–2014). They then looked at how many people in each group died every year.

After taking into account age, sex, body mass index, cigarette use, alcohol consumption, medication use, and additional illnesses, the researchers found that people with gout had higher mortality rates compared to those without gout in both the early and late groups. All other things being equal, for every person without gout who died of any cause, 1.25 people with gout died in the early group. In the late group, that number was 1.24. Mortality rates were nearly equal in the two groups, indicating that the mortality gap did not improve over time.

Contrast with RA Mortality

Lead study author Hyon K. Choi, MD, director of the gout and crystal arthropathy center at Massachusetts General Hospital in Boston, says the lack of improvement in gout’s mortality rate is in stark contrast to what has happened to mortality rates in rheumatoid arthritis. Dr. Choi’s group conducted a similar study of RA, also published recently in Annals of the Rheumatic Diseases, using the same database and the same time period.

They found that in the early group, people with RA were 56 percent more likely to die prematurely compared to those without RA. But in the late group, the mortality rate of people with RA was much lower: They were 29 percent more likely to die prematurely.

Dr. Choi says the improvement is most likely due to better treatment options available for people with RA and a trend for doctors to use medications earlier and more aggressively in order to reach certain treatment goals – an approach called “treat to target.”

N. Lawrence Edwards, MD, vice chairman and professor in the department of medicine at the University of Florida in Gainesville agrees. He says, “When you treat-to-target for rheumatoid arthritis, you really get to the basis of inflammation. Why that hasn’t happened with gout is very important. It is because we do an absolutely crummy job as a profession of treating-to-target with gout. We do a very good job at treating to target with RA.”

Gout is Undertreated

Drs. Choi and Edwards both say that gout tends to be taken much more lightly than RA as an inflammatory disease.

Dr. Edwards says that gout, roughly four times more common than RA, is a chronic inflammatory condition but people tend to think of it as intermittent episodes of a painful joint. In truth, inflammation is always at work in the joints of people who have gout. Even when the symptoms of an acute gout attack get better, inflammation continues.

Dr. Edwards notes, “We’ve known for decades that just having a chronic inflammatory condition puts you at risk for earlier death.”

Dr. Choi explains that the vast majority of people with gout should be receiving urate-lowering medication. However, only a small proportion actually receives treatment, and even fewer stay on it long enough and consistently enough to dissolve the uric acid crystals that trigger the chronic, underlying inflammation.

Lessen Your Risk of Early Death

On average, having gout raises a person’s risk of dying earlier than a similar person without gout by 25 percent. To lessen that risk, gout patients need to work with their doctor to lower uric acid levels to the target of <6 mg/dl – and keep it there throughout life, Dr. Edwards says. In addition, people with gout need to control medical conditions that go along with gout (comorbid conditions), such as hypertension, heart disease and kidney disease.

So if you have gout, here’s what you need to do to ensure you live the longest, healthiest life you can:

Dr. Choi urges, “Remember that gout is treatable and even curable with medication and other appropriate treatment. Work with your physician to lower uric acid levels – medication primarily, lifestyle changes, and management of comorbidities.”

Author: Beth Axtell for the Arthritis Foundation

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