Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile

OBJECTIVE

Our objective was to evaluate the independent relation between a history of gout and the future risk of type 2 diabetes among men with a high cardiovascular risk profile.

METHODS

We prospectively examined over a 6-yr period the relation between gout and the risk of incident type 2 diabetes in 11 351 male participants from the Multiple Risk Factor Intervention Trial (MRFIT). Incident diabetes was defined based on the American Diabetes Association (ADA) criteria for epidemiological studies. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

We documented 1215 new cases of type 2 diabetes. After adjusting for age, BMI, smoking, family history of type 2 diabetes, alcohol intake, dietary factors and presence of individual components of the metabolic syndrome, the multivariate relative risk (RR) for incident type 2 diabetes among men with gout at baseline, as compared with men without gout, was 1.34 (95% CI 1.09, 1.64). When we further adjusted for serum uric acid levels, the association remained significant (RR 1.26; 95% CI 1.02, 1.54). When we updated the status of gout annually during follow-up as a time-varying covariate, the association remained similar. The association also remained similar in our subgroup analyses by major covariates (P-values for interaction >0.16).

CONCLUSIONS

These findings from men with a high cardiovascular risk profile suggest that men with gout are at a higher future risk of type 2 diabetes independent of other known risk factors. These data expand on well-established, cross-sectional associations between hyperuricaemia, gout and the metabolic syndrome, and extend the link to the future risk of type 2 diabetes.

An unusual cause of fatal pulmonary embolism

We report on a case of a fatal pulmonary embolism--an unexpected finding at autopsy of a 71-year-old man who had suffered from severe erosive gouty arthritis. Using morphological findings, medical history and histopathological results, we show the potentially devastating complications of this fairly common medical condition, occurring as a result of massive bone marrow erosion and detachment and finally leading to embolization of the lungs.

Prospective cohorts and rheumatic disease research

Many large, prospective cohort studies originally were established to study common major medical conditions, including heart disease and cancer. These cohorts have provided important health information for decades (eg, the link between smoking and lung cancer). More recently, some of these cohorts also have provided excellent vehicles for addressing important study questions of common rheumatic disorders. An increasing number of important observational studies has been published or are being conducted based on these cohorts; the role of these data sources in rheumatic disease research are likely to grow in the future. This article intends to put these prospective cohort studies together to enhance the understanding of their usefulness in studying rheumatic disorders among investigators and readers. We summarize those cohorts with their published examples of rheumatic disease research.

Primary prevention in rheumatology: the importance of hyperuricemia

Hyperuricemia (HU) is present in 5-30% of the general population, although the prevalence is higher among some ethnic groups and seems to be increasing worldwide. Classically, chronic HU has been considered a risk factor for gout or lithiasis and is associated with alcoholism, obesity, hypertension, dyslipidemia, hyperglycemia/diabetes mellitus, renal failure and intake of certain drugs. HU is also associated with cardiovascular diseases such as hypertension, vascular disease, pre-eclampsia, pulmonary arterial hypertension, stroke, heart failure, ischemic heart disease and also metabolic syndrome, renal disease and increased mortality. It is uncertain if these associations are dependent or not, especially cardiovascular and renal diseases. Patients with chronic HU and also those with gout require both medical investigation for associated diseases or drugs as well as nutritional counseling and life-style changes. HU should alert physicians to possible complications.

A literature review of the epidemiology and treatment of acute gout

BACKGROUND

Gout is the most common cause of inflammatory arthritis in men aged >40 years and is frequently encountered in clinical practice.

OBJECTIVE

The goal of this article was to review the published literature on the epidemiology, treatment, and estimated burden of illness of acute gout.

METHODS

Articles on gout published in English between 1980 and June 2002 were identified through a MEDLINE search. Relevant clinical studies and review articles were found using the text- and keyword-search term gout alone and in combination with epidemiology, prevalence, incidence, complications, outcome, quality of life, economics, cost, prevention or drug therapy. The reference lists of identified articles, especially review articles, were checked for any additional studies that might have been missed in the original MEDLINE search.

RESULTS

The epidemiology of gout in various geographic regions has been well documented. Data suggest that environmental, racial, and hereditary factors may influence the development of gout, and that the prevalence of gout appears to be on the rise worldwide. Evidence from well-designed clinical studies evaluating drug therapies for gout is limited. Therapies for acute gout include corticotropin, corticosteroids, colchicine or, more often, nonsteroidal anti-inflammatory drugs (NSAIDs), which have shown comparable efficacy. A recent study suggests that etoricoxib, a new cyclooxygenase-2-selective inhibitor, may be as effective as and better tolerated than traditional NSAIDs in the treatment of gout. Urate-lowering therapy, prophylactic colchicine, and low-dose NSAIDs are used for the long-term prophylaxis of gout. However, all acute and prophylactic therapies are associated with adverse events. Using an economic model for gout, the annual direct burden of illness for new cases of acute gout can be estimated at 27,378,494 US dollars in the United States.

CONCLUSIONS

Gout is an increasingly prevalent condition worldwide and creates a heavy economic burden. Available treatments are generally effective; however, they are not devoid of adverse events. Well-designed, long-term, controlled clinical trials evaluating the comparative efficacy and tolerability of treatments for gout are needed.