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McCormick N, Lin K, Yokose C, Lu N, Zhang Y, Choi HK. Unclosing Premature Mortality Gap Among Patients With Gout in the US General Population, Independent of Serum Urate and Atherosclerotic Cardiovascular Risk Factors. Arthritis Care Res (Hoboken) 2024; 76:691-702. [PMID: 38191784 PMCID: PMC11039387 DOI: 10.1002/acr.25292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Gout flares are followed by transient major cardiovascular (CV) risk, implicating the role of inflammation; the aim of this study was to determine whether premature mortality rates in patients with gout and CV risk are independent of serum urate (SU) and atherosclerotic CV disease (ASCVD) risk factors. METHODS Using serial US nationwide prospective cohorts, we evaluated the independent association of prevalent gout with all-cause and CV mortality, adjusting for SU, ASCVD risk factors, comorbidities, medications, and kidney function and compared mortality rates between the early (1988-1994 baseline) and late cohorts (2007-2016 baseline). We replicated late cohort findings among patients with gout in a nationwide UK cohort (2006-2010 baseline). RESULTS Adjusted hazard ratios (HRs) for mortality rates in patients with prevalent gout were similar in early and late US cohorts (1.20 [1.03-1.40] and 1.19 [1.04-1.37], respectively); HRs with further adjustment for SU were 1.19 (1.02-1.38) and 1.19 (1.03-1.37), respectively. Adjusted HR among patients with gout from the UK late cohort was 1.61 (1.47-1.75); these associations were larger among women (P = 0.04) and prominent among Black individuals. Adjusted HR for CV mortality rates in the late US cohort was 1.39 (1.09-1.78); those for circulatory, CV, and coronary heart disease deaths among UK patients with incident gout were 1.48 (1.24-1.76), 1.49 (1.20-1.85), and 1.59 (1.26-1.99), respectively. CONCLUSIONS Patients with gout experience a persistent mortality gap in all-cause and CV deaths, even adjusting for SU and ASCVD risk factors, supporting a role for gout-specific pathways (eg, flare inflammation). These findings suggest gaps in current care, particularly in women and possibly among Black patients.
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Affiliation(s)
- Natalie McCormick
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
| | - Kehuan Lin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA USA
| | - Chio Yokose
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
| | - Na Lu
- Arthritis Research Canada, Vancouver BC Canada
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA USA
| | - Yuqing Zhang
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
| | - Hyon K. Choi
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
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Helget LN, Mikuls TR. Health disparities in gout. Curr Opin Rheumatol 2024; 36:120-125. [PMID: 38131351 DOI: 10.1097/bor.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Gout, the most common type of inflammatory arthritis in the world, is characterized by painful episodes of arthritis linked by asymptomatic intercritical periods of hyperuricemia. Once characterized as a disease of wealthy white men, contemporary evidence demonstrates gout disproportionately afflicts racial/ethnic minorities, Indigenous populations and other underrepresented groups leading to significant health disparities. RECENT FINDINGS Herein, we review the current literature reporting a higher incidence and prevalence of gout in racial/ethnic minorities and Indigenous populations, in addition to a growing gout burden reported in females. We also examine how these population are more likely to receive suboptimal treatment for flares and chronic phases of gout. Additionally, we examine biologic and social health determinants that may be contributing to these findings. SUMMARY Racial/ethnic minorities, Indigenous populations, and females have experienced a disproportionate rise in the prevalence and incidence of gout in recent years, are more likely to seek acute medical care and are less likely to receive optimal long-term care for gout with urate lowering therapy. Mechanisms underpinning these findings appear to be multifactorial and include differences in social determinants of care and in some cases may be due to population differences in select biologic factors such as differences in age, sex, genetics.
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Affiliation(s)
- Lindsay N Helget
- Veterans Affairs Nebraska-Western Iowa Healthcare System
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Healthcare System
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Merjanah S, Liew JW, Bihn J, Fillmore NR, Brophy MT, Do NV, Dubreuil M. Trends in Fracture Rates Over Two Decades Among Veterans With Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2023; 75:2481-2488. [PMID: 37308459 PMCID: PMC10704387 DOI: 10.1002/acr.25166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/09/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is an increased risk of fracture in individuals with ankylosing spondylitis (AS) compared to the general population, possibly due to systemic inflammatory effects. The use of tumor necrosis factor inhibitors (TNFi) may reduce fracture risk by inhibiting inflammation. We assessed fracture rates in AS versus non-AS comparators and whether these rates have changed since the introduction of TNFi. METHODS We used the national Veterans Affairs database to identify adults ≥18 years old with ≥1 International Classification of Diseases, Ninth Revision (ICD-9)/ICD-10 code for AS and at least 1 disease-modifying antirheumatic drug prescription. As comparators, we selected a random sample of adults without AS diagnosis codes. We calculated fracture incidence rates for AS and comparators, with direct standardization to the cohort structure in 2017. To compare fracture rates from 2000 to 2002 (pre-TNFi) versus 2004-2020 (TNFi era), we performed an interrupted time series analysis. RESULTS We included 3,794 individuals with AS (mean age 53 years, 92% male) and 1,152,805 comparators (mean age 60 years, 89% male). For AS, the incidence rate of fractures increased from 7.9/1,000 person-years in 2000 to 21.6/1,000 person-years in 2020. The rate also increased among comparators, although the ratio of fracture rates (AS/comparators) remained relatively stable. In the interrupted time series, the fracture rate for AS patients in the TNFi era was nonsignificantly increased compared to the pre-TNFi era. CONCLUSION Fracture rates have increased over time for both AS and non-AS comparators. The fracture rate in individuals with AS did not decrease after TNFi introduction in 2003.
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Affiliation(s)
- Sali Merjanah
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Jean W. Liew
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - John Bihn
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
| | - Nathanael R. Fillmore
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Mary T. Brophy
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Nhan V. Do
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Maureen Dubreuil
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- VA Boston Department of Medicine, VA Boston Healthcare System, Boston, MA
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Affiliation(s)
- Ted R Mikuls
- From the Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, and the VA Nebraska-Western Iowa Health Care System - both in Omaha
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