Background Untreated or undertreated gout is characterized by recurrent episodes of acute inflammation (EAIs) of joint structures, called gout flares, and flares are commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs). Proper control of hyperuricemia is associated with a decrease to none of EAIs (1).
Objectives To evaluate risk factors associated with gastrointestinal and renal complications attributed to NSAIDs in patients with gout in a cohort of patients in which variables of gout severity are available.
Methods Retrospective analysis of a cohort of 904 gout patients in whom general variables (age, gender, renal function, ethanol intake, hypertension, hyperlipidemia, diabetes, vascular events, diuretic use) and also variables related to gout and severity of gout (hyperuricemia, number for flares per year, presence of tophi, joint distribution, X-ray involvement, previous urate-lowering therapy) are available for analysis. Outcomes considered were perforation, bleeding, and obstruction (PBO) for gastrointestinal events, and loss of renal function for acute renal failure (ARF) following the RIFLE classification (risk, injury, and failure) for renal events. Variables associated to increased risk with Kaplan-Meier survival analysis were tested with multivariate Cox survival analysis, using time from onset of gout to the event as time exposed to NSAIDs.
Results Gout-related variables, such as the number of flares, polyarticular disease and presence of tophi were associated with higher risk of PBO events, along with variables previously associated in the literature, such as age and ethanol intake. The number of flares was also associated with higher risk of renal events, as were other variables also described in the literature, such as age, previous chronic renal disease, the use of diuretics, and presence of previous vascular events. Interestingly patients never treated previously with urate-lowering therapy also showed a higher risk or renal events (Table).
Conclusions The number of flares is a common risk for both gastrointestinal and renal complications in patients with gout. Other variables related to chronic gout, such as polyarticular distribution or presence of tophi was associated with increased risk of gastrointestinal events.
References Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L et al. Gout: why is this “curable” disease so seldom cured? Ann Rheum Dis 2012;10.1136/annrheumdis-2012-201687.
Acknowledgements Thanks to Mrs. Rosario Lopez Santamaría for cordination and administrative support
Disclosure of Interest F. Perez-Ruiz Consultant for: Ardea, Savient, Menarini, Astra, Metabolex, Pfizer, Novartis, SOBI, Speakers bureau: Menarini, A. HERRERO_BEITES: None Declared