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Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis
  1. Nicola Dalbeth1,
  2. Amanda Phipps-Green2,
  3. Christopher Frampton3,
  4. Tuhina Neogi4,
  5. William J Taylor5,
  6. Tony R Merriman2
  1. 1 Department of Medicine, University of Auckland, Auckland, New Zealand
  2. 2 Department of Biochemistry, University of Otago, Dunedin, New Zealand
  3. 3 Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
  4. 4 Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Medicine, University of Otago, Wellington, New Zealand
  1. Correspondence to Prof Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1, New Zealand; n.dalbeth{at}


Objectives To provide estimates of the cumulative incidence of gout according to baseline serum urate.

Methods Using individual participant data from four publicly available cohorts (Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, and both the Original and Offspring cohorts of the Framingham Heart Study), the cumulative incidence of clinically evident gout was calculated according to baseline serum urate category. Cox proportional hazards modelling was used to evaluate the relation of baseline urate categories to risk of incident gout.

Results This analysis included 18 889 participants who were gout-free at baseline, with mean (SD) 11.2 (4.2) years and 212 363 total patient-years of follow-up. The cumulative incidence at each time point varied according to baseline serum urate concentrations, with 15-year cumulative incidence (95% CI) ranging from 1.1% (0.9 to 1.4) for <6 mg/dL to 49% (31 to 67) for ≥10 mg/dL. Compared with baseline serum urate <6 mg/dL, the adjusted HR for baseline serum urate 6.0–6.9 mg/dL was 2.7, for 7.0–7.9 mg/dL was 6.6, for 8.0–8.9 mg/dL was 15, for 9.0–9.9 mg/dL was 30, and for ≥10 mg/dL was 64.

Conclusions Serum urate level is a strong non-linear concentration-dependent predictor of incident gout. Nonetheless, only about half of those with serum urate concentrations ≥10mg/dL develop clinically evident gout over 15 years, implying a role for prolonged hyperuricaemia and additional factors in the pathogenesis of gout.

  • gout
  • epidemiology
  • outcomes research

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  • Handling editor Tore K Kvien

  • Contributors ND conceived and planned the study, interpreted the data, and wrote the first draft of the manuscript. ND is responsible for the overall content of the manuscript as guarantor. AP-G contributed to analysis planning, data management and manuscript drafting. CF analysed the data and contributed to analysis planning and manuscript drafting. TN, WJT and TRM contributed to study conception and planning, data interpretation, and manuscript drafting.

  • Funding This work was supported by the Health Research Council of New Zealand. TN is supported by NIH K24 AR070892.

  • Competing interests ND has received consulting fees, grants or speaker fees from Takeda, Horizon, Menarini, AstraZeneca, Ardea, Pfizer, Amgen and Kowa outside of the submitted work. WJT has received consulting fees from AstraZeneca and Pfizer outside of the submitted work. TRM has received consulting fees or grants from Horizon, AstraZeneca and Ardea outside of the submitted work. The other authors have no financial disclosures.

  • Patient consent Analysis of publicly available data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it published Online First. The results section of the abstract has been corrected.

  • Presented at This manuscript is based on work previously presented at the American College of Rheumatology Annual Scientific Meeting, San Francisco, USA, 2017, and was published as the following conference abstract: Dalbeth N, Phipps-Green A, Frampton C, Neogi T, Taylor WJ, Merriman TR. The Relationship between Serum Urate Concentration and Incident Gout: An Individual Participant Data Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10).