Abstract
BackgroundGouty arthritis is a disease of global burden in which defective metabolism of uric acid causes arthritis. Gouty arthritis or medications used for its treatment may lead to uric acid-associated complications such as upper gastrointestinal bleeding (UGIB) and renal impairment.MethodsIn this cross-sectional study with retrospective record review, 403 established gouty arthritis patients were recruited to determine the incidence of UGIB and associated factors among gout patients who were on regular nonsteroidal anti-inflammatory drugs (NSAIDs).ResultsThe mean age of the 403 gouty arthritis patients was 55.7 years old and the majority (n = 359/403; 89.1%) were male. The incidence of UGIB among gouty arthritis patients who were on NSAIDs was 7.2% (n = 29/403). Older age (p < 0.001), diclofenac medication (p = 0.003), pantoprazole medication (p = 0.003), end-stage renal failure (ESRF) (p = 0.007), smoking (p = 0.035), hypertension (p = 0.042) and creatinine (p = 0.045) were significant risk factors for UGIB among the gouty arthritis patients in univariable analysis. Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis.ConclusionsAge and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. Hence, these high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data also suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients.
Highlights
Gout is a disease characterized by defective metabolism of uric acid that leads to arthritis
Once crystals are deposited into a joint, they can be released into the joint space and initiate an inflammatory cascade causing acute gouty arthritis
Patients were considered eligible for the study if they were above 18 years old, on nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 year pro re nata and fulfilled criteria from the American College of Rheumatology 2015 classification criteria consistent for gouty arthritis (Neogi et al, 2015)
Summary
Gout is a disease characterized by defective metabolism of uric acid that leads to arthritis. The underlying metabolic problem of hyperuricemia and the crystal depositions are treated by lowering the serum urate level and dissolving the crystal deposits This stops both the acute attacks and the progressive joint damage (Schumacher, 2008). Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis. Conclusions: Age and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. These high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients
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