Abstract
BackgroundGout is the most common type of inflammatory arthritis and is largely managed in primary care. It classically affects the first metatarsophalangeal joint and distal peripheral joints, whereas the axial joints are typically spared. The reason for this particular distribution is not well understood, however, it has been suggested that osteoarthritis (OA) may be the key factor.One hypothesis is that there is an association between the disease states of gout and OA as the conditions share common risk factors. The objective of this study was to determine whether there is an association between gout and radiographic osteoarthritis (OA).MethodsA cross-sectional study was nested within three observational cohorts of people aged ≥50 years with hand, knee and foot pain. Participants with gout were identified through primary care medical records and each matched by age and gender to four individuals without gout. The presence and severity of radiographic OA were scored using validated atlases. Conditional logistic regression models were used to examine associations between gout and the presence, frequency and severity of radiographic OA at the hand, knee and foot and adjusted for BMI, diuretic use and site of joint pain.ResultsFifty-three people with gout were compared to 211 matched subjects without gout. No statistically significant associations were observed between gout and radiographic hand, knee or foot OA. However, individuals with gout had increased odds of having nodal hand OA (aOR 1.46; 95 % CI 0.61, 3.50), ≥8 hand joints with moderate to severe OA (aOR 3.57; 95 %CI 0.62, 20.45), foot OA (aOR 2.16; 95 % CI 0.66, 7.06), ≥3 foot joints affected (aOR 4.00; 95 % CI 0.99, 16.10) and ≥1 foot joints with severe OA (aOR 1.46; 95 % CI 0.54, 3.94) but decreased odds of tibiofemoral (aOR 0.44; 95 % CI 0.15, 1.29) or patellofemoral (aOR 0.70; 95 % CI 0.22, 2.22) OA in either knee.ConclusionThere was no association between gout and radiographic OA, however, people with gout appeared to be more likely to have small joint OA and less likely to have large joint OA.
Highlights
Gout is the most common type of inflammatory arthritis and is largely managed in primary care
A link has been established between gout and OA, which could explain the distribution of joints affected by gout, the tendency for the first metatarsophalangeal joint (1st MTPJ) to be affected [1]
Radiographs of the hand and knees were taken in Clinical Assessment Study of the Hand (CASHA) and Clinical Assessment Study of the Knee (CASK); radiographs of the hands and feet were taken in Clinical Assessment Study of the Foot (CASF) [6,7,8]
Summary
Gout is the most common type of inflammatory arthritis and is largely managed in primary care It classically affects the first metatarsophalangeal joint and distal peripheral joints, whereas the axial joints are typically spared. The reason for this particular distribution is not well understood, it has been suggested that osteoarthritis (OA) may be the key factor. Previous studies have shown that joints affected by acute attacks of gout are more likely to display clinical or radiographic features of OA [2, 3]. A recent primary-care based case–control study did not find evidence between gout and clinicallyassessed nodal OA, people with gout were more likely to have hallux valgus and chronic pain in the knee and big toe, compared to age- and gender-matched controls without gout [5].
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