Gout Duration Research Articles

Hyperechoic Spots in the Renal Medulla as a Potential Indicator of Early Gouty Nephropathy

Introduction: The aim of the study was to explore the causes and clinical significance of hyperechoic renal medulla observed by ultrasonography in patients with primary gout. Methods: This study included 2,107 patients with primary gout treated in the Gout Clinic of our hospital from 2016 to 2022. The clinical data and biochemical data of these patients were collected and analyzed. According to the presence or absence of punctate hyperechogenicity in the renal medulla on ultrasound examination, the patients were divided into the hyperechoic medulla (HM) and the normal hypoechoic medulla (NM) groups, and the HM group was further divided into the partial HM (P-HM) and fulfilled HM (F-HM) subgroups according to the distribution range of hyperechogenicity. Results: Among the 2,107 patients with primary gout, 380 had hyperechoic renal medulla on renal ultrasound, including 106 patients with F-HM and 274 with P-HM. There were significant differences in the gout duration, urate arthropathy number, serum urate (SU) level, clinical tophi number, blood urea nitrogen, serum creatinine (sCr), and estimated glomerular filtration rate between the HM and NM groups or between the F-HM and P-HM subgroups (p < 0.05). Multivariate regression analysis showed that the presence of HM was positively correlated with gout duration, urate arthropathy number, gout attack frequency, SU, and sCr. The number of clinical tophi and sCr were closely related to F-HM. Conclusion: Ultrasound examination showed that a high medulla echo in patients with gout was often related to renal function damage. P-HM may be a transitory condition between NM and F-HM in patients with gout.

The Prevalence and Factors Associated with Coronary Heart Disease in Patients with Gout.

. The aim of this study was to determine the prevalence of CHD and factors associated with CHD in patients (pts) with gout. . The study involved 286 male patients with gout, age 51.2 [42.8; 59.4] years (ys), disease duration 6.2 [3.8; 12.1] ys. All patients underwent standard clinical examination screening traditional risk factors (TRFs) of CVDs. We estimated the adjusted odds ratio (OR) and 95% confidence interval (95% CI). . CHD was found in 111 out of the 286 pts (38.8%), MI had a history in 29.7%. Compared to individuals with CHD, participants without CHD were older (56.7[52.1; 61.1] vs 46.2[40.6; 53.4] ys), had longer duration of gout (9.3[4.7; 15.1] vs 5.6[3.3; 9.7] ys) (for all p < 0.05). Abdominal obesity (OR, 3.6; 95% CI, 1.2-10.9), family history of CHD (OR, 2.2; 95% CI, 1.3-3.7), disease duration of gout more 10 ys (OR, 2.8; 95% CI, 1.6-4.7), age of gout onset < 35 ys (OR, 5.5; 95% CI, 2.6-11.7), intraosseous tophi (OR, 3.03; 95% CI, 1.8-5.01), nephrolithiasis (OR, 1.7; 95% CI, 1.04-3.04), renal failure (OR, 5.6; 95% CI, 2.7-11.4), serum total cholesterol (TC), (OR, 1.6; 95% CI, 1.0-2.8), serum creatinine (OR, 2.5; 95% CI, 1.2-5.1), increased the risk for CHD in patients with a gout. . The prevalence of CHD was 38.8% among individuals with gout (one-third of patients had a history of MI 29.7%). Our study showed that both TRFs of CVD and the severity of gout and a history of renal failure contribute to the development of CHD in patients with gout.

Urolithiasis in Primary Gout, Incidence of Clinically Presented and Asymptomatic Kidney Stones: Identification of Significant Risk Factors

Background The aim of this study is to explore the prevalence of urolithiasis in patients with primary gout as well as its correlation with other associated risk factors. Methods The study was conducted on 102 patients with primary gout, they underwent ultrasonography examination and their general, clinical, and urinalysis data were recorded for further assessment and statistical analysis. Results There were 102 patients with primary gout included in our study, 69 (67.6%) males, mean age of patients was 64.3±9.7. The overall prevalence of urolithiasis in our patients with primary gout is 37.3% and 15.7% have “silent” urolithiasis. Patients with urolithiasis (Group 1) are significantly older, 68.9±7.4-years, had a long history of gout 10.3±4.5-years, presence of tophi in 9 (23.6%) patients and more than 3 gouty arthritis attacks per year in 17(44.7%) patients. Also, patients in Group 1 have a significantly lower urine pH of 5.2±0.4 compared to patients without urolithiasis (Group 2) who have a urine pH of 6.6±0.2. Results showed that obesity, diabetes, and hyperlipidemia are significantly more common in patients with urolithiasis (Group 1) while the presence of hypertension is not significantly different between groups. Correlation between urolithiasis and parameters related to disease (duration, tophi, and more than three attacks per year) and parameters related to urinalysis (pH and crystalluria) was tested and found statistically significant. Logistic regression analyses (univariate and multivariate) of tested parameters confirmed that obesity, diabetes mellitus, and hyperlipidemia are predictive factors for the presence of urolithiasis in patients with primary gout. Conclusion There is a high prevalence of urolithiasis in patients with primary gout including asymptomatic urolithiasis, associated with the age of patients, duration, and severity of gout, obesity, diabetes, and hyperlipidemia. Therefore, ultrasonographic screening as harmless and available should be recommended in order to prevent complications.

Clinical characteristics and risk factors associated with bone erosion in patients with tophi

IntroductionIf a large amount of urate crystals is deposited in a joint cavity for an extended period of time, bone erosion will occur and gradually cause skeletal muscle necrosis and joint deformity. The aim of this study was to describe the clinical characteristics and factors associated with bone erosion in gout patients with tophi.MethodsA total of 210 gout patients with tophi were enrolled and divided into a bone erosion group (n = 135) and a non-bone erosion group (n = 75). Digital radiography (DR) was performed to detect bone erosion in the elbow, wrist, knee, ankle joints, interphalangeal and metatarsophalangeal joints. The clinical characteristics were recorded and compared between the two groups. Multivariate logistic regression analysis was conducted to explore the factors associated with bone erosion.ResultsCompared with the non-bone erosion group, the bone erosion group had an older age, longer disease duration of gout and tophi, higher level of serum creatinine (sCr), higher proportion of drinking history and ulceration, and a lower glomerular filtration rate (GFR). Univariate logistic regression analysis results showed that sex, age, body mass index (BMI), gout duration, tophi duration, GFR, white blood cell (WBC) count, sCr level, smoking history, drinking history, and presence of ulceration were associated with bone destruction. Multivariable logistic regression analysis results indicated that tophi duration, drinking history, ulceration and sCr were positively and independently related to bone erosion.ConclusionsTophi patients with bone erosion presented different clinical characteristics. Tophi duration, drinking history, ulceration and sCr were associated with bone erosion in gout patients with tophi.

The association between gout flares and monosodium urate burden assessed using musculoskeletal ultrasound in patients with gout.

Ultrasound (US) has a high sensitivity in detecting monosodium urate (MSU) deposition in gout patients. However, the value of US in predicting gout flares has been reported only in a few monocentric studies. To investigate the association between gout flares in the previous year and US-detected MSU burden using two different US scores. A retrospective study. Patients with gout were consecutively recruited to undergo musculoskeletal US examinations of their knees, ankles, and feet. The score derived from Outcome Measure in Rheumatology (hereinafter referred to as MSU score) and musculoskeletal US features-based (hereinafter referred to as MSKF score) were used to quantify the MSU burden of gout. Odds ratios for frequent gout flares were calculated. We enrolled 1894 patients with gout (mean age: 45 years; gout duration: 5 years; males: 96.1%), experiencing a median of three flares over the past year. Of these, 428 (22.6%) patients reported frequent (⩾7) gout flares. The MSU and MSKF median scores were 6 and 9, respectively. For each five-point increase in MSU and MSKF score, the odds ratio of frequent gout flares increased 1.13-fold and 1.24-fold, respectively. The area under the curve (AUC) for the MSU and MSKF score was 0.635 [95% confidence interval (CI): 0.604-0.665] and 0.688 (95% CI: 0.659-0.718), respectively, (AUC difference 0.054, p value for AUC difference < 0.001). The MSU and MSKF scores were significantly associated with the number of gout flares in the previous year. The MSKF score outperformed the MSU score in terms of frequent gout flare discrimination.

Gout Knowledge: A Survey of Australian Outpatients with Gout.

The prevalence of gout has increased in the Western societies due to ageing and increasing BMI. Recently, lifestyle and dietary factors have been linked in epidemiological studies with an alteration of the risk of gout; however, there remains a lack of data on patient knowledge of these factors. The purpose of this survey-based study was to determine the knowledge of gout and its treatment both in the community and specialist care settings. Participants were recruited from a hospital rheumatology outpatient department, consumer organization and a random sample of participants from a population-based cohort who had self-reported gout in South Australia. Participants completed a survey regarding basic demographics, the Single Item Literacy Screener, use of medication and diet for treatment of their gout and knowledge of gout. Seventy-four people were recruited (87% male) with a mean age of 66 years (range 35-88). The mean duration of gout was 16.6 years (range 0-60). On screening with SILS, 19.0% were identified as having limited reading ability. Most gout was managed by the family practitioner (81.1%) and/or rheumatologist (18.9%). In regard to current gout medications, 52.7% were taking allopurinol, 17.6% colchicine, 9.5% non-steroidal anti-inflammatory drugs, 6.8% prednisolone and 5.4% herbal preparations. For further information regarding gout, participants would most commonly approach their general practitioner (85.1%). Most participants correctly identified certain triggers to gout attacks and almost half of participants (41.9%) reported that they had altered their diet due to gout. Conversely, participants often incorrectly identified common risk or protective factors for gout. Gout remains a common, yet undertreated, chronic condition. Our study highlights a lack of knowledge amongst patients of risk and protective factors in relation to gout. The increasing prevalence of gout within the population indicates a need to improve education and understanding among those with the condition.

Perceptions and practices of self-management among adult patients with gout at a primary care clinic: A qualitative study.

Gout is a chronic disease commonly associated with other comorbidities. Patients' perceived quality of life empowers them in managing their health. Self-management is imparted as part of management among patients with chronic disease. This study aimed to explore the perceptions and practices of self-management among patients with gout from different ethnic groups in Malaysia. A qualitative study was conducted among Malay, Chinese and Indian patients with gout via semi-structured in-depth interviews at the primary care clinic of University Malaya Medical Centre in either English or Malay language. All participants had a gout duration of more than 6 months and were either taking urate-lowering drugs or not using them at all. A total of 20 participants were successfully recruited for the study. Among the participants, 18 were men, while two were women. Further, nine were Malays; six, Chinese; and four, Indians. The age ranged from 29 to 81 years, while the gout duration ranged from 1 to 30 years. From the interviews, three themes emerged: experiences with gout, types of self-management of gout and factors influencing self-management of gout. Diet control is the main self-management practice of patients with gout. Traditional medicine practices include natural methods such as consumption of different types of vegetable juices, pineapple and papaya. Each ethnicity has its own unique beliefs and food cultures. By understanding the self-management practices of patients from diverse ethnic backgrounds, healthcare practitioners can tailor the treatment of gout to individual needs.

The prevalence and factors associated with coronary heart disease in patients with gout

Background. Gout is associated with increased risk of cardiovascular disease (CVD) morbidity and mortality. Therefore, an association between coronary heart disease (CHD) and gout deserves careful examination. The aim of this study was to determine the prevalence of CHD and factors associated with CHD in patients (pts) with gout. Methods. 286 male patients with gout were included; age – 51.2 [42.8; 59.4] years (ys), disease duration – 6.2 [3.8; 12.1] ys. All patients underwent standard clinical examination, screening traditional risk factors (TRF) of CVD. We estimated the adjusted odds ratio (OR) and 95% confidence interval (95% CI). Results. CHD was found in 111 out of the 286 pts (38.8%), MI had a history in 29.7%. Compared to individuals with CHD, participants without CHD were older (56.7 [52.1; 61.1] vs 46.2 [40.6; 53.4] ys), had longer duration of gout (9.3 [4.7; 15.1] vs 5.6 [3.3; 9.7] ys) (for all p&lt;0.05). Abdominal obesity (OR=3.6; 95% CI: 1.2–10.9), family history of CHD (OR=2.2; 95% CI: 1.3–5.4), disease duration of gout more 10 ys (OR=2.8; 95% CI: 1.6–4.7), age of gout onset &lt;35 ys (OR=5.5; 95% CI: 2.6–11.7), intraosseous tophi (OR=3.03; 95% CI: 1.8–5.01), nephrolithiasis (OR=1.7; 95% CI: 1.04–3.04), renal failure (OR=5.6; 95% CI: 2.7–11.4), serum total cholesterol (TC) (OR=1.6; 95% CI: 1.0–2.8), serum creatinine (OR=2.5; 95% CI: 1.2–5.1), increased the risk for CHD in patients with a gout. Conclusions. The prevalence of CHD was 38.8% among individuals with gout (third of patients had a history of MI 29.7%). Our study showed that both TRFs of CVD and the severity of gout and a history of renal failure contribute to the development of CHD in patients with gout.

Associated Factors of Tophaceous Gout: A Study Involving 20 Primary Care Clinics in an Urbanized State in Malaysia.

Gout is a treatable disease. A complication of untreated or poorly-controlled gout is tophi formation. We conducted this study to investigate the associated factors of tophaceous gout among patients who attended 20 primary care clinics in Selangor, an urbanized state in Malaysia. We conducted a cross-sectional study from July to October 2019 that included all patients with gout who attended the clinics. Data on clinical demographics and laboratory results were collected. Comparison between tophaceous and non-tophaceous groups was performed using descriptive analysis. A total of 421 patients with gout were involved in this study, 83 (19.7%) patients had visible tophi and were categorized into the tophaceous group, while the other 338 (80.3%) patients were categorized into the non-tophaceous group. The majority of patients were male with a mean age of 57.6±12.8 years. Three factors found to be significantly associated with tophaceous gout were age at symptom onset [tophaceous (45.6±13.3 years) vs. non-tophaceous (49.7±13.9 years), p = 0.026], mean disease duration of gout [tophaceous (105.2±92.6 months) vs. non-tophaceous (77.6±88.6 months), p = 0.013], and baseline serum uric acid level [tophaceous (622.3±129.1 µmol/L) vs. non-tophaceous (582.6±102.3 µmol/L), p = 0.021]. Tophaceous gout is associated with longer disease duration, higher baseline serum uric acid level, and younger age at symptoms onset. Hence, early initiation of urate-lowering therapy with a treat-to-target approach is crucial to prevent tophi formation.

1295-P: The Association between Risk of Gout Flares and Monosodium-Urate Burden Assessed Using Musculoskeletal Ultrasound in Patients with Gout

Objective: We aimed to investigate the association between the risk of gout flares and ultrasound (US)-detected monosodium urate (MSU) burden using two different US score. Methods: Patients with gout were consecutively recruited to undergo musculoskeletal ultrasound examinations of their knees, ankles, and feet. The Outcome Measure in Rheumatology (OMERACT) and musculoskeletal ultrasound features-based (MSUS) score were used to quantify the MSU burden of gout. Odds ratios for the risk of frequent gout attacks were calculated. Results: We enrolled 1253 patients with gout (median age, 46 years; gout duration, 5 years; males, 95.9%) and a median of 3 flares over the past year. Of these, 275 (21.9%) patients had frequent (≥7) gout attacks. The OMERACT and MSUS median scores were 6 and 9, respectively. For each 5-point OMERACT and MSUS score increase, the risk of frequent gout attack increased 1.13-fold and 1.27-fold, respectively. The area under the curve (AUC) for the OMERACT and MSUS score was 0.654 (95% confidence interval [CI] 0.617-0.691) and 0.699 (95% CI: 0.663-0.735), respectively, (AUC difference 0.046, P-value for AUC difference, 0.013). Conclusions: The OMERACT and MSUS score were significantly associated with the risk of frequent gout attacks. The MSUS score outperformed the OMERACT in terms of frequent gout attack discrimination. Disclosure S.Yang: None. X.Lin: None. Y.Gao: None. N.Liang: None. Y.Han: None. H.Sun: None. S.Qu: None. H.Chen: None. Funding Key Technologies Research and Development Program of China (2019YFA0904500); National Natural Science Foundation of China (81870606, 82170904); Three-Year Action Plan (2022-2024) to Promote Clinical Skills and Innovation in Municipal Hospitals of Shanghai

Efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis

Objective: To explore the efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis. Methods: A cohort study. The clinical data of patients with refractory chronic gouty arthritis who were treated with rasburicase at Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 2021 and July 2022 were retrospectively analyzed. Refractory chronic gouty arthritis was defined as serum uric acid (sUA)>360 μmol/L and urate volume>10 cm3 under dual-energy computed tomography after tolerable maximal oral urate-lowering therapy for at least 3 months. The administration of low-dose rasburicase was applied intravenously with total dosage ranging from 4.5 to 7.5 mg each dose, at 4-week intervals for a maximum of three doses. Efficacy was evaluated by the changes of sUA level, tophus and urate volume. Results: A total of 22 patients were included for analysis, with 95.4% (21/22) male, the mean age was (44±15) years, and the median duration of gout was 11 (6-15) years. The mean sUA at baseline was (667±112) μmol/L. The levels of sUA significantly decreased after each dose of rasburicase (P<0.001), and the median reduction of sUA after each dose of rasburicase was 568 (471-635), 187 (66-335) and 123 (49-207) μmol/L, respectively. At week 12, nine patients (40.9%) exhibited sUA<360 μmol/L and tophus disappeared in one patient. The urate volume significantly decreased at week 12 when compared with that before the first dose of rasburicase in all the patients [40 (16-172) cm3 vs 17 (7-134) cm3, P<0.001], with a median reduction rate of 41.6% (22.9%-58.5%). The everall safety of rasburicase was good, and no serious adverse reactions occurred. Conclusions: Low-dose rasburicase is well-tolerated and effective for decreasing the urate burden in patients with refractory chronic gouty arthritis. Further prospective randomized controlled trials are needed to validate these findings.

Pegloticase efficacy and safety in kidney transplant recipients; results of the phase IV, open-label PROTECT clinical trial.

Kidney transplant (KT) recipients have a high prevalence and severity of gout. Pegloticase (pegylated recombinant uricase) rapidly metabolizes serum uric acid (sUA), and its efficacy is not impacted by kidney function. This open-label, Phase 4 trial (PROTECT NCT04087720) examined safety and efficacy of pegloticase in 20 participants with KT>1 year prior to enrollment and with uncontrolled gout (sUA ≥7mg/dL, intolerance/inefficacy to urate lowering therapy, and ≥1 of the following: tophi, chronic gouty arthritis, ≥2 flares in past year) and functioning KT (estimated glomerular filtration rate [eGFR] ≥15mL/min/1.73 m2 ) on stable immunosuppression therapy. The primary endpoint was sUA response during month 6 (sUA<6mg/dL for ≥80% of time). The study enrolled 20 participants (mean±SD); age: 53.9±10.9 years, time since KT: 14.7±6.9 years, sUA: 9.4±1.5mg/dL, gout duration: 8.4±11.6 years; all on ≥2 stable doses of immunosuppression agents. Pegloticase (8mg intravenous every 2weeks) in KT recipients with uncontrolled gout showed a high response rate of 89% (16/18 responders). Two participants discontinued treatment solely due to COVID-19 concerns prior to month 6 were not included in the primary analysis. Pegloticase exposures were higher than those historically observed with pegloticase monotherapy, and no anaphylaxis or infusion reaction events occurred during the study. This improved response rate to pegloticase in the KT population reflects observations from other trials and reports on immunomodulation with pegloticase. As the KT population has a high prevalence of gout and limitations with oral urate lowering medication options, these findings suggest a potential option for uncontrolled gout therapy in KT participants.

Increased frequency of hepatic steatosis and fibrosis in patients with gout detected by transient elastography.

It has been suggested that gout is associated with non-alcoholic fatty liver disease (NAFLD). Our aim was to assess NAFLD in gout patients using the validated non-invasive imaging technique, transient elastography (FibroScan). FibroScans in consecutive gout patients in a single centre from 11/1/2016 to 11/1/2021 and reviewed retrospectively. FibroScan results include the E- score (kPA), measuring liver stiffness, and controlled attenuation parameter (CAP) score (dB/m), assessing steatosis. In addition, a FIB-4 fibrosis score was calculated. 47 gout patients (7 females, 14.9%; 40 males, 85.1%) underwent FibroScans. The mean age was 59.8 years, the mean body mass index (BMI) was 30.95 kg/m2, and gout duration 0-49 years. Tophi were present in 11 (26.2%). Comorbidities included dyslipidaemia (86.7%), diabetes mellitus (31.1%), known liver disease (33.3%), current alcohol consumption (46.8%), ALT or AST elevations (54.4%), and hyperuricaemia (53.7%). FibroScan results revealed hepatic steatosis (CAP >238 dB/m) in 40 (85.1%) and were significantly associated with BMI (r=0.53, p=0.0001) but not age, serum urate (SU), glucose, triglycerides, ALT, AST. FibroScan also revealed fibrosis (E score >7) in 9 (19.1%); severe fibrosis (cirrhosis) in 8. Fibrosis was significantly associated with age (p=0.03) and known liver disease (p=0.003) but not BMI, SU, or comorbidities. The FIB-4 score was significantly associated with the fibrosis score (r2=0.24, p=0.0009) but not with CAP, ALT, or AST. Despite not being associated with common gout comorbidities, fatty liver and liver fibrosis were common in this gout cohort, suggesting FibroScan screening in gout patients to assess NAFLD, irrespective of serum transaminase levels.

P039 The association between gout and psychological co-morbidity: a five-year prospective cohort study

Abstract Background/Aims Gout is associated with physical co-morbidities and a reduction in physical health-related quality of life. However, the association between gout and psychological comorbidity (depression and anxiety) has received less attention. A secondary analysis of data from a five-year prospective cohort study was performed to determine the prevalence and incidence of anxiety and depression in people with gout, and gout characteristics associated with psychological co-morbidity. Methods Adults aged ≥18 years with gout were identified via Read codes or allopurinol prescriptions from 20 general practices across the West Midlands. Questionnaires were mailed at baseline and at 12-, 36- and 60-months. Questionnaire data included socio-demographics, gout-related characteristics (flare frequency, oligo- or poly-articular gout, gout duration and allopurinol use) and validated anxiety (GAD-7) and depression (PHQ-9) questionnaires. Current anxiety and depression were defined as scores&amp;gt;10 on the GAD-7 and PHQ-9 respectively. The prevalence and incidence of new-onset anxiety or depression were described at 12, 36 and 60 months in those without anxiety and depression at baseline. Binary logistic regression used to determine baseline gout characteristics associated with developing new-onset anxiety or depression at each time point (odds ratios (OR), 95% confidence intervals (CI), adjusted for age, gender and deprivation). Results Of 1184 baseline responders, 721, 605 and 411 responded at 12-, 36- and 60-months, respectively. The peak prevalence of both depression and anxiety was at baseline at 12.6% and 10.0%, respectively. Responders with anxiety (GAD-7 ≥10) or depression (PHQ-9 ≥10) at baseline were excluded from new-onset analysis. Over five years, one in thirteen (7.5%) developed new-onset anxiety, and one in eleven (9.2%) developed new-onset depression at any future time point. Developing anxiety was associated with a history of oligo- or poly-articular gout flares at baseline (OR 2.31, 95% CI:1.26 to 4.23) but not flare frequency, gout duration, or allopurinol use. New-onset depression was associated with allopurinol use at baseline (OR 1.93, 95% CI: 1.01 to 3.69) but not flare frequency, gout duration, or oligo- or poly-articular gout flares. Conclusion Psychological co-morbidity is common in people living with gout; clinicians should be aware of this when assessing and treating people with gout. Disclosure J.J.R. Higgs: None. L. Clarson: None. R. Bajpai: None. S. Muller: None. E. Roddy: None.

Association between gout at midlife and cognitive impairment at late life - The Singapore Chinese Health Study

ObjectivesThe association between gout and risk of cognitive impairment or dementia is not well established. We examined the relationship between having gout at midlife and the risk of developing cognitive impairment later on. MethodsWe used data of 16,948 participants from the population-based Singapore Chinese Health Study cohort. Participants were recruited from 1993 to 1998 at mean age of 53 years and re-contacted for three follow-up interviews: 1999 to 2004 for follow-up 1, 2006 to 2010 for follow-up 2, and 2014 to 2016 for follow-up 3. History of physician-diagnosed gout was self-reported at follow-up 1 and follow-up 2, while cognitive function was assessed with the Singapore modified Mini-Mental State Examination during follow-up 3, when participants had a mean age of 73.2 years. ResultsGout was reported by 1281 (7.6%) participants at either follow-up 1 or 2, and 2243 (14.4%) had cognitive impairment at follow-up 3. A history of gout was associated with reduced risk of cognitive impairment (OR 0.78, 95% CI 0.65–0.93). This risk was reduced in a stepwise manner with either increased duration of gout or lower age at first diagnosis of gout (Ptrend <0.001). Compared to those without gout, those with gout for ≥20 years (OR 0.56, 95% CI 0.39–0.80) and those with age of onset of gout <50 years old (OR 0.59, 95% CI 0.37–0.94) had a lower risk of developing cognitive impairment. ConclusionA young age of onset or a long history of gout was associated with reduced risk of cognitive impairment in late life.

Early urate-lowering therapy in gouty arthritis with acute flares: a double-blind placebo controlled clinical trial

BackgroundGouty arthritis (GA) is a chronic systemic disease with recurrent acute monoarthritis. In a previous study, a higher incidence of acute flares was observed during the initial marked decrease in serum urate level. Our study evaluated the effect of early urate-lowering therapy in patients with acute GA flares.MethodsThis study included 40 patients with acute GA; of them, 20 received colchicine 0.5 mg colchicine twice daily, while 20 received probenecid 500 mg and colchicine 0.5 mg twice daily. We evaluated GA severity and laboratory data for 2 weeks after the initial therapy. Medians and interquartile ranges (IQRs) were calculated to evaluate clinical presentations between these two groups.ResultsRapidly decreasing median serum uric acid levels was found in the patients treated with probenecid and colchicine compared with the patients treated with colchicine alone on day 8 (− 1.9 [IQR, − 3.7 to 0] vs 0.8 [IQR, − 0.1–2.2]; P < 0.001). However, the median decrease in visual analog scale score did not differ significantly between the two groups (− 5.5 [IQR, − 8.0 to − 3.0] vs − 3.5 [IQR, − 5.9 to − 2.0]; P = 0.080).ConclusionNo significant increase was noted in acute gout flare severity or duration among GA patients treated with early aggressive control of hyperuricemia using probenecid plus colchicine.

S1436 Hepatic Steatosis and Fibrosis in Patients With Gout Detected by Elastography

Introduction: Gout is associated with non-alcoholic fatty liver disease (NAFLD), but neither the frequency nor severity of NAFLD in gout is well described. Elastography is a well-established ultrasonic method to evaluate both steatosis and fibrosis in the liver but has not been applied to evaluate gout patients. Methods: We employed the FibroScan to evaluate patients with advanced gout at one center from 11/1/2016-11/12021. We assessed the Fibrosis score (kPA), which measures liver stiffness (E score), and the controlled attenuation parameter dB/m (CAP) score, which measures steatosis. In addition, we assessed the four-factor fibrosis (FIB-4) Index formula. Results: 47 gout patients (7 females, 14.9%; 40 males, 85.1%) were evaluated. The mean age was 59.8 years and the mean BMI was 30.95 kg/m2. Tophi were present in 11. Disease duration ranged from 0-49 years. Comorbidities included: dyslipidemia (86.7%), DM (31.1%), HTN (63.6%), CHF (12.8%), CAD (12.8%), CKD (19.15%), known liver disease (33.3%) and current alcohol use (46.8%). 53.7% had hyperuricemia and 54.4% had elevations in ALT/AST. Hepatic steatosis was found in 40 (85.1%), but was not significantly different in males or females (p=0.37) or those with CHF (p=0.87), CAD (p=0.94), HTN (p=0.17), DM (p=0.68), dyslipidemia (p=0.59) or the presence of known liver diseases (p=0.37). CAP was correlated with BMI (r=0.53, p=0.0001) but not age, serum urate (SU), glucose, triglycerides (TGs), ALT, AST, FIB-4, or Fibrosis scores. By Fibroscan, 9 (19.1%) had evidence of fibrosis (E score >7), including one with moderate and 8 with severe fibrosis (cirrhosis). Moderate or severe fibrosis was significantly associated with age (p=0.03), known liver disease (p=0.003), but not ancestry, gender, BMI, TGs, HDL, glucose, gout duration, CHF, CAD, HTN, dyslipidemia, or DM. SU was comparable in those with or without moderate or severe fibrosis (p=0.24). The Fib-4 score was significantly greater in those with severe or moderate fibrosis (3.77) versus those with no or mild fibrosis (1.59, p=0.0045). There was a significant correlation between the Fibrosis score and FIB-4 score (r2=0.24, p=0.0009), but not between the Fibrosis score and ALT (p=0.44) or AST(p=0.41). Conclusion: Hepatic steatosis and fibrosis are common in patients with gout, but not associated with typical gout co-morbidities. Screening for NAFLD with elastography should establish the actual frequency of NAFLD in gout and provide a means to manage this co-morbidity more effectively.

The Negative Association Between NAFLD Severity and CKD in a Non-Diabetic Gouty Population.

Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share common pathogenic mechanisms and risk factors. We aim to evaluate the association between NAFLD and CKD in a non-diabetic gouty population. The retrospective cross sectional study was performed on 1049 non-diabetic gouty participants, who were hospitalized between 2014 and 2020, across 4 districts in Shandong, China. Demographic and clinical characteristics of the study population were collected. The odds ratios (OR) and corresponding 95% confidence intervals (CI) about the NAFLD severity determined by ultrasonography were obtained by multiple logistic regression analysis. An unexpectedly inverse relationship was found between NAFLD severity and the risk of CKD in people with gout. Multivariate logistic regression analysis demonstrated that a higher degree of NAFLD severity is independently associated with a lower risk of CKD in people with gout, after adjusted for age, sex, smoking, gout duration, and metabolic risk factors including obesity, hypertension, hyperglycemia, hyperuricemia, and dyslipidemia, with OR 0.392 (95% CI 0.248-0.619, p<0.001), 0.379 (95% CI 0.233-0.616, p<0.001) and 0.148 (95% CI 0.043-0.512, p=0.003) in participants with mild, moderate, and severe NAFLD, respectively, compared to those without NAFLD. We also observed a weakened association of serum uric acid (SUA) with metabolic risk factors and NAFLD under circumstances of CKD in people with gout (r=-0.054, p=0.466). In conclusion, the presence and severity of NAFLD were negatively associated with the risk of CKD in the non-diabetic gouty population.

Prevalence and Risk Factors for Peripheral Neuropathy in Chinese Patients With Gout.

ObjectivePeripheral neuropathies (PNs) are a group of disorders that affect the peripheral nervous system. PN in gout has been scarcely described. This study is conducted to determine the prevalence and related risk factors of PN, as assessed by vibration perception threshold (VPT) in patients with gout.MethodsA total of 442 patients were included in the cross-sectional study. The VPT values were measured by using the Biothesiometer sensory quantitative tester on each patient. The VPT value of either limb higher than 15 V was considered abnormal and is considered to have PN. The univariate and multivariate logistic regression models were used to identify risk factors for PN in patients with gout.ResultsWe included 442 patients with gout, 97.5% men, 26.9% tophaceous gout, mean age 45.5 ± 15.2 years, and 7.4 ± 4.6 years of disease duration. The prevalence of PN in patients with gout was 11.1%. Patients in the abnormal VPT group were older, had a longer gout duration, and had significantly higher levels of waist circumference, waist-to-hip ratio, systolic blood pressure (SBP), and erythrocyte sedimentation rate (ESR), as compared to patients in the normal vibration group (P < 0.05). The univariate logistic regression analysis demonstrated that there was a significant association between abnormal VPT and age, duration of gout, SBP, C-reactive protein, ESR, presence of tophi, and estimated glomerular filtration rate (eGFR) in all the subjects (P < 0.05). The multivariate logistic regression analysis indicated that age (odds ratio, 1.094) and presence of tophi (odds ratio, 1.048) were independent risk factors for PN in patients with gout.ConclusionThe abnormal VPT was significantly correlated with age and presence of tophi in patients with gout and the VPT level may be useful as a screening tool for assessment of PN in gout.

Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study

BackgroundPatients with gout frequently have low urinary pH, which is associated with the nephrolithiasis. However, the specific distribution of urinary pH and potential relationship of acidic urine pH to broader manifestations of kidney disease in gout are still poorly understood.MethodsA 2016–2020 population-based cross-sectional study was conducted among 3565 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University to investigate the association between low urinary pH and kidney disease. We studied patients that we defined to have “primary gout”, based on the absence of > stage 2 CKD. All subjects underwent 14 days of medication washout and 3-day standardized metabolic diet. We obtained general medical information, blood and urine biochemistries, and renal ultrasound examination on the day of the visit. The primary readouts were urine pH, eGFR, nephrolithiasis, renal cysts, microhematuria, and proteinuria. Patients were assigned into 5 subgroups (urine pH ≤5.0, 5.0 <pH≤ 5.5, 5.5 <pH< 6.2, 6.2 ≤pH≤ 6.9, and pH >6.9), aligning with the clinical significance of urine pH.ResultsOverall, the median urine pH and eGFR of all patients was 5.63 (IQR 5.37~6.09), and 98.32 (IQR 86.03~110.6), with acidic urine in 46.5% of patients. The prevalence of nephrolithiasis, microhematuria, and proteinuria were 16.9%, 49.5%, and 6.9%, respectively. By univariate analysis, eGFR was significantly associated with age, sex, duration of gout, tophus, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, serum utare, hypertension, diabetes, and urine pH. On multivariable analysis, eGFR was associated with age, sex, diastolic blood pressure, serum uric acid, hypertension, diabetes, and urine pH. Acidic urine pH, especially urine pH < 5.0, was significantly associated with the prevalence of kidney disease, including > stage 1 CKD, nephrolithiasis, kidney cyst, and microhematuria. Patients with 6.2 ≤ urine pH ≤ 6.9 and SU ≤ 480 μmol/L had the highest eGFR with the lowest prevalence of nephrolithiasis, microhematuria, and proteinuria.ConclusionsApproximately half of gout subjects had acidic urine pH. Urine pH < 5.0 was associated with significantly increased nephrolithiasis, renal cyst, microhematuria, and proteinuria. The results support prospective clinical investigation of urinary alkalinization in selected gout patients with acidic urine pH.