Serum urate predicts 10-year risk for recurrent gout hospitalization, flares
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Key takeaways:
- Higher baseline serum urate levels correlated with increased rates of gout flares and hospitalization.
- Findings support baseline serum urate to assess 10-year risk for recurrent gout.
Patients with higher baseline serum urate levels demonstrate increased recurrent gout hospitalization rates and subsequent risk for flare over 10 years of follow-up, according to data published in JAMA.
The findings suggest that most gout flares are “potentially preventable at the population level” with the achievement of serum urate targets of less than 6 or 5 mg/dL, Hyon K. Choi, MD, DrPH, director of clinical epidemiology at Massachusetts General Hospital, told Healio.
“Serum urate is not followed in primary care practice, even after initiation of urate-lowering therapy, in the vast majority of gout patients,” Choi said. “Instead, [treat-to-avoid-symptoms], not relying on target urate levels, has often been adopted. Targeting these serum urate levels for gout patient care as per rheumatology guidelines would help reduce the gout flare burden tremendously.”
To investigate links between serum urate and risk for flares and hospitalization, Choi and colleagues conducted a retrospective study of UK Biobank information among all participants with a history of gout in their primary care data at baseline. In all, the analysis included data from 3,613 patients with gout history who experienced a total of 1,773 acute gout flares over a mean follow-up period of 8.3 years.
The researchers used negative binomial regression to find links between baseline serum urate levels and subsequent risk for gout flares, determined via primary discharge diagnosis, primary care records and prescriptions. Covariates included potential confounders of serum urate levels such as diabetes, cardiovascular disease, hypertension and chronic kidney disease.
According to the researchers, patients with a baseline serum urate level of 5 mg/dL or greater experienced 98% of all acute gout flares, while 95% of flares occurred in those with a level of 6 mg/dL or greater. The rate of hospitalization per 1,000 person-years ranged from 0.97, among participants with baseline urate levels between 6 and 6.9 mg/dL, to 9.7, for those with serum urate greater than or equal to 10 mg/dL.
The researchers concluded that a single measure of serum urate level “was strongly associated with the risk for recurrent gout flares,” supporting the ability of serum urate to assess risk of recurrent gout over nearly 10 years of follow-up, they wrote.
The next step in the research will involve implementation science to determine the best way to achieve serum urate targets “effectively in primary clinical practices and beyond, which can become readily overwhelmed by multiple comorbidities,” Choi said.
“Involving nurses, pharmacists, or interactive online or app systems — as in other chronic treat-to-target regimens, such as anticoagulation, blood pressure or lipid care — is actively being researched,” he added. “Also, we are trying to find the effective and safe medications, and non-pharmacologic measures, to reduce the urate burden, which can also simultaneously take care of gout’s frequent cardiovascular-kidney comorbidities.”
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