Uncontrolled Serum Uric Acid Levels Significantly Increase Mortality Risk in Gout Patients

Patients with severe cases of gout are at an increased risk of mortality. According to recent research, this risk is even more significant in gout patients with increased serum uric acid (sUA) levels. 

The goal of the present study was to determine if achieving sUA under 6 mg/dl, as opposed to greater, had an impact on mortality risk for gout patients. Researchers collected data on 1,193 gout patients (92% men, mean age 60, 6.8 years disease duration, with an average of 3 to 4 flares in the previous year) attending a specialized clinic between 1992 and 2017 who had at least one follow-up visit. They tracked sUA levels during follow-up, and “and the average sUA until sUA was stable was used as the primary exposure dichotomized as < 6 mg/dl (versus > 6 mg/dl).” 

At baseline, mean sUA was 9.1 mg/dl, and 16.3% of patients had elevated sUA levels (≥6 mg/dl), even with treatment. Overall mortality was 13%, with 158 deaths, and 286 (24%) patients were lost to follow-up. The overall crude mortality rate was 32.7 per 1,000 patient-years, (95% confidence interval [CI]: 28.0-38.2). Patients with elevated sUA levels had a significantly higher mortality risk (80.9 per 1,000 person years, 95% CI 59.4-110.3) than patients with sUA <6 mg/dl (25.7 per 1,000 person-years, 95% CI: 21.3-30.9). When adjusting for age, sex, previous cardiovascular events, and sUA concentration at baseline, patients with increased sUA had a 139% increased risk of mortality compared to patients with sUA <6 mg/dl. 

The findings of the study were presented at the annual meeting of the American College of Rheumatology by Fernando Perez-Ruiz, MD, PhD, a rheumatologist at Hospital Universitario Cruces, Barakaldo, Spain. 

“Failure to reach a target sUA level of 6 mg/dl is an independent predictor of mortality in gout patients,” the study authors wrote. “Control of gout with achievement of sUA target <6 mg/dl should be considered in order to improve patient survival.” 

The study demonstrates the need for a treat-to-target approach for gout patients, Perez-Ruiz said at a press conference. Perez-Ruiz pointed out that this approach is already used in treating other diseases, such as diabetes and hypertension. 

“A lot of physicians including, unfortunately, rheumatologists don’t treat gout to target. They feel like if a patient is doing nicely, that’s good enough. But it’s like lowering cholesterol: If you’re at 400 mg/dL and you go to 300, does that mean it’s fine and you won’t get a myocardial infarction?” he said. 

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Source: American College of Rheumatology