Tophaceous gout at higher mortality risk than non-tophaceous gout

A large observational study found increased hazard ratios for mortality, acute myocardial infarction (MI), and end-stage renal disease (ESRD) in patients with tophaceous gout than in those with non-tophaceous gout. At 5 years, the likelihood of mortality was 24% higher in individuals with tophi.

“Over the past 2 decades, it has become increasingly clear that gout is an independent risk factor for increased mortality,” Dr Gregory Challener (Massachusetts General Hospital, MA, USA) stated [1]. Due to the growing interest in the question of whether tophaceous gout itself could be linked to a higher risk of mortality, a longitudinal cohort analysis investigated potential differences between the gout subgroups. Data for the multicentre study was collected from the US TriNetX Diamond network of claims records. Outcomes of mortality, acute MI, and ESRD were measured at years 1 and 5.

The tophaceous gout cohort included 73,569 patients and the non-tophaceous gout cohort 284,241. The mean age was about 67 years, over 50% were men, around 70% had hypertension, just over 25% had ischaemic heart disease, and 27.3–28.5% had chronic kidney disease. Before matching, significant differences existed between the cohorts for diabetes, obesity, and medication. “Following propensity score matching, all of these differences disappeared,” Dr Challener clarified.

At 1 year, the mortality risk for tophaceous gout versus non-tophaceous gout within the 2 matched groups was 5.0% versus 4.3%, leading to an HR of 1.20 (95% CI 1.15–1.26). After 5 years, the likelihood of mortality was 24% greater for patients with tophaceous gout (HR 1.24; 95% CI 1.20–1.27). Also, the chances for acute MI at 1 and 5 years were increased in the tophaceous gout group: HR 1.20 (95% CI 1.10–1.31) and HR 1.21 (95% CI 1.15–1.28), respectively. Kidney impairment in terms of ESRD followed a similar pattern: HR 1.12 (95% CI 1.02–1.24) at 1 year and HR 1.16 (95% CI 1.09–1.25) at 5 years. Dr Challener underlined that the results from the unmatched analysis were very similar.

Although this was a retrospective study, Dr Challener pointed out that it had strengths in its large population, multicentricity, and propensity score matching. “This result suggests that it is important to identify patients with tophaceous gout and to treat them aggressively, including with uricase treatment in those with an inadequate response on xanthine oxidase inhibitors,” Dr Challener concluded.  The place for uricase therapy and its optimal use remains an area of ongoing research.

1. Challener G, et al. Risk of mortality in patients with tophaceous versus non-tophaceous gout. OP0170, EULAR 2024 Congress, 12–15 June, Vienna, Austria.

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Posted on 29 July 2024