Gout & Crystal Arthropathy Center

This study looked at 400,401 patients who started allopurinol (a common drug prescribed for gout care) between 1999 and 2012 to determine and compare the risks of being hospitalized with an allopurinol-associated severe cutaneous adverse reactions (AASCARs) for various demographics. The study found only 203 hospitalized AASCAR cases (0.05% of the study group). However, when analyzing by ethnicity, the study found higher relative risks of AASCAR hospitalization for blacks, Asians, Native Hawaiians/Pacific Islanders compared to whites/Hispanics. Furthermore, female sex, older age (≥ 60 years), presence of chronic kidney disease, and higher initial allopurinol dose (> 100 mg/day) were all associated with higher risks of hospitalized AASCARs.

This study used nationally representative data from the National Health and Nutrition Examination Survey from 2007-2016 to estimate gout and hyperuricemia (>7.0 mg serum urate/ dL blood in men and >5.7 mg serum urate/dL blood in women) prevalence rates in each year and examine the year-by-year trend. Overall, the study found that, in 2015-2016, the prevalence of gout was 3.9% among U.S adults (5.2% in men and 2.7% in women). The prevalence of hyperuricemia was 20.2% in men and 20.0% in women. Across the decade, the prevalence rates for both were stable.

The study also looked at the usage of urate-lowering therapy (ULT), a proven and established treatment for patients with gout. From 2007-2014, the prevalence of ULT usage among patients with gout was 33% with a stable year-to-year trend.

This study looked at population data from British Columbia, Canada to identify all incident allopurinol (a common urate-lowering drug used for gout care) users between 1997 and 2015 to investigate the association between heart disease and risk of hospitalization for severe cutaneous adverse reactions. 130,325 allopurinol initiators were identified from the data, of which, 109 (0.08%) were admitted to the hospital for allopurinol-associated severe cutaneous adverse reactions (AASCARs). Initiators with heart disease were found to be 1.55 times more likely to be admitted for AASCAR than initiators without heart disease. Accounting for other factors, those with heart disease and chronic kidney disease that initiated allopurinol at a dosage greater than 100 mg/day were 11 times more likely to be admitted for AASCAR. Conversely, those with heart disease and chronic kidney disease that initiated allopurinol at a lower dosage were 5 times less likely to be admitted for AASCAR.

This study used CT scans to investigate the clustering patterns of monosodium urate (MSU) crystal deposition and bone erosions in patients with gout on urate lowering therapy (ULT). 153 patients with gout on ≥ 300 mg/day allopurinol were scanned at the hands/wrists, feet/ankles, and knees over the course of ≥ 3 months. The study found that MSU crystal deposition affected 67% of the patients at multiple body parts. Furthermore, if there was MSU crystal formations in one joint, the odds of a MSU crystal formation in the corresponding joint on the other side of the body would be significantly higher (26.1 times higher odds for hands/wrists, 46.9 times higher odds for feet/ankles, and 9.9 higher odds for knees). Bone erosion was 8 times more likely in sites with MSU crystal deposition compared to sites without MSU crystal deposition. The study concluded that MSU crystal deposition and bone erosions affected gout patients on ULT symmetrically.

This study investigated the association between vaccination and odds of a gout flare. Information was collected online from patients with gout, looking at two-day hazard periods before gout flares and two-day control periods without a gout flare. The study concluded that vaccination was associated with a twofold higher odds of gout flaring. However, the absolute magnitude of the increase in odds is small and should be interpreted within the context of the overwhelming benefits of vaccinations.