This gout & rheumatoid arthritis report is a layman’s summary of an investigation into the coexistence of gout and rheumatoid arthritis presented at the 2012 ACR meeting.
Rheumatoid Arthritis is a prolonged and progressive disease in which the immune system attacks the joints. Symptoms of rheumatoid arthritis include:
- Pain, inflammation and swelling of the joints
- Loss of mobility
Tissues throughout the body can be affected, including:
- Blood vessels
Gout & Rheumatoid Arthritis Study
- Co-Existence of Gout in Rheumatoid Arthritis: It Does Happen! A Population Based Study
- Adlene Jebakumar, Cynthia S. Crowson, P. Deepak Udayakumar and Eric L. Matteson, Mayo Clinic, Rochester, MN
- ACR Annual Meeting Nov 2012
Gout & Rheumatoid Arthritis Study: Background/Purpose
It is popularly believed that gout does not occur in rheumatoid arthritis patients, yet some cases have been reported in medical press.
This investigation assesses the numbers, symptoms, and possible causes of gout in rheumatoid arthritis patients.
Gout & Rheumatoid Arthritis Study: Methods
Rheumatoid arthritis patients were selected between 1980 to 2007. Their medical history was followed until April 2012. From these subjects, patients with confirmed gout were analyzed. Gout was confirmed by the presence of uric acid crystals in joint fluid, or other established criteria, and excluded patients with:
- Hyperuricemia without gout
- Septic arthritis
- Traumatic arthritis
- Rheumatoid arthritis initially misdiagnosed as having gout
Total gout cases in rheumatoid arthritis patients were analyzed statistically.
Gout & Rheumatoid Arthritis Study: Results
A study total of 813 patients had the following symptoms:
- 537 (66%) were rheumatoid factor positive
- 33% had rheumatoid nodules
- 53% had erosive joint disease
These patients had an average 12 years rheumatoid arthritis, representing 9771 total person-years in the study. 22 patients developed gout by clinical criteria. The great toe was the most common site of gout (12 of 22 patients). The 25 year cumulative incidence of gout diagnosed by clinical criteria was 5.3%.
Typical uric acid crystals were present in 9 of 22 patients with acute gout. All had developed gout after first getting diagnosed with rheumatoid arthritis.
The 25 year cumulative incidence of gout diagnosed by clinical criteria including presence of urate crystals is 1.3%. The prevalence of gout in rheumatoid arthritis on Jan 1, 2008 was 1.9% (11 of 582 patients) as opposed to expected prevalence of 5.2% (or 30 patients) based on National Health and Nutrition Examination Survey (NHANES) data using age and sex specific prevalence rates.
Risk factors for gout in rheumatoid arthritis were:
- older age (1.5 more likely per 10 year increase)
- male sex (3.18 more likely than female)
- obesity (3.5 more likely)
The presence of erosive rheumatoid arthritis joint disease reduced the risk of gout to slightly less than one quarter.
Gout has become 5.6 times more common in patients diagnosed with rheumatoid arthritis in recent years (1995-2007) than in previous years (1980-1994).
Gout & Rheumatoid Arthritis Study: Conclusion
Gout does occur in patients with rheumatoid arthritis, though at a lower rate than in the general population. The minimum/maximum cumulative incidence is 1.3/5.3%.
Risk factors for gout in rheumatoid arthritis are similar to those in the general population.
Gout & Rheumatoid Arthritis: Next Steps
If you suspect that you have gout at the same time as rheumatoid arthritis, it is important to consult a rheumatologist.
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