Credit: Original article published here.
Gout is a common form of arthritis caused by the accumulation of uric acid crystals in joints, which can result in pain, swelling, and stiffness. Previous studies have suggested that gout is associated with an increased risk of fracture, but the effects of hyperuricemia and urate-lowering therapy (ULT) on fracture risk have been inconsistent.
To address this knowledge gap, researchers conducted a study to examine whether lowering serum urate (SU) levels with ULT to a target level reduces the risk of fracture among patients with gout. The study was published in Arthritis & Rheumatology.
The researchers used data from The Health Improvement Network, a primary care database in the United Kingdom, to emulate analyses of a hypothetical target trial via a “cloning, censoring, and weighting” approach. The study included individuals with gout who were 40 years or older and had initiated ULT. The researchers examined the association between lowering SU with ULT to the target levels and the risk of fracture.
The study included 28,554 patients with gout, and the results showed that the 5-year risk of hip fracture was lower in the “achieving the target SU level” arm compared with the “not achieving the target SU level” arm. Specifically, the 5-year risk of hip fracture was 0.5% for the “achieving the target SU level” arm and 0.8% for the “not achieving the target SU level” arm. The risk difference and hazard ratio for the “achieving the target SU level” arm were –0.3% (95% CI, –0.5% to –0.1%) and 0.66 (95% CI, 0.46-0.93), respectively, compared with the “not achieving the target SU level.” Similar results were observed when assessing the associations between lowering SU levels with ULT to a target level and the risk of composite fracture, major osteoporotic fracture, vertebral fracture, and nonvertebral fracture.
The researchers concluded that lowering SU levels with ULT to the guideline-based target level is associated with a lower risk of incident fracture in patients with gout. These findings provide important insight into the management of gout and the prevention of fractures in those with the condition. Health care providers may consider monitoring SU levels and adjusting ULT as appropriate to achieve the target SU level and reduce the risk of fracture.
Source: Arthritis & Rheumatology
