Factors affecting the frequency of arthritis attacks in patients with gout not receiving urate-lowering therapy (results of a pilot retrospective study)

Abstract

Gout manifests as acute arthritis attacks, the frequency of which varies and is unpredictable.The aim of this study was to identify factors associated with the frequency of arthritis attacks in patients with gout who have not received urate-lowering therapy (ULT).Materials and methods. A retrospective cohort study included 116 patients (6 females, 110 males) with gout, with a mean age of 50.1±12.05 years, who were not receiving ULT. The frequency of arthritis attacks in the past year and the presence of subcutaneous tophi were evaluated. Analyzed factors included alcohol consumption, smoking, body mass index (BMI), blood pressure values, comorbidities, diuretic use, and laboratory tests, including serum levels of glucose, creatinine, creatine phosphokinase (CPK), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), uric acid (UA), C-reactive protein (CRP), and estimated glomerular filtration rate (eGFR).Results. The mean disease duration was 9.2 [3.9; 15.8] years. The average number of arthritis attacks per year was 5 [2; 6], with ≥4 arthritis attacks per year observed in 40% of patients, and subcutaneous tophi present in 33.6%. A weak positive correlation was found between the frequency of exacerbations and systolic blood pressure (p<0.001), serum GGT levels (p<0.001), CPK levels (p=0.120), and serum CRP levels (p=0.040). Serum UA levels correlated only with the presence of subcutaneous tophi (p=0.017), but not with the frequency of arthritis attacks (p=0.972). OR >4 attacks of arthritis was significant for: presence of heredity for gout – 1.955 (95% CI: 1.224–3.121; p<0.05); presence of tophi – 1.746 (95% CI: 1.161–2.626; p=0.007); alcohol consumption – 2.656 (95% CI: 1.766–3.994; p<0.001); in the presence of a sUA level ≥540 µmol/l – 1.586 (95% CI: 1.041–2.416; p=0.031). Diuretics users had attacks more frequently (р<0,001).Conclusion. The frequency of arthritis attacks in untreated gout patients may be associated with the presence of subcutaneous tophi, systolic blood pressure values, serum GGT, uric acid levels (when >540 µmol/L), diuretic use, and alcohol consumption.