Urate-lowering treatment and risk of total joint replacement in patients with gout.
Objectives: To examine whether gout is an independent risk factor for total joint replacement (TJR) and whether urate-lowering treatment (ULT) reduces this risk.
Methods: Using the Taiwan National Health Insurance database and the UK Clinical Practice Research Datalink, 74 560 Taiwan patients and 34 505 UK patients with incident gout were identified and age and sex matched to people without gout. Cox proportional hazards models and condition logistic regression were used to examine the risk of TJR in gout patients and the association between cumulative defined daily dose (cDDD) of ULT and TJR.
Results: The prevalence rates of TJR in the patients at the time of diagnosis of gout and in people without gout were 1.16% vs 0.82% in Taiwan and 2.61% vs 1.76% in the UK. After a gout diagnosis, the incidence of TJR was higher in the patients with gout compared with those without (3.23 vs 1.91 cases/1000 person-years in Taiwan and 6.87 vs 4.61 cases/1000 person-years in the UK), with adjusted HRs of 1.56 (95% CI 1.45, 1.68) in Taiwan and 1.14 (1.05, 1.22) in the UK. Compared with patients with gout with <28 cDDD ULT, the adjusted ORs for TJR were 0.89 (95% CI 0.77, 1.03) for 28-90 cDDD, 1.03 (0.85, 1.24) for 90-180 cDDD and 1.12 (0.94, 1.34) for >180 cDDD ULT in Taiwan. In the UK, the respective ORs were 1.09 (0.83, 1.42), 0.93 (0.68, 1.27) and 1.08 (0.94, 1.24).
Conclusion: This population-based study provides evidence from two nation populations that gout confers significant TJR risk, which was not reduced by current ULT.
|ジャーナル名||Rheumatology (Oxford, England)|
|投稿者||Kuo, Chang-Fu; Chou, I-Jun; See, Lai-Chu; Chen, Jung-Sheng; Yu, Kuang-Hui; Luo, Shue-Fen; Hsieh, Ao-Ho; Zhang, Weiya; Doherty, Michael|
|組織名||Division of Rheumatology, Allergy and Immunology and Center for Artificial;Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.;Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine,;University of Nottingham, Nottingham, UK.;Division of Paediatric Neurology, Chang Gung Memorial Hospital, Chang Gung;University, Taoyuan, Taiwan.;Department of Public Health, College of Medicine, Chang Gung University, Taoyuan,;Taiwan.;Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung|