AB0323 IS GOUT ASSOCIATED WITH AN EXCESS FRACTURE RISK?

• Published in: Annals of the rheumatic diseases Vol. 83; no. Suppl 1; p. 1405
• Main Authors: Makhlouf, Y., Tekaya, W., Miladi, S., Fazaa, A., Boussaa, H., Souabni, L., Ouenniche, K., Kassab, S., Chekili, S., Ben Abdelghani, K., Laatar, A.
• Format: Journal Article
• Language: English
• Published: Kidlington BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2024; Elsevier B.V; Elsevier Limited
• Subjects: Allopurinol; Bone; Bone density; Bone mineral density; Cohort analysis; Colchicine; Comorbidities; Comorbidity; Corticosteroids; Descriptive Studies; Diabetes; Diabetes mellitus; Diagnosis; Disease; Dyslipidemia; Fractures; Gout; Hypertension; Nephropathy; Nonsteroidal anti-inflammatory drugs; Osteopenia; Osteoporosis; Patients; Population studies; Prognostic factors; Renal insufficiency; Rheumatism; Rheumatoid arthritis; Rheumatology; Scientific Abstracts; Sex ratio; Statistical analysis; Steroids; Trauma; Uric acid; Vertebrae; Descriptive Studies; Bone; Comorbidities; Prognostic factors
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2024-eular.6244

Background:Chronic inflammatory rheumatic diseases (RD), notably rheumatoid arthritis (RA) and spondylarthritis (SpA), increase the susceptibility to fractures. However, the question of whether gout also elevates the risk of fractures remains a subject of debate [1,2].Objectives:This study aimed to assess the prevalence of fractures among patients with gout compared to patients with RD.Methods:We conducted an observational cohort study including patients with gout and RD (SpA and RA), followed up at the Rheumatology Department of Mongi Slim Hospital, over 14 years (2010-2023). Socio-demographic, and disease-related data were collected and analyzed. Fracture history as well as bone mineral density measurement were documented, and factors associated with fracture occurrence were investigated. A significance threshold was set at p<0.05.Results:The study enrolled 64 patients, with gout (51.6%), RA (37.5%), and SpA (10.9%). The mean age across all patients was 57.5 years (15,04) [17-85], with pathology-specific averages of 62 years (13,59) [36-85] for gout, 57.7 (11,15) years [39-85] for RA, and 35.1 (14,71) years [17-59] for SpA. Among the patients, 57.8% were males, yielding a sex ratio of 1.37. The mean disease duration was 9.7 years (5,07) [0,1-20] for gout, 11.6 years (11,55) [0,3-43] for RA, and 5.2 years (3,99) [0,5-11] for SpA. Comorbidities were present in 70.3% of total cases and distributed as follows: hypertension (50%) and diabetes (23.2%). Gout patients presented comorbidities as follows: 60.6% hypertension, 18.2% diabetes, 27.3% dyslipidemia, 36.4% renal insufficiency, and 24.2% smokers. Treatment specifics varied, with 84.4% of gout patients on Allopurinol, 59.4% on colchicine, 12.1% on NSAIDs, and 6.1% on corticosteroids. For RD patients, 70.9% were on long-term corticosteroid therapy with an average dose of 8.6 mg (2,59) of prednisone [5-15]. Signs of chronic gout were present in 45.5% of cases: 25% nephropathy, 12.5% tophus, and 18.8% arthropathy. Uric acid levels at diagnosis averaged 534.7 μmol/L (138,5) [256-868], with a current mean level of 418 μmol/L (127,2) [231-820]. The mean number of flares was 0,6 [0-3] with 39.3% of patients experiencing at least one flare in the last year. Bone mineral density (BMD) testing when performed in gout patients, revealed osteopenia in 40% of cases and osteoporosis in one patient. In RD cases, BMD showed osteoporosis and osteopenia were found in 50% and 30.8% of cases respectively. The prevalence of fractures among gout patients was 18.2% and 66.6% of them were low trauma. Conversely, all RD fractures were low trauma: the vertebrae (n=4), the upper limb (n=1), and the hip (n=1). Fracture prevalence was comparable between gout and RD patients (18.2% vs 19.4%, p=0.9). In contrast, there was a statistically significant association between a history of fracture and chronic gout (p=0.03). However, no significant associations were found between the history of fracture and disease duration (p=0,32), uric acid levels at diagnosis (p=0.4), current levels (p=0.1), recent flares (p=0.8), or the use of Urate-lowering drugs (p=0.9).Conclusion:Our study demonstrated that the fracture risk was similar between individuals with gout compared to RD patients. Long-standing gout appears to increase this risk. Additional prospective studies on a larger scale and broader assessments of BMD in individuals with gout are necessary to ascertain this association.REFERENCES:[1] Liu et al. Gout is not associated with the risk of fracture: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2019; 14:272.[2] Tzeng HE, Lin CC, Wang IK, Huang PH, Tsai CH. Gout increases risk of fracture: a nationwide population-based cohort study. Medicine (Baltimore). 2016;95(34):e4669.Acknowledgements:NIL.Disclosure of Interests:None declared.