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The coexistence of gout in ankylosing spondylitis patients: a case control study

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Ankylosing spondylitis (AS) and gout are common inflammatory arthropathies. It had been claimed previously that the two conditions rarely coexist. The aim of this study was to compare the prevalence of gout in a population of AS patients to its prevalence in the general population. To conduct this population-based case–control study, data of adult patients with a physician diagnosis of AS were retrieved from the database of the largest health-care provider organization in Israel, Clalit Health Services. For each patient with AS, five age- and sex-matched subjects without AS were randomly selected from the same database. Different parameters including the existence of gout, hypertension, body mass index, socioeconomic status, and smoking were evaluated in both the AS and the control groups. The study included 3763 patients with AS and 19,214 controls. The proportion of gout in the AS group was higher than in the control group: 73 subjects in the AS group had gout, while only 107 subjects in the non-AS group had gout (1.94% and 0.56%, respectively, OR 3.53, P < 0.001). Logistic regression adjusting for possible confounding variables found that AS was independently associated with gout (OR 1.41, P = 0.037). Our study suggests that gout is not less common in AS patients in comparison with the general population, and that it might even be more common in AS patients.

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Ankylosing spondylitis


Confidence intervals


Odds ratio


Non-steroidal anti-inflammatory drugs


Clalit Health Services


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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation and data collection were performed by TG, DC, and ADC. Statistical analysis was performed by ST. The first draft of the manuscript was written by TG and revisions of the study were overseen by OS and HA. The co-ordination between all the authors was done by OS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ora Shovman.

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Conflict of interest

Relationships relevant to this manuscript within the last 3 years: Prof. Arnon Cohen received research grants from Janssen, Novartis, AbbVie, Janssen, and Sanofi. Prof. Arnon Cohen served as a consultant, advisor, or speaker to AbbVie, Amgen, Boehringer Ingelheim, Dexcel Pharma, Janssen, Kamedis, Lilly, Neopharm, Novartis, Perrigo, Pfizer, Rafa, Samsung Bioepis, Sanofi, Sirbal, and Taro. All other authors declare no conflict of interest.

Ethical statement

The study fulfilled the ethical guidelines of the most recent Declaration of Helsinki and received approval by the local ethical committee of the Clalit Health Services on 27/08/18. The protocol number for this study was 0212-17-COM.

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Gonen, T., Tiosano, S., Comaneshter, D. et al. The coexistence of gout in ankylosing spondylitis patients: a case control study. Rheumatol Int 40, 465–470 (2020).

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