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

Abstract

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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Abbreviations

AS:

Ankylosing spondylitis

CI:

Confidence intervals

OR:

Odds ratio

NSAIDs:

Non-steroidal anti-inflammatory drugs

CHS:

Clalit Health Services

BMI:

Body mass index

CV:

Cardiovascular

References

  1. 1.

    Taurog JD, Chhabra A, Colbert RA (2016) Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med 374:2563–2574. https://doi.org/10.1056/NEJMra1406182

    Article  PubMed  Google Scholar 

  2. 2.

    Smith JA (2014) Update on ankylosing spondylitis: current concepts in pathogenesis. Curr Allergy Asthma Rep 15:489. https://doi.org/10.1007/s11882-014-0489-6

    CAS  Article  Google Scholar 

  3. 3.

    Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23:61–66. https://doi.org/10.1007/s00296-002-0237-4

    Article  PubMed  Google Scholar 

  4. 4.

    Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390. https://doi.org/10.1016/S0140-6736(07)60635-7

    Article  PubMed  Google Scholar 

  5. 5.

    Kuo C-F, Grainge MJ, Zhang W, Doherty M (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11:649–662. https://doi.org/10.1038/nrrheum.2015.91

    Article  PubMed  Google Scholar 

  6. 6.

    Zlnay D, Rovensky J, Bosak V, Zlnay M (2004) The coincidence of ankylosing spondylitis and gouty arthritis. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 10:47–50. https://doi.org/10.1097/01.rhu.0000111306.55417.19

    Article  Google Scholar 

  7. 7.

    Yildiz N, Sutbeyaz ST, Koseoglu F (2011) Coexisting ankylosing spondylitis and gouty arthritis/Ankilozan spondilit ve gut artriti birlikteligi. Turk J Phys Med Rehabil 57:111–114. https://doi.org/10.4274/tftr.57.23

    Article  Google Scholar 

  8. 8.

    Wong DM, Chalmers IM (1994) Coexistent acute gouty arthritis and ankylosing spondylitis. A rare occurrence. J Rheumatol 21:773–774

    CAS  PubMed  Google Scholar 

  9. 9.

    Duda J, Rovensky J, Tauchmannova H, Bakosova J (2005) Coincidence of ankylosing spondylitis, gouty arthritis and chondrocalcinosis articularis. Isr Med Assoc J IMAJ 7:679

    CAS  PubMed  Google Scholar 

  10. 10.

    Ho H-H, Yu K-H, Chen J-Y, Lin J-L, Wu Y-JJ, Luo S-F, Liou L-B (2007) Coexisting ankylosing spondylitis and gouty arthritis. Clin Rheumatol 26:1655–1661. https://doi.org/10.1007/s10067-007-0563-8

    Article  PubMed  Google Scholar 

  11. 11.

    Merdler-Rabinowicz R, Tiosano S, Comaneshter D, Cohen AD, Amital H (2017) Comorbidity of gout and rheumatoid arthritis in a large population database. Clin Rheumatol 36:657–660. https://doi.org/10.1007/s10067-016-3477-5

    Article  PubMed  Google Scholar 

  12. 12.

    Houri Levi E, Watad A, Whitby A, Tiosano S, Comaneshter D, Cohen AD, Amital H (2016) Coexistence of ischemic heart disease and rheumatoid arthritis patients—a case control study. Autoimmun Rev 15:393–396. https://doi.org/10.1016/j.autrev.2016.01.006

    Article  PubMed  Google Scholar 

  13. 13.

    Bieber V, Cohen AD, Freud T, Agmon-Levin N, Gertel S, Amital H (2013) Autoimmune smoke and fire-coexisting rheumatoid arthritis and chronic obstructive pulmonary disease: a cross-sectional analysis. Immunol Res 56:261–266. https://doi.org/10.1007/s12026-013-8395-x

    Article  PubMed  Google Scholar 

  14. 14.

    Dahan S, Shor DB-A, Comaneshter D, Tekes-Manova D, Shovman O, Amital H, Cohen AD (2016) All disease begins in the gut: celiac disease co-existence with SLE. Autoimmun Rev 15:848–853. https://doi.org/10.1016/j.autrev.2016.06.003

    Article  PubMed  Google Scholar 

  15. 15.

    Watad A, Cohen AD, Comaneshter D, Tekes-Manova D, Amital H (2016) Hyperthyroidism association with SLE, lessons from real-life data—a case–control study. Autoimmunity 49:17–20. https://doi.org/10.3109/08916934.2015.1090985

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    MacFarlane LA, Kim SC (2014) Gout: a review of non-modifiable and modifiable risk factors. Rheum Dis Clin N Am 40:581–604. https://doi.org/10.1016/2Fj.rdc.2014.07.002

    Article  Google Scholar 

  17. 17.

    Schlesinger N (2014) Treatment of acute gout. Rheum Dis Clin N Am 40:329–341. https://doi.org/10.1016/j.rdc.2014.01.008

    Article  Google Scholar 

  18. 18.

    Bajaj S, Fessler BJ, Alarcon GS (2004) Systemic lupus erythematosus and gouty arthritis: an uncommon association. Rheumatology 43:349–352. https://doi.org/10.1093/rheumatology/keh043

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Merola JF, Wu S, Han J, Choi HK, Qureshi AA (2015) Psoriasis, psoriatic arthritis, and risk of gout in US men and women. Ann Rheum Dis 74:1495–1500. https://doi.org/10.1136/annrheumdis-2014-205212

    Article  PubMed  Google Scholar 

  20. 20.

    Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M (2016) Comorbidities in patients with gout prior to and following diagnosis: case–control study. Ann Rheum Dis [Internet]. https://doi.org/10.1136/annrheumdis-2014-206410

    Article  Google Scholar 

  21. 21.

    Howard RG, Samuels J, Gyftopoulos S, Krasnokutsky S, Leung J, Swearingen CJ, Pillinger MH (2015) Presence of gout is associated with increased prevalence and severity of knee osteoarthritis: among older men: results of a pilot study. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 21:63–71. https://doi.org/10.1097/RHU.0000000000000217

    Article  Google Scholar 

  22. 22.

    Roddy E, Doherty M (2012) Gout and osteoarthritis: a pathogenetic link? Jt Bone Spine 79:425–427. https://doi.org/10.1016/j.jbspin.2012.03.013

    Article  Google Scholar 

  23. 23.

    MacDonald AG, Downham C, Jones GT, Macfarlane GJ, Dean LE, Sturrock RD (2013) Global prevalence of ankylosing spondylitis. Rheumatology 53:650–657. https://doi.org/10.1093/rheumatology/ket387

    Article  PubMed  Google Scholar 

  24. 24.

    Malesci D, Niglio A, Mennillo GA, Buono R, Valentini G, La Montagna G (2006) High prevalence of metabolic syndrome in patients with ankylosing spondylitis. Clin Rheumatol 26:710. https://doi.org/10.1007/s10067-006-0380-5

    Article  PubMed  Google Scholar 

  25. 25.

    Puig JG, Martínez MA (2008) Hyperuricemia, gout and the metabolic syndrome. Curr Opin Rheumatol 20:187. https://doi.org/10.1097/BOR.0b013e3282f4b1ed

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Choi HK, Atkinson K, Karlson EW, Curhan G (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 165:742–748. https://doi.org/10.1001/archinte.165.7.742

    Article  PubMed  Google Scholar 

  27. 27.

    Thottam GE, Krasnokutsky S, Pillinger MH (2017) Gout and metabolic syndrome: a tangled web. Curr Rheumatol Rep 19(10):60. https://doi.org/10.1007/s11926-017-0688-y

    Article  PubMed  Google Scholar 

  28. 28.

    Ahmed N, Prior JA, Chen Y, Hayward R, Mallen CD, Hider SL (2016) Prevalence of cardiovascular-related comorbidity in ankylosing spondylitis, psoriatic arthritis and psoriasis in primary care: a matched retrospective cohort study. Clin Rheumatol 35:3069–3073. https://doi.org/10.1007/s10067-016-3362-2

    Article  PubMed  Google Scholar 

  29. 29.

    Yi YS (2018) Role of inflammasomes in inflammatory autoimmune rheumatic diseases. Korean J Physiol Pharmacol 22(1):1–15. https://doi.org/10.4196/kjpp.2018.22.1.1

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J (2006) Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 440:237–241. https://doi.org/10.1038/nature04516

    CAS  Article  PubMed  Google Scholar 

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Author information

Affiliations

Authors

Contributions

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.

Ethics declarations

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). https://doi.org/10.1007/s00296-019-04462-x

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Keywords

  • Ankylosing spondylitis
  • Gout
  • Comorbidities
  • Case–control study
  • Rheumatic diseases