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Gout and chronic pain in older adults: a Medicare claims study


To assess if gout is associated with a higher risk of incident chronic pain. This study used the 2006–2012 Medicare claims data. We used multivariable-adjusted Cox regression analyses to examine the association of pre-existing diagnosis of gout with incident (new) diagnosis of chronic pain, adjusting for demographics, medical comorbidity, and use of common medications for cardiovascular disease and gout. Sensitivity analyses substituted Charlson-Romano score with a categorical variable or each Charlson-Romano comorbidity. There were 1,321,521 eligible people, of whom 424,518 developed incident chronic pain. Crude incidence rates of chronic pain were as follows: gout, 158.1 per 1000 person-years and no gout, 64.5 per 1000 person-years. In multivariable-adjusted Cox regression analyses, gout was associated with higher hazard ratio of chronic pain, 2.02 (95% CI, 1.98, 2.05), confirmed in sensitivity analyses 1.96 (95% CI, 1.93, 1.99) (model 2) and 1.77 (95% CI, 1.74, 1.80) (model 3). No meaningful differences were found by gender and race in subgroup analyses; slightly lower hazard of chronic pain with gout was seen in oldest people. Use of allopurinol or febuxostat was associated with lower risk of chronic pain, 0.79 (95% CI, 0.77, 0.82; model 1) and 0.72 (95% CI, 0.56, 0.92; model 1). Gout was associated with a doubling of the risk of chronic pain and gout treatments with reduction in the risk. Efforts must be made to optimize gout control, so that chronic pain can be avoided as a long-term sequalae of gout and when present, treated early and appropriately.

Key points
Gout was associated with twofold higher risk of incident (or new) diagnosis of chronic pain.
Gout treatments were associated with a lower chronic pain risk.
Increased risk of chronic pain with gout was similar across age, race, and sex.
Studies should examine if optimal gout control with treat-to-target approach can reduce the risk of chronic pain in people with gout.

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Data availability

These data can be obtained from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse. We are ready to share the data with colleagues, after obtaining appropriate permissions from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse and the University of Alabama at Birmingham (UAB) Ethics Committee, related to HIPAA and Privacy policies.



International Classification of Diseases, ninth revision, common modification


xanthine oxido-reductase system


coronary artery disease

ACE inhibitor:

angiotensin converting enzyme inhibitor


urate-lowering therapy


Centers for Medicare and Medicaid Services


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We thank Dr. Jeffrey Curtis of the UAB Division of Rheumatology, who permitted us to re-use the 5% Medicare data.


The funding body did not play any role in design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.


This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.

Author information




JAS designed the study, developed the study protocol, reviewed the analyses, and wrote the first draft of the paper. DC performed the data abstraction and data analyses. All authors revised the manuscript, read, and approved the final manuscript.

Corresponding author

Correspondence to Jasvinder A. Singh.

Ethics declarations

Conflict of interest

JAS has received consultant fees from Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee, and the co-Chair of the ACR Criteria and Response Criteria subcommittee. DC has no conflicts to declare. There are no non-financial competing interests for any of the authors.

Ethics/IRB approval and consent to participate

The University of Alabama at Birmingham’s Institutional Review Board approved this study and all investigations were conducted in conformity with ethical principles of research. The IRB waived the need for informed consent for this study.

Consent to publish

No individual person’s data were presented in any form in this study and therefore no consent to publish is required.

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Singh, J.A., Cleveland, J.D. Gout and chronic pain in older adults: a Medicare claims study. Clin Rheumatol 38, 1953–1960 (2019).

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  • Chronic pain
  • Elderly
  • Gout
  • Older adults
  • Risk