THU0462 Mortality in patients with gout: a systematic review
Authors: S Mitchell, H Liedgens, E Johannes
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Gout is a chronic, progressive, inflammatory disease characterised by elevated serum uric acid (sUA) levels (1). In Europe the prevalence of gout ranges from 0.9–2.5%, and is increasing (2). Published data indicate that gout is an independent risk factor for both all-cause and cardiovascular (CV)-related mortality (3, 4). <h3>Objectives</h3> To conduct a systematic review to identify studies reporting the association between gout and mortality (all-cause and CV-related). <h3>Methods</h3> Relevant publications were identified by interrogating electronic databases; Medline &amp; MEDLINE In-Process, EMBASE and the Cochrane Library (accessed 3 May 2016). Eligibility criteria included adult patients with a definitive diagnosis of acute/chronic gout (self-reported/physician diagnosed), with no restriction on publication date, study design or geography. <h3>Results</h3> Nineteen studies met the pre-defined inclusion criteria and were reviewed. The studies were conducted in: the US (n=8); Taiwan (n=5); Canada (n=3); Spain (n=1); Singapore (n=1); and the UK (n=1). In addition to patients having a diagnosis of acute/chronic gout, 6 of the 19 studies were conducted in the following patient subgroups: renal transplant (n=1); chronic kidney disease (n=2); patients with a recent acute myocardial infraction (n=2); and patients with heart failure (n=1). There were several consistent finding across the 19 studies: (i) gout was associated with an increase in both all-cause mortality (reported hazard ratios [HR] ranged from 1.13 to 2.37) and CV-related mortality (reported HR ranged from 1.10 to 3.88) compared with patients without gout; (ii) the increased risk in all-cause mortality was primarily driven by an increase in CV-related mortality; (iii) the increased mortality risk was higher in females than males. One study reported that the presence of tophi was independently associated with a higher risk of all-cause mortality. Notably one study reported that patients who received urate-lowering therapy (ULT) have a statistically significant lower all-cause mortality and CV-related mortality risk relative to patients who do not receive ULT. <h3>Conclusions</h3> This systematic review confirms that gout is associated with an increased risk of all-cause and CV-related mortality; this was consistently reported across the eligible studies. The findings highlight the risk associated with gout and emphasise the need for appropriate treatment of this curable disease. <h3>References</h3> Keenan R, et al. Etiology and pathogenesis of hyperuricemia and gout. Kelley9s textbook of rheumatology. Elsevier Saunders. 2013;94:1533–53. Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2016:annrheumdis-2016-209707. Lottmann K, et al. Association between gout and all-cause as well as cardiovascular mortality: a systematic review. Curr Rheumatol Rep. 2012;14(2):195–203. Clarson L, et al. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015;22(2):335–43. <h3>Disclosure of Interest</h3> S. Mitchell: None declared, H. Liedgens Employee of: Grünenthal GmbH, E. Johannes Employee of: Grünenthal GmbH