OP0170 RISK OF MORTALITY IN PATIENTS WITH TOPHACEOUS VERSUS NON-TOPHACEOUS GOUT
Authors: G. Challener, K. S. K. MA, N. Mccormick, C. Yokose, A. Tinianow, H. Choi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> While it is well established that patients with gout have increased mortality risk compared to the general population [1, 2], even when adjusting for atherosclerotic cardiovascular disease (ASCVD) risk factors [3], it is less clear whether this risk is further heightened in patients with tophaceous as opposed to non-tophaceous gout. Two prior cohort studies reported increased mortality risk in those with tophaceous gout, but these cohorts were both relatively small with fewer than 1000 patients [4,5], and one was limited to patients seen in tertiary care [5]. Similarly, while gout has been associated with an increased risk of acute myocardial infarction (MI) [1,6,7,8] and end-stage renal disease (ESRD) [9], it has not been previously demonstrated that these risks are further heightened in those with tophaceous gout. <h3>Objectives:</h3> To determine whether patients with tophaceous gout are at increased risk of mortality, acute MI, or ESRD compared to those with non-tophaceous gout. <h3>Methods:</h3> We conducted a cohort study using the TriNetX Diamond network, a large, multicenter network of United States claims data. International Classification of Diseases, Tenth Revision (ICD-10) codes identified patients with tophaceous and non-tophaceous gout. We analyzed the risks of mortality, acute MI, and ESRD at 1 year and 5 years from the time of gout diagnosis. Propensity score matching included 126 factors to adjust for demographics, comorbidities, medications, and serum urate level; some representative covariates are included in Table 1. Kaplan-Meier analysis and Cox proportional hazard models estimated the probability of the outcomes of interest. <h3>Results:</h3> A total of 284,241 patients with tophaceous gout and 73,569 patients with non-tophaceous gout among 213 million patients were included. After 1:1 propensity score matching, 73,495 patients in each group were compared, with well-balanced baseline characteristics (Table 1; all standardized mean differences &lt; 0.1). After 1 year of follow-up, 5.0% of patients with tophaceous gout died versus 4.2% with non-tophaceous gout (hazard ratio [HR] 1.20, 95% CI: 1.15-1.26). At 5 years, mortality rates were 14.1% and 11.4%, respectively (HR 1.24, 95% CI: 1.20-1.27) (Figure 1). Patients with tophaceous gout had 1.7% and 4.4% risk of acute MI at 1 and 5 years, respectively, compared to 1.4% and 3.7%, respectively, among patients with non-tophaceous gout (HR 1.20 with 95% CI of 1.10-1.31 at 1 year; HR 1.21 with 95% CI of 1.15-1.28 at 5 years). Patients with tophaceous gout had 1.2% and 3.2% risk of ESRD at 1 and 5 years, respectively, compared to 1.1% and 2.8%, respectively, among patients with non-tophaceous gout (HR 1.12 with 95% CI of 1.02-1.24 at 1 year; HR 1.16 with 95% CI of 1.09-1.23 at 5 years). <h3>Conclusion:</h3> This study of a large gout population suggests that tophaceous gout is associated with increased risks of mortality, acute MI, and ESRD compared to non-tophaceous gout. This may relate to increased total urate burden, inflammation, cumulative cardio-renal adverse effects of NSAID or glucocorticoid use, and functional decline related to severe gout, calling for investigations for potential roles of intensive urate-lowering therapy (e.g., uricase) to reduce these critical risks. <h3>REFERENCES:</h3> [1] PMID: 17698728. [2] PMID: 37832433. [3] PMID: 38191784. [4] Choi HK, et al. Tophaceous gout and the risk of mortality: A general population-based study [abstract]. Arthritis Rheumatol. 2016;68 (suppl 10). [5] PMID: 23313809. [6] PMID: 16871533. [7] PMID: 26230580. [8] PMID: 29859125. [9] PMID: 22513212. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Gregory Challener: None declared, Kevin Sheng-Kai Ma: None declared, Natalie McCormick: None declared, Chio Yokose: None declared, Alex Tinianow: None declared, Hyon Choi ANI, LG, Horizon, Shanton, Protalix, Horizon.