Coexistent Hyperuricemia and Gout in Rheumatoid Arthritis: Associations With Comorbidities, Disease Activity, and Mortality

Objective Although hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes inRAis unclear. We undertook this study to examine associations of coexistent hyperuricemia and gout withRAdisease measures,RAtreatments, and survival. Methods Participants from a longitudinalRAstudy were categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics,RAdisease activity, treatments, and comorbidities. Associations of baseline serumUAlevels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses. Results Of 1,999 participants withRA, 341 (17%) had serumUAconcentrations of >6.8 mg/dl, and 121 (6.1%) were diagnosed with gout. There were no significant associations of serumUAconcentration or gout withRAdisease activity or treatment at enrollment, with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs. After adjustments for age and sex, moderate hyperuricemia (serumUA>6.8 to <= 8 mg/dl) was associated with an increased risk ofCVD-related mortality (hazard ratio 1.56 [95% confidence interval 1.11-2.21]). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompany hyperuricemia. Results corresponding with serumUAconcentrations of >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline serumUAconcentration with all-cause mortality. Conclusion Our study reports the frequency of hyperuricemia and gout in patients withRA. These results demonstrate strong associations of hyperuricemia withCVDmortality in this population, a risk that appears to be driven by excess comorbidity.