JAMA

Are serum urate levels predictive of gout flares?

February 9, 2024

Among patients with a history of gout, serum urate concentrations at baseline were associated with risk of subsequent flares and hospitalization for recurrent gout.

This retrospective study included patients in the UK with a history of gout identified between 2006 and 2010 who were followed up through medical record linkage until 2017 and through the Hospital Episode Statistics database until 2020.

Among 3,613 patients with gout (mean age, 60 years; 86% men), 1,773 gout flares were recorded over a mean follow-up of 8.3 years. Of these, 1,679 flares (95%) occurred in individuals with baseline serum urate ≥6 mg/dL and 1731 (98%) occurred in those with baseline serum urate ≥5 mg/dL.

Rates of acute gout flares per 1,000 person-years and rate ratios over 10 years stratified by baseline urate levels were as follows:

• <6 mg/dL: 10.6; rate ratio (RR), 1.0
• 6.0 to 6.9 mg/dL: 40.1; RR, 3.37
• 7.0 to 7.9 mg/dL: 82.0; RR, 6.93
• 8.0 to 8.9 mg/dL: 101.3; RR, 8.67
• 9.0 to 9.9 mg/dL: 125.3; RR, 10.81
• ≥10 mg/dL: 132.8; RR, 11.42

Rates of hospitalization per 1,000 person-years during follow-up and rate ratios of hospitalization for gout adjusting for age, sex, and rate were as follows:

• <6 mg/dL: 0.18; RR, 1.0
• 6.0 to 6.9 mg/dL: 0.97; RR, 4.70
• 7.0 to 7.9 mg/dL: 1.8; RR, 8.94
• 8.0 to 8.9 mg/dL: 2.2; RR, 10.37
• 9.0 to 9.9 mg/dL: 6.7; RR, 33.92
• ≥10 mg/dL: 9.7; RR, 45.29

The findings support the use of baseline serum urate levels to assess risk of recurrent gout over ∼10 years of follow-up.

Source:

McCormick N, et al. (2024, February 6). JAMA. Serum Urate and Recurrent Gout. https://pubmed.ncbi.nlm.nih.gov/38319333/