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The association of gout with incident giant cell arteritis in older adults - 02/03/19

Doi : 10.1016/j.jbspin.2018.05.011 
Jasvinder A. Singh a, b, c, , John D. Cleveland b
a Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA 
b Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0022, USA 
c Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA 

Corresponding author at: University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294-0022, USA.University of Alabama at Birmingham, Faculty Office Tower 805B510 20th Street SBirminghamAL35294-0022USA

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Highlights

The crude incidence rate of GCA was 28.0 per 100,000 person-years in people without gout and 63.7 per 100,000 person-years in people with preexisting gout.
In the main multivariable-adjusted model, preexisting gout was associated with an increased risk of incident GCA, HR was 2.05 (95% CI: 1.82, 2.54), after adjusting for GCA risk factors, medical comorbidity and use of common cardiovascular and gout medications.
Women were 2.2-times more likely to have incident GCA compared to men, and having 2 or more medical comorbidities was associated with a 1.7-times HR of incident GCA.
Black or other race were each associated with 0.6–0.7 times HR of incident GCA compared to white race, and older age was associated with a higher risk of GCA.
Subgroup analyses showed no statistically significant differences by age, race, and gender for the association of preexisting gout with a subsequent new diagnosis of GCA.

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Abstract

Objectives

To assess whether gout is associated with a higher or lower risk of a new diagnosis of giant cell arteritis (GCA) in older adults, adjusting for known risk factors of GCA.

Methods

We used the 5% Medicare claims to conduct a multivariable Cox regression analyses to assess the association of gout with incident GCA in adults 65 years or older adjusting for age, gender, race (known risk factors for GCA) and Charlson–Romano comorbidity score, the use of medications for cardiovascular diseases (statins, beta-blockers, diuretics, ACE-inhibitors) and gout (allopurinol, febuxostat). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.

Results

There were 3004 incident cases (new diagnosis) of GCA with crude incidence rates of GCA of 28.0/100,000 person-years in patients without gout and 63.8/100,000 person-years in patients with gout. Multivariable-adjusted analyses showed that preexisting gout was associated with a higher risk of incident/new GCA diagnosis with a hazard ratio of 2.05 (95% CI: 1.76, 2.40), confirmed in sensitivity analyses that substituted continuous Charlson–Romano comorbidity score with categorized score or individual comorbidities (plus hypertension, hyperlipidemia, and coronary artery disease). Older age, female gender, white race and higher comorbidity index, were also associated with a higher hazard of GCA. Subgroup analyses did not show any significant variation of the association of preexisting gout with incident GCA by age, race or sex.

Conclusions

Gout was associated with more than 2-fold higher risk of incident GCA in older adults, independent of known risk factors of GCA. Future studies should explore the underlying mechanisms for this association.

Le texte complet de cet article est disponible en PDF.

Keywords : Gout, Giant cell arteritis, Temporal arteritis, Elderly, Risk, Older adults


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Vol 86 - N° 2

P. 219-224 - mars 2019 Retour au numéro
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