Jasvinder A Singh1,2,3, John D Cleveland2. 1. Medicine Service, VA Medical Center, Birmingham. 2. Department of Medicine at School of Medicine. 3. Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
OBJECTIVE: In the absence of previous studies, the objective was to assess whether gout is associated with a lower risk of PMR. METHODS: We used the 5% Medicare sample to assess whether gout in adults 65 years or older increases the risk of incident PMR. The main multivariable-adjusted model included age, gender, race, Charlson-Romano co-morbidity score, the use of medications for cardiovascular diseases (statins, β-blockers, diuretics, angiotensin-converting enzyme inhibitors) and gout (allopurinol, febuxostat). Hazard ratios and 95% CI were calculated. RESULTS: There were 11 744 cases of incident PMR, with crude incidence rates of PMR of 289/100 000 person-years in patients with gout and 109/100 000 person-years in patients without gout. People with incident PMR had a mean duration of gout of 2.2 years before PMR diagnosis (s.d., 1.6; median, 1.8; interquartile range, 0.8, 3.2). Multivariable-adjusted analyses showed that gout was associated with PMR with a hazard ratio of 2.45 (95% CI, 2.28, 2.64; P < 0.0001). Older age, female gender, White race and higher co-morbidity index were associated with a higher hazard of PMR. Sensitivity analyses that substituted continuous Charlson-Romano co-morbidity score with categorized score or individual co-morbidities (plus hypertension, hyperlipidaemia and coronary artery disease) confirmed the main findings with minimal attenuation of hazard ratio, 2.39 (95% CI, 2.22, 2.57; P < 0.0001) and 2.13 (95% CI, 1.98, 2.29; P < 0.0001), respectively. CONCLUSION: Contrary to our hypothesis, gout was associated with >2-fold higher risk of incident PMR in older adults. Studies should explore whether inflammation or hyperuricaemia is the underlying mechanism for this association.
OBJECTIVE: In the absence of previous studies, the objective was to assess whether gout is associated with a lower risk of PMR. METHODS: We used the 5% Medicare sample to assess whether gout in adults 65 years or older increases the risk of incident PMR. The main multivariable-adjusted model included age, gender, race, Charlson-Romano co-morbidity score, the use of medications for cardiovascular diseases (statins, β-blockers, diuretics, angiotensin-converting enzyme inhibitors) and gout (allopurinol, febuxostat). Hazard ratios and 95% CI were calculated. RESULTS: There were 11 744 cases of incident PMR, with crude incidence rates of PMR of 289/100 000 person-years in patients with gout and 109/100 000 person-years in patients without gout. People with incident PMR had a mean duration of gout of 2.2 years before PMR diagnosis (s.d., 1.6; median, 1.8; interquartile range, 0.8, 3.2). Multivariable-adjusted analyses showed that gout was associated with PMR with a hazard ratio of 2.45 (95% CI, 2.28, 2.64; P < 0.0001). Older age, female gender, White race and higher co-morbidity index were associated with a higher hazard of PMR. Sensitivity analyses that substituted continuous Charlson-Romano co-morbidity score with categorized score or individual co-morbidities (plus hypertension, hyperlipidaemia and coronary artery disease) confirmed the main findings with minimal attenuation of hazard ratio, 2.39 (95% CI, 2.22, 2.57; P < 0.0001) and 2.13 (95% CI, 1.98, 2.29; P < 0.0001), respectively. CONCLUSION: Contrary to our hypothesis, gout was associated with >2-fold higher risk of incident PMR in older adults. Studies should explore whether inflammation or hyperuricaemia is the underlying mechanism for this association.
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: Ann Intern Med Date: 2007-10-16 Impact factor: 25.391