Gout is a very common condition. It is caused by deposits of crystals of a substance called uric acid (also known as urate) in the joints, which leads to inflammation. Periods of time when patients are experiencing gout symptoms are called flares. Flares can be unpredictable and debilitating, developing over a few hours and causing severe pain in the joints. Guidelines for the treatment of gout recommend lowering uric acid levels, although maintaining too low levels is a concern because uric acid is thought to protect the brain.2,3
"We welcome these results as they contribute to our understanding of the relationship between uric acid and dementia," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "Previous studies have shown contradictory results with some indicating an increased risk of dementia, while others reporting the opposite."
"Our study found a considerable increased risk of dementia associated with gout in the elderly," said Dr. Jasvinder Singh, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham, USA (study author). "Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk."
The study included 1.23 million Medicare beneficiaries, of which 65,325 had incident dementia. In an analysis which was adjusted for various potential confounding variables including demographics, comorbidities and commonly used medications (HR 1.17, 95% CI 1.13-1.21), the results showed that gout is independently associated with a significantly higher risk of dementia.1 The association was larger in older age groups, females, black race, and people with higher medical comorbidity.1
Subgroup analyses indicated that gout was associated with a significant 20-57% (p<0.0001) increase in dementia in patients without key comorbidities; coronary artery disease (CAD), hyperlipidemia, cardiovascular disease, diabetes, or hypertension. However, this was not the case in patients with each of these comorbidities, except in patients with CAD.1
1 Singh JA, Cleveland JD. Gout and dementia in the elderly: A medicare claims study. EULAR 2018; Amsterdam: Abstract OP0182.
2 Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64:1431–46.
3 Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76:29–42.
4 van der Heijde D, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Annals of the Rheumatic Diseases. 2018;doi:10.1136/annrheumdis-2017-212565. [Epub ahead of print].
5 EULAR. 10 things you should know about rheumatic diseases fact sheet. Available at: https://www.eular.org/myUploadData/files/10%20things%20on%20RD.pdf [Last accessed April 2018].
Source: European League Against Rheumatism (EULAR)
Full bibliographic information
Annual European Congress of Rheumatology (EULAR 2018) Amsterdam, The Netherlands, 13-16 June 2018 Abstract number: OP0182