FRI0254 Clinical features and risk factors for developing gout attacks during anti-tuberculosis medication: a case-control study in south korea. (12th June 2018)

• Record Type: Journal Article
• Authors: Ha, Y.-J.; Chung, S.W.; Lee, J.; Kang, E.H.; Lee, Y.J.; Song, Y.W.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 667
• Page End: 667
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.6590
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Gout is a form of inflammatory arthritis that develops in some people with hyperuricemia. Several drugs may induce hyperuricemia and gout attack. Some anti-tuberculosis (TB) medications are also known to increase uric acid level and trigger acute gout attack. However, there have been no well-described studies for gout during anti-TB therapy. Objectives: To investigate the clinical features and risk factors of gout attacks following anti-TB treatment in South Korea. Methods: We conducted the case-control study including 49 patients who developed gout attack following anti-TB medications and 147 age- and sex- matched TB controls without gout attack. Demographic, clinical features and laboratory findings of patients with gout attacks following anti-TB medication were analysed and compared to those of controls in order to establish risk factors associated with gout attack during anti-TB treatment. Results: The mean age was 67.7±13.2 years and 39 patients (79.6%) were male. Twenty-four patients (49.0%) had a previous history of gout. The mean time interval to develop gout attack from the initiation of anti-TB therapy was 4.13±4.49 months. The attacks tended to involve lower extremity joints (43/49, 87.8%), especially the ankle and the first metatarsophalangeal joint. Factors associated with experiencing gout attack during anti-TB medication were higher body mass index (BMI, 23.7±3.6 vs 21.8±3.6, p = 0.003), higher pre-treatment uric acid level (7.2±2.5 vs 6.2±1.7 mg/dL, p < 0.001), previous history of gout (49.0% vs 1.4%, p < 0.001), absence of dyslipidemia (4.1% vs 16.3%, p = 0.008), and decreased renal function (eGFR 63.6±27.5 vs 82.6±29.9, p = 0.003). In multivariate model, higher BMI, chronic kidney disease (CKD, eGFR <60 ml/min/1.73m 2 ), previous history of gout, and pre-treatment hyperuricemia (uric acid ≥6.8 mg/dL) were found to be independent risk factors for gout attack following anti-TB medication (table 1). Conclusions: TB patients with obesity, history of gout, pre-treatment hyperuricemia, and CKD have higher risk for having gout attack following anti-TB medication. When starting anti-TB therapy in TB patients with these risk factors, physicians should pay attention to the development of gout attack and educate the patients. References: [1] Gerdan G, Nurullah A, Ucan ES, et al. Paradoxical increase in uric acid level with allopurinol use in pyrazinamide-induced hyperuricemia. Singapore Med J. 2013;54(6):e125–128. [2] Postlethwaite AE, Bartel AG, Kelley WN. Hyperuricemia due to ethambutol. N Engl J Med. 1972;286(14):761–762. [3] Ben Salem C, Slim R, Fathallah N, Hmouda H. Drug-induced hyperuricaemia and gout. Rheumatology (Oxford)2017;56(5):679–688. Disclosure of Interest: None declared