Clinical Epidemiology Research and Training Unit, Department of Medicine, Boston University School of Medicine, , Boston, Massachusetts, USA.
Ann Rheum Dis. 2014 Feb;73(2):385-90. doi: 10.1136/annrheumdis-2012-202589. Epub 2013 Jan 23.
To examine the association between cardioprotective use of low-dose aspirin and the risk of recurrent gout attacks among gout patients.
We conducted an online case-crossover study of individuals with gout over 1 year. The following information was obtained during gout attacks: the onset dates, symptoms and signs, medications, and exposure to potential risk factors, including daily aspirin use and dosage, during the 2-day hazard period prior to the gout attacks. The same exposure information was also obtained over 2-day control periods.
Of the 724 participants analysed, 40.5% took aspirin ≤325 mg/day during either a hazard or a control period. Compared with no aspirin use, the adjusted OR of gout attacks increased by 81% (OR=1.81, 95% CI 1.30 to 2.51) for ≤325 mg/day of aspirin use on two consecutive days. The corresponding ORs were stronger with lower doses (eg, OR=1.91 for ≤100 mg, 95% CI 1.32 to 2.85). These associations persisted across subgroups by sex, age, body mass index categories and renal insufficiency status. Concomitant use of allopurinol nullified the detrimental effect of aspirin.
Our findings suggest that the use of low-dose aspirin on two consecutive days is associated with an increased risk of recurrent gout attacks. Recommended serum urate monitoring with concomitant use and dose adjustment of a urate-lowering therapy among patients with gout may be especially important to help avoid the risk of gout attacks associated with low-dose aspirin.
研究低剂量阿司匹林的心脏保护作用与痛风患者复发性痛风发作风险之间的关系。
我们对超过 1 年的痛风患者进行了在线病例交叉研究。在痛风发作期间获得了以下信息：发病日期、症状和体征、药物以及潜在危险因素（包括每日使用阿司匹林及其剂量）的暴露情况，在痛风发作前的 2 天危险期内。在 2 天对照期内也获得了相同的暴露信息。
在 724 名分析参与者中，40.5%的人在危险期或对照期内服用 ≤325 mg/天的阿司匹林。与不使用阿司匹林相比，连续两天使用 ≤325 mg/天的阿司匹林的痛风发作调整后 OR 增加了 81%（OR=1.81，95%CI 1.30 至 2.51）。剂量较低时，相应的 OR 更强（例如，≤100 mg 的 OR=1.91，95%CI 1.32 至 2.85）。这些关联在按性别、年龄、体重指数类别和肾功能不全状态划分的亚组中持续存在。别嘌呤醇的同时使用消除了阿司匹林的有害影响。
我们的研究结果表明，连续两天使用低剂量阿司匹林与复发性痛风发作风险增加相关。建议在痛风患者中同时使用并调整降尿酸治疗的剂量，同时进行血清尿酸监测，这可能尤其重要，有助于避免与低剂量阿司匹林相关的痛风发作风险。
