Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK.
Service de Rhumatologie, APHP, Hôpital Lariboisière, Paris, France.
Rheumatology (Oxford). 2021 Dec 24;61(1):407-412. doi: 10.1093/rheumatology/keab283.
To investigate the onset of comorbidities and pattern of flares over 5 years according to baseline comorbidity clusters in people with gout.
In a prospective primary care-based cohort study, adults aged ≥18 years with gout were identified from primary care medical records in 20 general practices across the West Midlands, UK and followed up over 5 years. Four clusters of participants have been defined previously according to baseline comorbidity status. The associations of (i) incident comorbidities and (ii) gout flares with baseline cluster membership were estimated using age and sex-adjusted Poisson regression and mixed effects ordinal logistic regression, respectively.
The comorbidity with the highest incidence was coronary artery disease (39.2%), followed by hypertension (36.7%), chronic kidney disease stage ≥3 (18.1%), obesity (16.0%), hyperlipidaemia (11.7%), diabetes (8.8%) and cancer (8.4%). There were statistically significant associations observed between cluster membership and incidence of coronary artery disease, hyperlipidaemia, heart failure and hypertension. In each cluster, nearly one-third of participants reported two or more gout flares at each time-point. History of oligo/polyarticular flares (odds ratio [OR]= 2.16, 95% confidence interval [CI]: 1.73, 2.70) and obesity (1.66, 95% CI: 1.21, 2.25) were associated with increasing flares whereas current use of allopurinol was associated with lower risk (0.42, 95% CI: 0.34-0.53). Cluster membership was not associated with flares.
Substantial numbers of people in each cluster developed new comorbidities that varies by cluster membership. People also experienced multiple flares over time, but these did not differ between clusters. Clinicians should be vigilant for the development of new comorbidities in people with gout.
根据基线合并症聚类，调查痛风患者 5 年内合并症的发病情况和 flares 模式。
在一项前瞻性初级保健为基础的队列研究中，从英国西米德兰兹 20 家全科诊所的初级保健病历中确定了年龄≥18 岁的痛风患者，并随访了 5 年。根据基线合并症状况，之前已经定义了四个参与者聚类。使用年龄和性别调整的泊松回归和混合效应有序逻辑回归，分别估计（i）新发合并症和（ii）痛风 flares 与基线聚类成员的关联。
发病率最高的合并症是冠状动脉疾病（39.2%），其次是高血压（36.7%）、慢性肾脏病 3 期及以上（18.1%）、肥胖（16.0%）、高脂血症（11.7%）、糖尿病（8.8%）和癌症（8.4%）。聚类成员与冠状动脉疾病、高脂血症、心力衰竭和高血压的发病存在统计学显著关联。在每个聚类中，几乎三分之一的参与者在每个时间点报告了两次或更多次痛风 flares。寡关节/多关节 flares 史（比值比[OR]=2.16，95%置信区间[CI]：1.73，2.70）和肥胖（1.66，95% CI：1.21，2.25）与 flares 增加相关，而目前使用别嘌醇与较低的风险相关（0.42，95% CI：0.34-0.53）。聚类成员与 flares 无关。
每个聚类中都有相当数量的人出现了新的合并症，这些合并症因聚类成员而异。随着时间的推移，人们也经历了多次 flares，但这些 flares 在聚类之间没有差异。临床医生应该警惕痛风患者新合并症的发生。
