Greater Risk of Gout Found in Patients With Psoriasis

Patients with psoriasis may be at greater risk of developing gout, particularly those who are not taking nonsteroidal anti-inflammatory drugs (NSAID), according to a new study. Findings were published in Clinical Epidemiology.

Along with the dermatological implications of psoriasis, recent studies have associated the condition with several systemic inflammatory disorders that could lead to increased risk of morbidity and early mortality.

The most common inflammatory arthritis, gout, is characterized by a rise in blood uric acid level with age, in which patients are likely to experience comorbidities. With the prevalence of gout growing globally in recent years, researchers sought to explore the association and risk factors of developing the condition in patients with psoraisis.

“Substantial progress has been made in elucidating comorbidities associated with psoriasis. However, only a few large-scale studies have been conducted in this field,” said the study authors. “While the coexistence of psoriasis and gout has been documented, the association between them is not clearly defined.”

They conducted a nationwide cohort study of 1 million patients registered in Taiwan’s National Health Insurance Research Database who had follow-up data for at least 14 years. A 1:4 propensity score matching test was used to compare age, sex, and index year between 2 cohorts designated as psoriasis and nonpsoriasis.

Both patient groups were followed until the onset of gout, withdrawal from the national insurance system, or December 31, 2013, whichever occurred first. Incidence of several comorbidities was also explored, including hypertension, hyperlipidemia, diabetes, obesity, chronic liver disease, chronic renal disease, chronic obstructive pulmonary disease (COPD), and autoimmune disease.

“Diffuse diseases of the connective tissue, rheumatoid arthritis and other inflammatory polyarthropathies, and ankylosing spondylitis and other inflammatory spondylopathies were included as autoimmune diseases,” added researchers. “Additionally, NSAID usage was considered when they had been used for greater than or equal to 30 days.”

Overall, 7833 people with psoriasis were included and matched with 7833 people without psoriasis, in which mean (SD) age (37.8 [20.1] vs 37.9 [20.3] years, respectively) was similar between the 2 groups. Hypertension was cited as the most common comorbidity among the psoriasis group and 67.7% reported use of NSAIDs.

Of the study cohort, incidence densities of gout were 6.96 and 5.09 per 1000 person-years in the psoriasis and nonpsoriasis cohorts, respectively. After adjusting for age, sex, urbanization, comorbidities, and NSAID use, patients in the psoriasis group exhibited a 38% increased risk of incidental gout vs the nonpsoriasis group (adjusted HR [aHR], 1.38; 95% CI, 1.2-1.6).

Risk factors for gout were cited as older age, male sex, hypertension, and COPD. Moreover, a significantly decreased risk of gout was shown in patients with psoriasis using NSAIDs vs those with psoriasis who did not use NSAIDs (aHR, 0.39; 95% CI, 0.34-0.45).

“Increased clinical vigilance is required to prevent the possible coexistence of gout and psoriasis. However, the biological mechanisms underlying this association remain unclear,” concluded researchers. “Further research is necessary to elucidate the molecular mechanisms involved in this process.”

Reference

Wei JCC, Chang YJ, Wang Yeh CJ. The risk of gout in patients with psoriasis: a population-based cohort study in Taiwan. Clin Epidemiol. 2022;14:265-273. doi:10.2147/CLEP.S346128