JAMA Network Open: Controlling uric acid and avoiding gout may reduce the risk of lower extremity amputation

Gout is the most common inflammatory arthritis worldwide, affecting up to 4% of adults, and while gout alone poses a significant burden, it is also strongly associated with comorbidities and increased mortality
.

Cardiovascular disease, hypertension, chronic kidney disease (CKD), and diabetes all account for a large proportion of gout patients.

Gout is the most common inflammatory arthritis worldwide, affecting up to 4% of adults, and while gout alone poses a significant burden, it is also strongly associated with comorbidities and increased mortality

Ted R.
Mikuls and others published a research article in JAMA Network Open ,

This study used a multivariate Cox proportional hazards regression model to examine the association of gout with LEA
.

In an analysis limited to gout patients, the attributes of serum uric acid control and uric acid-lowering therapy were examined as factors associated with LEA

This cohort study included 5,924,918 patients, of whom 556,521 had gout (mean [SD] age, 67 [12] years; 550,963 males (99.
0%)) and 5,368,397 subjects without gout (mean [SD] age, 67 [12] years old; 5,314,344 men [99.
0%])
.

Risk of lower extremity amputation in gout patients versus gout-free controls

Risk of lower extremity amputation in gout patients versus gout-free controls

Compared with subjects without gout, patients with gout were more likely to have amputations, and the ratio remained increased after adjustment ( adjusted hazard ratio, 1.
20; 95% CI, 1.
16-1.
24), and was highest among patients with below-knee amputation (adjusted hazard ratio, 1.
59; 95 % confidence interval, 1.
39 - -1.
81)
.

Gout patients were more likely to amputate their limbs compared to subjects without gout, and the ratio remained increased after adjustment Gout patients were more likely to amputate their limbs compared to subjects without gout, and the ratio remained increased after adjustment ( ( in patients with below-knee amputations the highest was below the knee ).
highest among amputees

Cumulative incidence of lower extremity amputation (LEA)

Cumulative incidence of lower extremity amputation (LEA)

In gout patients, poor control of serum uric acid (mean 7 mg/dL in the previous year) was associated with a 25% to 37% increase in amputation rates
.

Conversely, urate-lowering therapy was not associated with LEA incidence

In gout patients, poor control of serum uric acid (mean 7 mg/dL in the previous year) was associated with a 25% to 37% increase in amputation rates

People with gout are more likely to develop LEA

original source

Mikuls TR, Soto Q, Petro A, et al.

Mikuls TR, Soto Q, Petro A, et al.
Comparison of Rates of Lower Extremity Amputation in Patients With and Without Gout in the US Department of Veterans Affairs Health System.
  JAMA Netw Open.
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