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Journal of Endocrinological Investigation

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31-10-2023 | Gout | Original Article

Clustering of gout-related comorbidities and their relationship with gout flares: a data-driven cluster analysis of eight comorbidities

Authors: S. Liu, H. Sun, S. Yang, N. Liang, Y. Gao, S. Qu, H. Chen

Published in: Journal of Endocrinological Investigation | Issue 5/2024

Abstract

Objectives

To study the aggregation of multiple comorbidities in people with gout and explore differences in prognosis of gout flares among different subgroups.

Methods

Hierarchical clustering was performed to identify homogeneous subgroups among 2639 people with gout using eight comorbidities. A one-year follow-up of acute gout flares in 463 of these people was conducted; the incidence and the timing of gout flares in each cluster were assessed to explore prognosis of gout flares. Binary logistic regression was applied to assess factors associated with gout flares.

Results

In baseline study, we identified five subgroups (C1–C5). C1 (n = 671, 25%) was characterized by isolated gout with few comorbidities. C2 (n = 258, 10%) were all obese. Almost all people in C3 (n = 335, 13%) had diabetes (99.7%). All people in C4 (n = 938, 36%) had dyslipidemia. C5 (n = 437, 17%) had the highest proportion of cardiovascular disease (CVD, 53%), chronic kidney disease (CKD, 56%), and cancer (7%). In follow-up study, C5 had the highest incidence (71.9%) and earliest onset (median 3 months) of gout flares. C2 had the lowest incidence (52.1%) and the latest onset (median 10 months) of gout flares. The highest relative risk for gout recurrent was seen for C5 (OR = 2.09). Other factors associated with the risk of gout flares were age at diagnosis of gout, duration of gout, presence of tophi, and smoking ≥ 20 cigarettes/day.

Conclusions

We clustered people with gout into five groups with varying comorbidities. People with CVD, CKD, and cancer had the highest risk of gout flares and should receive comprehensive care.

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Kluck V, Jansen T, Janssen M, Comarniceanu A, Efde M, Tengesdal IW et al (2020) Dapansutrile, an oral selective NLRP3 inflammasome inhibitor, for treatment of gout flares: an open-label, dose-adaptive, proof-of-concept, phase 2a trial. Lancet Rheumatol 2(5):e270–e280. https://doi.org/10.1016/s2665-9913(20)30065-5CrossRefPubMedPubMedCentral

Bardin T, Richette P (2017) Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC Med 15(1):123. https://doi.org/10.1186/s12916-017-0890-9CrossRefPubMedPubMedCentral

Rashid N, Levy GD, Wu YL, Zheng C, Koblick R, Cheetham TC (2015) Patient and clinical characteristics associated with gout flares in an integrated healthcare system. Rheumatol Int 35(11):1799–1807. https://doi.org/10.1007/s00296-015-3284-3CrossRefPubMedPubMedCentral

Rothenbacher D, Primatesta P, Ferreira A, Cea-Soriano L, Rodriguez LA (2011) Frequency and risk factors of gout flares in a large population-based cohort of incident gout. Rheumatology (Oxford) 50(5):973–981. https://doi.org/10.1093/rheumatology/keq363CrossRefPubMed

Primatesta P, Plana E, Rothenbacher D (2011) Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population. BMC Musculoskel Disord 12:103. https://doi.org/10.1186/1471-2474-12-103CrossRef

Koto R, Nakajima A, Horiuchi H, Yamanaka H (2021) Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan. Ann Rheum Dis 80(11):1483–1490. https://doi.org/10.1136/annrheumdis-2021-220439CrossRefPubMed

Richette P, Clerson P, Perissin L, Flipo RM, Bardin T (2015) Revisiting comorbidities in gout: a cluster analysis. Ann Rheum Dis 74(1):142–147. https://doi.org/10.1136/annrheumdis-2013-203779CrossRefPubMed

Huang CF, Liu JC, Huang HC, Chuang SY, Chen CI, Lin KC (2017) Longitudinal transition trajectory of gouty arthritis and its comorbidities: a population-based study. Rheumatol Int 37(2):313–322. https://doi.org/10.1007/s00296-016-3634-9CrossRefPubMed

Fatima T, Nilsson PM, Turesson C, Dehlin M, Dalbeth N, Jacobsson LTH et al (2020) The absolute risk of gout by clusters of gout-associated comorbidities and lifestyle factors-30 years follow-up of the Malmo Preventive Project. Arthrit Res Ther 22(1):244. https://doi.org/10.1186/s13075-020-02339-0CrossRef

10.

Bevis M, Blagojevic-Bucknall M, Mallen C, Hider S, Roddy E (2018) Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology (Oxford) 57(8):1358–1363. https://doi.org/10.1093/rheumatology/key096CrossRefPubMed

11.

Bajpai R, Muller S, Mallen C, Watson L, Richette P, Hider SL et al (2021) Onset of comorbidities and flare patterns within pre-existing morbidity clusters in people with gout: 5-year primary care cohort study. Rheumatology (Oxford) 61(1):407–412. https://doi.org/10.1093/rheumatology/keab283CrossRefPubMed

12.

Alduraibi FK, Saleem M, Ricart K, Patel RP, Szalai AJ, Singh JA (2022) Clustering patients with gout based on comorbidities and biomarkers: a cross-sectional study. J Rheumatol. https://doi.org/10.3899/jrheum.220635CrossRefPubMed

13.

Choi HK, Ford ES, Li C, Curhan G (2007) Prevalence of the metabolic syndrome in patients with gout: the third national health and nutrition examination survey. Arthritis Rheum 57(1):109–115. https://doi.org/10.1002/art.22466CrossRefPubMed

14.

Berenson CS, Lashner B, Korman L, Hohmann E, Deshpande A, Louie TJ et al (2023) Prevalence of comorbid factors in patients with recurrent Clostridioides difficile infection in ECOSPOR III, a randomized trial of an oral microbiota-based therapeutic. Clin Infect Dis. https://doi.org/10.1093/cid/ciad448CrossRefPubMedPubMedCentral

15.

Bluher M (2019) Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 15(5):288–298. https://doi.org/10.1038/s41574-019-0176-8CrossRefPubMed

16.

Pillinger MH, Klein AB, Baumgartner S, Morlock R (2017) Cardiovascular disease and gout: real-world experience evaluating patient characteristics, treatment patterns, and health care utilization. J Manag Care Spec Pharm 23(6):677–683. https://doi.org/10.18553/jmcp.2017.23.6.677CrossRefPubMed

17.

Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A (2022) Association between gout flare and subsequent cardiovascular events among patients with gout. JAMA 328(5):440–450. https://doi.org/10.1001/jama.2022.11390CrossRefPubMedPubMedCentral

18.

Latourte A, Bardin T, Clerson P, Ea HK, Flipo RM, Richette P (2018) Dyslipidemia, alcohol consumption, and obesity as main factors associated with poor control of urate levels in patients receiving urate-lowering therapy. Arthritis Care Res (Hoboken) 70(6):918–924. https://doi.org/10.1002/acr.23347CrossRefPubMed

19.

Tsushima Y, Nishizawa H, Tochino Y, Nakatsuji H, Sekimoto R, Nagao H et al (2013) Uric acid secretion from adipose tissue and its increase in obesity. J Biol Chem 288(38):27138–27149. https://doi.org/10.1074/jbc.M113.485094CrossRefPubMedPubMedCentral

20.

Zhang X, Zhu C, Gao J, Mei F, Yin J, Bu L et al (2018) Gender difference in the relationship between serum uric acid reduction and improvement in body fat distribution after laparoscopic sleeve gastrectomy in Chinese obese patients: a 6-month follow-up. Lipids Health Dis 17(1):288. https://doi.org/10.1186/s12944-018-0934-yCrossRefPubMedPubMedCentral

21.

Kim JW, Choe JY, Park SH (2022) Metformin and its therapeutic applications in autoimmune inflammatory rheumatic disease. Korean J Intern Med 37(1):13–26. https://doi.org/10.3904/kjim.2021.363CrossRefPubMed

22.

Ji L, Jiang H, An P, Deng H, Liu M, Li L, Feng L, Song B, Han-Zhang H, Ma Q, Qian L (2021) IBI362 (LY3305677), a weekly-dose GLP-1 and glucagon receptor dual agonist, in Chinese adults with overweight or obesity: a randomised, placebo-controlled, multiple ascending dose phase 1b study. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2021.101088CrossRefPubMedPubMedCentral

23.

Pei L, Xie L, Wu J, Zhang H, Zhang X (2020) Study on the relationship between FFA and gout flare. Clin Rheumatol 39(4):1251–1255. https://doi.org/10.1007/s10067-019-04903-9CrossRefPubMed

Title: Clustering of gout-related comorbidities and their relationship with gout flares: a data-driven cluster analysis of eight comorbidities
Authors: S. Liu
H. Sun
S. Yang
N. Liang
Y. Gao
S. Qu
H. Chen
Publication date: 31-10-2023
Publisher: Springer International Publishing
Keywords: Gout
Chronic Kidney Disease
Dyslipidemia
Published in: Journal of Endocrinological Investigation / Issue 5/2024
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-023-02224-y

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Abstract

Objectives

Methods

Results

Conclusions

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