medwireNews: Women with gout are more likely to require total knee replacement (TKR) for severe knee osteoarthritis (OA) than those without gout, study results suggest.
In an analysis of 51,858 adults who took part in the Singapore Chinese Health Study, the researchers found that 1435 participants, 82.6% of whom were women, had a TKR procedure over a mean follow-up of 9.7 years. A total of 710 women and 1380 men reported having physician-diagnosed gout at the follow-up interview.
After adjustment for factors including age, body mass index (BMI), smoking, physical activity, and comorbidities, women with gout were significantly more likely to undergo TKR than those without gout (hazard ratio [HR]=1.39). However, there was no significant association between gout and TKR among men (HR=0.78), report Gim Gee Teng (National University Health System, Singapore) and co-authors in Osteoarthritis and Cartilage.
These findings suggest that “crystal arthritis may play a role in the pathogenesis or progression of OA,” say Teng and colleagues. They hypothesize that the development of monosodium urate crystals “may be a more prominent pathway in women compared to men, due to the higher propensity to develop severe [knee] OA among women.”
In subgroup analyses, the risk for TKR was similar among women who had gout diagnosed in the past 5 years and those with longer duration of gout (HR=1.41 and 1.34, respectively), suggesting that longer exposure to monosodium urate crystals did not further increase the risk for severe knee OA requiring TKR, say the researchers.
They did, however, identify an interaction between BMI and the relationship between gout and TKR, with stronger associations seen among women with a BMI below 23 kg/m2 – the recommended overweight threshold for Asian people – than those with a higher BMI (HR=2.17 and 1.24, respectively).
The team cautions that their results should be interpreted in the context of a number of limitations, including lack of baseline information on knee OA, self-reported gout status, and the observational nature of the study.
Nevertheless, they conclude that “[w]hile lifestyle modifications and weight loss remain as the mainstay of treatment” for knee OA,” the study has implications for management of the condition, and “suggests that the use of urate lowering therapy, especially in lean women, may reduce the risk of developing severe [knee] OA that requires TKR.”
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