Venous thromboembolism (VTE) risk increases shortly after a gout flare, investigators suggest.
In a case series of 314 adults with gout from the UK’s National Health System, 58% experienced deep vein thrombosis and 42% pulmonary embolism. For 48 patients (15.3%), VTE was fatal. Approximately one-third of patients had other risk factors for VTE such as heart failure, cancer, or previous stroke.
VTE occurred at a significant 1.8-fold higher adjusted rate after a gout flare compared with a flare-free baseline period, Edoardo Cipolletta, MD, of University of Nottingham in Nottingham, UK, and colleagues reported in Arthritis & Rheumatology. The VTE rate was 2.3-fold higher during the first 30 days after gout flare compared with baseline.
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The investigators observed no significant increase in the adjusted rate during days 31–60 and days 61–90 compared with baseline.
The absolute increase in VTE risk was 4.70 per 1000 person-years in the 90 days after a gout flare compared with 3.65 per 1000 person-years after gout diagnosis.
Previous studies found increased VTE risk among patients with gout, but did not examine the timing.
Among the study’s limitations, the investigators could not determine whether gout flare or the antiinflammatory medications prescribed to treat it influenced VTE risk. They also could not account for environmental and dietary exposures, such as dehydration, dietary excess, and alcohol overconsumption that contribute to both gout flares and VTE.
“Patients with gout should be counseled about the increased risk of VTE and advised to remain well hydrated and active in the 30 days after the gout flare,” Dr Cipolletta’s team wrote. “As [treat-to-target urate-lowering] treatment prevents gout flares in the long-term, our findings provide an additional reason to use [treat-to-target urate-lowering therapy] with flare prophylaxis in people with recurrent gout flares.
Reference
Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Risk of venous thromboembolism with gout flares. Arthritis Rheumatol. 2023 Sep;75(9):1638-1647. doi:10.1002/art.42480