Oral Presentation ARA-NSW 2019 - 41st Annual NSW Branch Meeting

Allopurinol Use in Patients with Autoimmune Inflammatory Arthritis – An ARAD-based Study (#11)

Jeremy Wang 1 , Lyn March 2 , Catherine Hill 3 , Barrett Claire 4 , Buchbinder Rachelle 5 , Fletcher Ashley 5 , Marissa Lassere 6
  1. Westmead Hospital, Sydney
  2. RNSH, Sydney
  3. Royal Adelaide Hospital, Adelaide
  4. Redcliffe Hospital, Brisbane
  5. Monash University, Melbourne
  6. St George Hospital, Sydney

Background:

Gout and hyperuricaemia co-exist with and complicate autoimmune inflammatory arthritides. The objective of this study is to report the prevalence of gout in patients with autoimmune IAs using the ARA Database and PBS Database linkage, and to examine the effects of gout on the outcome of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Methods: 

PBS Database linkage with ARAD participants was between 2012 and 2016. Patients were categorised by the diagnostic groups in ARAD and were further categorised by presence of gout. Participants with gout were identified by the continuous dispensing of prescriptions for urate-lowering agents. The prevalence of gout for each IA group was determined and groups were compared by the use of corticosteroids, synthetic or biologic DMARDs, and patient reported outcome.

Results:

126/3039 patients (4.15%) from our cohort were taking allopurinol, including 87/2152 (4.04%) patients with RA, 23/419 (5.45%) patients with PsA, and 16/468 (3.42%) patients with AS.RA patients taking allopurinol had higher HAQ scores compared to those not taking allopurinol (1.214 vs 1.161, t-test, unpaired, p-value <0.001). However, HAQ scores were not significantly different in the PsA or AS groups.

Oral prednisoloneusedid not differ between participants taking allopurinol and those not takingallopurinol. Although in the PsA group, there is a trend of increased allopurinol use in participants taking prednisone(OR= 2.24, 95% C.I.0.9608 –5.2218, p-value = 0.06). Use of csDMARDs and bDMARDs were not significantly different in patients taking allopurinol from patients not taking allopurinol. Use of diuretics was commonand was associatedwith allopurinol amongst participants with a diagnosis of rheumatoid arthritis or psoriatic arthritis.

 

Conclusions:

Allopurinol use/gout is not infrequent in patients with inflammatory arthritis. DMARD therapy did not appear to differ between patients with gout from those without. However, presence of gout may be linked to other cardiovascular risk factors in all inflammatory arthritis groups.