Patients with psoriasis and psoriatic arthritis (PsA) are also at an increased risk of developing gout, according to results of a recent prospective study published in the Annals of the Rheumatic Diseases.
Previous studies have shown that patients with psoriasis have increased blood levels of uric acid, which is the cause of gout.
Joseph F. Merola, MD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues examined the risk for gout among patients with physician-diagnosed psoriasis (27,751 men and 71,059 women) who participated in the Health Professionals Follow-up Study (1986–2010) and Nurses’ Health Study (1998–2010). Incident gout diagnoses were confirmed based on the American College of Rheumatology survey criteria.
A total of 2,217 incident cases of gout were discovered during follow-up: 1,368 cases (4.9%) in men and 849 cases (1.2%) in women.
The risk of gout was substantially increased in patients with psoriasis and concomitant PsA (pooled multivariate hazard ratio, 4.95; 95% CI: 2.72-9.01) compared with those without psoriasis, and appeared to be stronger in men than in women.
Because of the diagnostic challenge and the often-missed clinical presentation of concomitant psoriasis, PsA and gout, the study authors suggest that inflammatory crystal arthopathy should be considered in the differential diagnosis of patients with psoriasis if they present with asymmetric, inflammatory synovitis.
“Clinically, an awareness of the relationship between psoriasis, PsA and gout is therefore particularly important when evaluating the psoriasis patient for possible inflammatory arthritis symptoms,” wrote the researchers.
This work was supported by Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, a Nurses’ Health Study grant CA87969) and a Nurses’ Health Study II grant (R01 CA50385). HKC is supported by NIH (NIAMS) grants R01-AR056291, R01-AR065944, P60 AR047785 and R21AR056042.