%, Mean, or Median
158 39 197 196**
80.2 19.8 52 (29–83) 30 (22–40)
14 70 61 52
7.1 35.5 31.0 26.4
10 42 42 30 54 19
5.1 21.3 21.3 12.2 27.4 9.6
2 174 16 5 321* 196† 197
1.0 88.3 8.1 2.5 2 (0–24) 8.2 (0–36) 73.6
5 6 92 16 64 37
2.6 3.1 46.9 8.2 32.7 19.0
did not provide
the data on BMI or years of dis-
Table 1. Characteristics of participants in the Internet-based case-crossover study of gout, 2003–04.
Sex, % Men Women Age, median (range) BMI, median (range) Education, % High school graduate/GED Some college/technical school College graduate Completed professional or graduate school Household income, % < 20,000 25,000–49,999 50,000–74,999 75,000–99,999
Missing Race, % African American Caucasian Other Missing No. of days between attack date and logon, median (range) Years of disease duration, median (range) Regular alcohol consumption, % Self-report comorbidities, % Heart attack Heart failure Hypertension Kidney problem Tophus Crystal diagnosis
321 hazard visits contributed by 197 subjects. ** One subject
ease duration. BMI: body mass index.
mean number of control-period questionnaires completed was 2.4 (SD 1.5) and hazard period questionnaires was 1.6 (SD 0.9). About 33% of subjects had tophus, 19% had crystal in their affected joint, and 50% of subjects’ medical records indi- cated that the participants had hyperuricemia.
95% CI 1.1–9.5). A similar effect was also observed for loop diuretic use (OR 3.8, 95% CI 0.3–51.0); however, the number of subjects using loop diuretics was relatively small and the CI of the point estimate was wide.
During the followup period, 141 subjects did not take any diuretic medication over either hazard or control period and 56 subjects used at least one type of diuretic. Of these, 14 used only loop diuretics, 39 used only thiazides, and 3 used both loop and thiazide diuretics. Since subjects who did not use any type of diuretic during the followup period would not con- tribute informative data on the effect of diuretic use, we excluded these subjects from the analyses. We limited our analyses to the remaining 56 subjects who used at least one type of diuretic during the study period.
DISCUSSION Our results suggest that recent use of diuretics within 48 hours is associated with a significantly increased risk of recurrent gout attacks among persons with preexisting gout. Such an effect was observed for both thiazide and loop diuretics, although the effect for the latter was not statistically signifi- cant. While the association of diuretics with hyperuricemia has been known for years, this is the first study to find and quantify the effect of diuretics on the risk of recurrent gout attacks.
As shown in Table 2, the odds ratio (OR) of recurrent gout attacks for any type of diuretic use over last 48 hours was 3.6 (95% CI 1.4–9.7). When the effect of a specific type of diuret- ic use was assessed separately, thiazide use alone had more than 3-fold increased risk for recurrent gout attacks (OR 3.2,
Many persons with gout continue to have recurrent gout attacks3,4. These attacks are painful, increase functional limi- tation, and can potentially lead to cumulative joint damage5. Both prevalence and incidence of gout have increased over the last 2 decades in industrialized countries2. One explanation
Hunte , et al: Diuretics and recurrent gout