Gout Is Not Significantly Associated with Increased Risk of Colorectal Cancer

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Gout is not significantly linked to an increased risk of colorectal cancer in the Korean population, according to a new study.¹

Gout is the most prevalent inflammatory arthritis, and the number of people with the condition has doubled in the past 3 decades. Gout is associated with elevated uric acid levels, progressive buildup of monosodium urate crystals in the joints and throughout the body, metabolic syndrome, obesity, chronic kidney disease, cardiovascular diseases, and malignancy.

Studies have explored whether gout increases the risk of colorectal cancer—the third most common cancer—but have received mixed results. Some studies found a significant positive association between gout and the risk of colorectal cancer, but some did not. For instance, Somtochukwu Onwuzo, MD, from Cleveland Clinic, presented his team’s data at Digestive Disease Week 2023 about how chronic tophaceous gout was associated with an increased risk for colorectal cancer.² Yet, other studies showed how gout is associated with protecting an individual with colorectal cancer.³

A new nested case-control study, led by Mi Jung Kwon, from the department of pathology at Hallym University Sacred Heart Hospital in Anyang, Republic of Korea, aimed to evaluate whether factors like age, gender, socioeconomic, and comorbidities affect the relationship between gout and the risk of developing colorectal cancer.¹

The sample consisted of 9920 colorectal patients and 39,680 controls (patients without colorectal cancer), collected from the Korean National Health Insurance Service-National Sample Cohort database. Data came from January 2002 – December 2019.

The investigators conducted propensity score overlap-weighted multivariate logistic regression analyses, matching cancer patients with control patients by age, sex, income, and region of residence in a 1:4 ratio. They categorized participants into 10 age groups with 5-year intervals, 5 income categories, and residential areas by county name or city name (and further classification of urban or rural areas).

After comparing the 2 groups, the investigators found patients with gout are not at a higher risk for colorectal cancer than the control group. The groups had similar results when adjusted for odds ratio (0.95; 95% CI, 0.86 – 1.04; P = .282). Moreover, gout is associated with lowering the risk of colorectal cancer for the majority of the age groups. A subgroup analysis demonstrated an 18% reduction in the risk of colorectal cancer among patients <65 years old with gout (95% CI, 0.70 – 0.95; P = .009).

“This diminished risk might be associated with the frequent use of medications, such as colchicine, urate-lowering agents, and anti-inflammatory drugs by patients with gout, potentially contributing to a lower risk within this age group,” the investigators wrote. “It has been established that non-steroidal anti-inflammatory drug (NSAID) use is linked to a decreased [colorectal cancer] risk in the general population, and it is plausible that this protective effect extends to individuals with gout.”

The team continued to point out how colchicine, used to control acute gout attacks, has “anti-cancer effects.” Also, other drugs used for gout management, such as the xanthine oxidase inhibitor allopurinol, are thought to have anti-cancer effects by decreasing acid production and managing oxidative stress. Taking allopurinol for >1 year reduces the risk of prostate cancer by 34 - 36%.

Another subgroup analysis showed no association between gout and the risk of colorectal cancer despite factors like sex, income level, residential location, and charlson comorbidity index score. The lack of an association applied even to patients ≥65 years old.

“The most significant takeaway from our study was the finding that patients with gout in the Korean population may not be at increased risk for [colorectal cancer] development, regardless of age,” the investigators wrote.

References

1. ^{Kwon MJ, Han KM, Kim J-H, Kim JH, Kim M-J, Kim NY, Choi HG, Kang HS. Gout and Colorectal Cancer Likelihood: Insights from a Nested Case-Control Study of the Korean Population Utilizing the Korean National Health Insurance Service-National Sample Cohort. Cancers. 2023; 15(23):5602. https://doi.org/10.3390/cancers15235602}
2. ^{Pine, L. Chronic Tophaceous Gout Increases Risk of Colorectal Cancer. HCPLive. May 6, 2023. https://www.hcplive.com/view/chronic-tophaceous-gout-increases-risk-of-colorectal-cancer. Accessed December 12, 2023.}
3. ^{Gout May Be Associated with Protective Effect Against Colorectal Cancer. Rheumatology Advisor. December 17, 2019. https://www.rheumatologyadvisor.com/home/topics/gout/gout-may-be-associated-with-protective-effect-against-colorectal-cancer/#:~:text=Over%20the%2010%2Dyear%20study,0008). Accessed December 12, 2023.}