Patients With Hyperuricemia at Increased Risk of Gout Flares 1 Year Postoperative

Gout recurrence in patients with hyperuricemia during the perioperative period increased 1 year after orthopedic surgery, according to a study published in Journal of Orthopaedic Surgery and Research.¹ This underscores the importance of monitoring the uric acid levels to prevent gout flares during both the perioperative period and the 1-year follow-up period. The risk independently increased in patients who had tophi, further emphasizing the need to maintain normal blood uric acid levels during the perioperative period.

“Surgery is believed to predispose patients to gout attacks,” Hui Wang, of the Department of Orthopedics Surgery at the 900th Hospital of Joint Logistic Support Force in China, and colleagues, wrote. “Moreover, perioperative gout may interfere with patient diagnoses, possibly resulting in the misdiagnosis of an infectious disease, delaying the patient's operation and/or postoperative recovery, and increasing the patient's medical treatment costs. Therefore, in several respects, early detection and management of perioperative gout are important.”

A hospital-based retrospective study was performed between January 2018 and December 2020. Patients were categorized into the normal uric acid level group or hyperuricemia according to blood uric acid levels at admission. Hyperuricemia was defined as a serum uric acid level of ≥ 416 µmol/L (7.0 mg/dL) in males or ≥ 357 µmol/L (6.0 mg/dL) in females.

Demographics, such as age, sex, and body mass index (BMI), comorbidities, inflammatory indicators, medication history, smoking and drinking status, serum uric acid levels, and follow-up recurrence rates were collected at admission, during the gout flare, and upon remission. Results were compared between groups.

Of the subjects observed, 64 patients reported acute gout attacks during the perioperative period, with 26 in the normoglycemic group and 38 in the hyperuricemia group. Six patients experienced gout flare prior to surgery and 58 experienced then during the 1-year postoperative period. No significant differences were observed in sex, BMI, or age between the cohorts. Approximately half of patients in the hyperuricemia cohort (47.4%; n = 18) exhibited single joint involvement, compared with 84.6% (n = 22) in the normal uric acid level group.

Patients in the normal uric acid level group reported significantly higher uric acid decline ratio when compared with the hyperuricemia group (42.12 ± 19.52 vs 22.65 ± 10.24, P <.001; respectively). This was also observed in inflammatory indexes, including white blood cell count and C-reactive protein level, at the time of gout attack. Those who were given diuretics and patients with hyperuricemia with diabetes and tophi were more likely to experience an acute gout attack when compared with those with normal uric acid level at admission (P <.05).

Gout recurrence rate was 44.7% (n = 17) after 1-year follow-up in the hyperuricemia group, which was significantly higher when compared with the normoglycemic group (n = 3, 11.5%; P = .005). Gout recurrence was significantly higher in patients with serum uric acid levels ≤ 420 µmol/L and ≤ 360 µmol/L at admission when compared with those with uric acid levels > 420 µmol/L and > 360 µmol/L, indicating that it may be safer for a patient to have a preoperative level below 300 µmol/L.

Investigators noted that presenting tophi in perioperative patients was found to be an independent risk factor for gout recurrence within the first year (RR = 4.80; P = .029).

Serum uric acid measurements collected during the perioperative period were not performed under standard conditions, which may have impacted findings. Further, patients undergoing surgery often exhibit inflammatory markers that peak within 24-72 hours postoperative. Therefore, these markers may not accurately represent the gout glare. Future research involving larger sample sizes should be conducted to verify results.

References

1. ^{Wang H, Yan C, Wu Q, et al. Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients. J Orthop Surg Res. 2023;18(1):61. Published 2023 Jan 23. doi:10.1186/s13018-023-03536-8}