Risk of incident gout in rheumatoid arthritis from a nationwide cohort study in South Korea

Rheumatoid arthritis (RA) coexisting with gout is considered rare, with only few case studies reporting this coexistence. This study aimed to evaluate the association between RA and subsequent gout risk in South Korea, considering the serostatus (seropositive RA [SPRA], seronegative RA [SNRA]) and type of biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). This nationwide, population-based cohort study analyzed 34,356 patients newly diagnosed with RA between 2010 and 2017 and 103,068 matched non-RA participants (1:3 ratio based on age and sex). The incident gout was defined according to the claims database diagnostic code for gout. RA patients had a 2.7-fold higher risk of developing gout than non-RA participants (95% confidence interval [CI]: 2.63-2.80). Patients with SPRA and SNRA had a higher risk of gout than non-RA participants, with an adjusted hazard ratio (aHR) of 2.79 and 2.56, respectively. The risk of gout was slightly higher in SPRA than in SNRA (aHR 1.07). RA patients using b/tsDMARDs had lower risk of gout (aHR, 1.93) than those not using these medications (aHR, 2.78). Contrary to common perceptions, both SPRA and SNRA were associated with a higher risk of gout, with slightly higher risk in SPRA than in SNRA. Using b/tsDMARDs may reduce the risk of gout in patients with RA.