S2014 From Bowel to Joint: Unraveling the Link Between Inflammatory Bowel Disease and Acute Gout in Hospitalized Patients—A National Inpatient Sample Analysis

Introduction: Inflammatory Bowel Disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic GI condition marked by systemic inflammation and extraintestinal manifestations. While musculoskeletal complications are well known, emerging evidence suggests a link to acute gout flares, potentially due to shared inflammatory pathways and altered gut permeability. We conducted a national inpatient analysis to assess the association between IBD and acute gout flares. Methods: Using the National Inpatient Sample (2016–2020), we identified adult hospitalizations with IBD using International Classification of Diseases-10 codes. Cases were stratified by the presence of acute gout flares. Demographics and comorbidities were compared. Multivariable logistic regression was used to assess the independent association between IBD and gout flares, adjusting for traditional risk factors (P < 0.05). Results: Among 148,767,786 hospitalizations analyzed, 2.8% (4,215,894) involved an acute gout flare. The IBD cohort included 994,790 patients with Crohn’s disease and 609,820 with ulcerative colitis. Patients with IBD who developed gout were younger (68.5 vs 70.6 years, P < 0.001) and more likely to be women (35.4% vs 31.9%, P < 0.001) compared to non-IBD gout patients. After adjusting for traditional risk factors, both Crohn’s disease and ulcerative colitis were independently associated with an increased risk of gout flares (odds ratio [OR] 1.25, 95% CI 1.21–1.29; OR 1.05, 95% CI 1.01–1.08, respectively). In contrast, IBD-associated arthritis and rheumatoid arthritis did not show significant associations. Among the strongest predictors were male sex (OR 1.57, 95% CI 1.55–1.59), renal insufficiency (OR 1.46, 95% CI 1.43–1.49), obesity (OR 1.41, 95% CI 1.38–1.45), and hypertension (OR 1.37, 95% CI 1.34–1.40). Alcohol dependence or abuse also demonstrated a strong association (OR 1.61, 95% CI 1.57–1.66), while smoking was inversely associated with gout flares (OR 0.82, 95% CI 0.80–0.84). Additional contributing factors included older age, Black or Asian/Pacific Islander race, congestive heart failure, dyslipidemia, diabetes mellitus, and hematologic malignancies. Conclusion: Hospitalized patients with IBD, particularly Crohn’s disease, have increased risk of acute gout flares even after accounting for traditional risk factors. This highlights the potential role of overlapping immune dysfunction and gut barrier impairment. Our results emphasize the need for early recognition and targeted management of gout in IBD inpatients.