Use of Diuretics and Risk of Incident Gout A Population-Based Case-Control Study

摘要

Gout is a painful, inflammatory, acute-onset arthritis, characterized by deposition of monosodium urate monohydrate crystals in affected joints (1,2). The disease is common in Western countries, with a reported prevalence of —1.4% in the overall UK population (3,4). Gout predominantly affects men >40 years of age, and prevalence increases as individuals age (3). Other risk factors include obesity (5) and alcohol intake (6).Most patients with gouty arthritis have hyperuri-cemia, which is considered an important risk factor (2,7). Hyperuricemia mainly results from decreased uric acid excretion or increased uric acid reabsorption in the kidneys. Diuretics, including loop diuretics, most thia-zide diuretics, and potassium-sparing agents (such as spironolactone or eplerenone), have been linked to hyperuricemia via a presumed mechanism of decreased renal uric acid excretion or increased uric acid reabsorption (8-10). Volume contraction and direct effects on urate transporters in the proximal tubule have been proposed as potential explanations (10). Studies have demonstrated that hydrochlorothiazide increases urate absorption by inhibition of organic anion transporter 4 (11), and the reduction of urate secretion by multidrug resistance protein 4 (similar to furosemide) has also been seen (9).