Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial

Cristina Maglio, Markku Peltonen, Martin Neovius, Peter Jacobson, Lennart Jacobsson, Anna Rudin, Lena M S Carlsson, Cristina Maglio, Markku Peltonen, Martin Neovius, Peter Jacobson, Lennart Jacobsson, Anna Rudin, Lena M S Carlsson

Abstract

Objectives: To assess the long-term effect of bariatric surgery on the incidence of gout and hyperuricaemia in participants of the Swedish Obese Subjects (SOS) study.

Methods: This report includes 1982 subjects who underwent bariatric surgery and 1999 obese controls from the SOS study, a prospective intervention trial designed to assess the effect of bariatric surgery compared with conventional treatment. None of the subjects had gout at baseline. An endpoint on gout incidence was created based on information on gout diagnosis and use of gout medications through national registers and questionnaires. Median follow-up for the incidence of gout was about 19 years for both groups. Moreover, the incidence of hyperuricaemia over up to 20 years was examined in a subgroup of participants having baseline uric acid levels <6.8 mg/dL.

Results: Bariatric surgery was associated with a reduced incidence of gout compared with usual care (adjusted HR 0.60, 95% CI 0.48 to 0.75, p<0.001). The difference in absolute risk between groups was 3 percentage points at 15 years, and the number of subjects needed to be treated by bariatric surgery to prevent one incident gout event was 32 (95% CI 22 to 59). The effect of bariatric surgery on gout incidence was not influenced by baseline risk factors, including body mass index. During follow-up, the surgery group had a lower incidence of hyperuricaemia (adjusted HR 0.47, 95% CI 0.39 to 0.58, p<0.001). The difference in absolute risk between groups was 12 percentage points at 15 years, and the number of participants needed to be treated by bariatric surgery to prevent hyperuricaemia was 8 (95% CI 6 to 13).

Conclusions: Bariatric surgery prevents gout and hyperuricaemia in obese subjects.

Trial registration number: NCT01479452; Results.

Keywords: Arthritis; Gout; Treatment.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interests form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that LC has relationships with Astra Zeneca, MSD and Johnson and Johnson outside the submitted work in the previous 3 years; MN reports grants from Pfizer and Astra Zeneca and relationships with Roche and Itrim outside the submitted work in the previous 3 years; AR reports that part of the salary for her university full professor position at The Sahlgrenska Academy at the University of Gothenburg is covered by a grant from AstraZeneca IMed RIA (Respiratory, Inflammation, Autoimmunity) in compensation for advice regarding basic research in inflammation at the company; however, AR is not involved in any work regarding development of new treatments for gout.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Cumulative incidence of gout. Kaplan-Meier unadjusted estimates of the cumulative incidence of gout in the bariatric surgery group and in the control group.
Figure 2
Figure 2
Cumulative incidence of hyperuricaemia. Kaplan-Meier unadjusted estimates of the cumulative incidence of hyperuricaemia in the bariatric surgery and in the control group. Only subjects with serum uric acid

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