Low-Dose Aspirin Linked to Gout Flare-Ups

Aspirin is a staple in many households. Many older adults follow a low-dose regimen for preventing myocardial infarction and stroke. Before starting patients on a an aspirin regimen, clinicians weigh the benefits of therapy against the risks of adverse effects. A new study suggests that clinicians should add one more possible adverse effect into their clinical judgment: risk of gout attacks. Zhang and colleagues conducted an online case-crossover study of 724 adults with gout for more than 1 year. The investigators examined data on these patients’ onset dates, symptoms, medications, exposure to potential risk factors, and use of aspirin during a 2-day hazard period prior to gout attacks. They compared this information with a 2-day control period. Approximately 40% of participants were taking a daily dose of aspirin (≤325 mg) during the hazard period or control period. Zhang and colleagues found that compared with participants not taking aspirin, the adjusted odds ratio (OR) of gout attacks increased by 81% for aspirin use (≤325 mg/day) on 2 consecutive days (OR=1.81; 95% confidence interval [CI], 1.32-2.85). The corresponding ORs were stronger with lower doses of aspirin. For example, the OR for a daily dose of 100 mg or less was 1.91 (95% CI, 1.32-2.85). These findings were consistent across sex, age, body mass index, and renal status. Additionally, they reported, concomitant use of allopurinol, an antigout agent, helped to nullify the adverse effect of aspirin. Gout is a painful inflammation of the joints caused by a buildup of serum uric acid. Many other medications and certain foods have been associated with the urate overproduction and decreased uric acid excretion that are thought to contribute to uric acid buildup. Therefore, the authors concluded, “Recommended serum urate monitoring with concomitant use and dose adjustment of a urate-lowering therapy among patients with gout may be especially important to help avoid the risk of gout attacks associated with low-dose aspirin.” - Allison Musante, ELS Reference Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi H. Low-dose aspirin use and recurrent gout attacks. Ann Rheum Dis. 2014;73(2):385-390.