Patients With Tuberculosis at Increased Risk of Gout

New research has highlighted an increased risk of gout in patients with tuberculosis (TB) and associations with TB medications and comorbidities.1

“Patients with TB are typically prescribed a combined regimen of isoniazid (INH), ethambutol (ETB), rifampin (RFP), and pyrazinamide (PZA). Since PZA and ETB impact uric acid levels in the circulation by decreasing the clearance of uric acid in the kidneys, it could be hypothesized that patients with TB are at an increased risk of developing gout.2 However, to our knowledge, the incidence of gout in patients with TB has not been described in the literature,” lead investigator Chi Young Kim, from the department of internal medicine at Yonsei University College of Medicine, Seoul, Republic of Korea, and colleagues wrote.1

Kim and colleagues identified incident cases of TB in the South Korean National Health Claims and patients diagnosed with gout (n = 3848) within 6 months of TB diagnosis. They then estimated the risk in that population compared to the general population by calculating the standardized incidence ratios (SIRs). They also performed a nested case–control analysis among patients with TB with matching subjects diagnosed with and without gout in a 1:5 ratio to identify the risk factors for gout.

Looking at people with TB diagnosed with gout, the investigators found that 70.2% were male, 33.0% were at least 70 years of age, and 52.8% were diagnosed with gout within the first 2 months of TB diagnosis. Overall, the SIR of gout in patients with TB was 1.42 (95% CI, 1.37–1.46; sex-adjusted SIR, 1.32 [95% CI, 1.28–1.37]; age-adjusted SIR, 1.04 [95% CI, 1.01–1.08]) compared with the general population.1

Investigators found that INH, RFP, PZA, and ETB were more frequently prescribed to patients with gout than to those without gout during the follow-up (all P < .001). Furthermore, Kim and colleagues conducted conditional logistic regression analysis and found that hypertension (odds ratio [OR], 1.43 [95% CI, 1.31–1.58]), heart failure (OR, 1.19 [95% CI, 1.01–1.39]), chronic kidney disease (OR, 2.47 [95% CI, 1.99–3.06]), and use of PZA (OR, 1.02 [95% CI, 1.02–1.02]) and ETB (OR, 1.00 [95% CI, 1.00–1.01]) were associated with gout.1

“In conclusion, the present study's results indicate that the risk of gout is higher in patients with TB than in the general population. Underlying diseases such as hypertension, heart failure, chronic kidney disease, and PZA and ETB use were associated with the occurrence of gout in patients with TB, underscoring the need for higher vigilance for gout in this patient group,” Kim and colleagues wrote.1

The investigators noted limitations of their retrospective study, including the lack of lifestyle data (alcohol, smoking, exercise) to be able to adjust for and the fact that hypertension and chronic kidney disease were identified as risk factors for gout in TB but are also related to TB occurrence in the general population.

REFERENCES

1. Kim CY, Ha JW, Jung I, Han M, Ahn SS. Risk of Gout Among Patients With Tuberculosis: A Nationwide Cohort Study in South Korea. Int J Rheum Dis. 2025;28(3):e70197. doi:10.1111/1756-185X.70197

2. Pham AQ, Doan A, Andersen M. Pyrazinamide-induced hyperuricemia. P T. 2014;39(10):695-715.