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Research Letter
July 2018

Association of Gout With Uveitis in Older Individuals

Author Affiliations
  • 1Medicine Service, Veterans Affairs Medical Center, Birmingham, Alabama
  • 2Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham
  • 3Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham
JAMA Ophthalmol. 2018;136(7):835-837. doi:10.1001/jamaophthalmol.2018.1758

Uveitis, often associated with autoimmune diseases, leads to 30 000 new cases of legal blindness annually in the United States and $243 million in health care expenses.1-3 Limited epidemiologic information is available from 2 US population-based studies2,4 that did not focus on older individuals (≥65 years of age), a population expected to increase to more than 70 million in 2030 in the United States. Therefore, our objective was to assess whether gout, a crystal-induced inflammatory arthritis, is associated with an increased risk of a new diagnosis of uveitis in older individuals.

We used the 5% Medicare claims data from January 1, 2005, through December 31, 2012, for this cohort study. Medicare beneficiaries enrolled in Medicare fee-for-service (Parts A and B) and not enrolled in a Medicare Advantage Plan who resided in the United States from 2006 to 2012 were included. Gout was identified by the presence of 2 claims for gout at least 4 weeks apart, with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 274.xx. Study outcome was incident uveitis, identified by 2 claims for uveitis with an ICD-9-CM code of 364.xx at least 4 weeks apart, and an absence of uveitis claims in the baseline 365-day period.5 The University of Alabama at Birmingham’s Institutional Review Board approved this study and waived the need for informed consent for this database study. All investigations were conducted in conformity with ethical principles of research. We assessed the association of gout with uveitis using multivariable-adjusted Cox proportional hazards regression analyses, controlling for several covariates or potential confounders: age; race/ethnicity; sex comorbidities, assessed using the Charlson Comorbidity Index (Romano adaptation), a validated, weighted comorbidity measure; and use of cardiovascular medications (statins, β-blockers, diuretics, and angiotensin-converting enzyme inhibitors; data from Medicare Part D) and urate-lowering medications for gout (allopurinol and febuxostat).