Physical Function, Hyperuricemia, and Gout in Older Adults

Abstract

Objectives Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. Methods We studied gout, hyperuricemia, and physical function in 5,819 older adults (age ≥ 65) attending the 2011–2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity [Short Physical Performance Battery (SPPB) and 4 meter walking speed] and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalences of poor physical performance (first quartile) by gout and hyperuricemia were estimated using adjusted modified Poisson regression. Results 10% of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P=0.77). Participants with gout performed worse on the SPPB test; they had 0.77-times (95%CI:0.65,0.90; P=0.001) the prevalence odds of 1-unit increase in SPPB score and were 1.18-times (95%CI:1.07,1.32; P=0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference = −0.03, 95%CI: −0.05, −0.01; P<0.001) and were 1.19-times (95%CI:1.06,1.34; P=0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. Conclusion Older adults with gout and hyperuricemia are more likely to have worse lower but not upper extremity function.

Results of an Observational Cohort Study of Hyperuricemia as a Predictor of Poor Physical Performance in the Elderly

“…After 4.4 years of followup, people with hyperuricemia at baseline had an increased risk of having poor SPPB scores and chair‐stands time levels in both men and women. Our findings are in general agreement with the only cross‐sectional study assessing the association between hyperuricemia and these outcomes in the elderly . By contrast, the association between hyperuricemia at baseline and leg muscle strength seems to be equivocal.…”

“…In the literature thus far, the association between SUA and physical performance has mainly been explored through measures of handgrip strength. As stated previously, contrasting findings have emerged from studies conducted in Asia , while the only study conducted in a western country did not find any association between SUA and handgrip strength . Unfortunately, these investigators did not explore sex differences in the relationship, and thus we cannot know if their findings are similar to ours or not.…”

“…Perhaps more importantly, both studies only considered handgrip strength as a proxy of physical performance and did not include a sufficient number of older people, in which, as mentioned, the prevalence of hyperuricemia seems to be higher than among other ages . One more recent large study among 5,819 older Americans suggested that hyperuricemia is associated with worse leg but not arm performance . While all of these studies have advanced our knowledge in this field, some other pertinent limitations persist.…”

“…For instance, all studies have used a cross‐sectional design that does not enable us to understand the direction of the association between hyperuricemia and physical performance, and only one has investigated possible sex differences, despite the established differences of both SUA levels and physical performance measures between men and women. While the study of Burke et al did stratify their results according to sex, the analyses were not adjusted for potential confounders, leaving the question whether the differences found between sexes (particularly regarding handgrip strength) depend on hyperuricemia per se or on the differences in prevalence of some comorbidities between men and women. Given the aforementioned limitations, we aimed to conduct the first longitudinal analysis investigating the possible association between hyperuricemia with physical performance after 4.4 years of followup in a large cohort of older Italian men and women.…”

Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007–2016

“…Gout is a type of inflammatory arthritis that is triggered by the crystallization of monosodium urate monohydrate inside the joints and is preceded by hyperuricemia. Gout flares lead to substantial morbidity by causing severe pain, reduced quality of life , decreased physical function , increased health care costs , and economic productivity loss . Furthermore, gout is strongly associated with metabolic syndrome and may contribute to myocardial infarction , type 2 diabetes mellitus , chronic kidney disease (CKD) , and premature mortality .…”