Use of diuretics and the risk of gouty arthritis: a systematic review.
OBJECTIVE
To systematically review the literature investigating the relationship between use of diuretics and the risk of gouty arthritis.


METHODS
PubMed (1950-October 2009), Embase (1974-October 2009), and the Cochrane Library (up to October 2009) were searched using keywords and MeSH terms diuretics, adverse effects, and gout. For this review, the technique of "best evidence synthesis" was used. Studies reporting frequency, absolute or relative risks, odds ratio, or rate ratio of gouty arthritis in diuretic users compared with nonusers were selected and evaluated. Studies had to be published in English. Checklists from the Dutch Cochrane Centre were used to assess the quality of randomized controlled trials (RCTs), cohort, and case-control studies.


RESULTS
Two RCTs, 6 cohort studies, and 5 case-control studies met the inclusion criteria. The overall quality of the studies was moderate. In a RCT the rate ratio of gout for use of bendrofluazide vs placebo was 11.8 (95% CI 5.2-27.0). The other RCT found a rate ratio of 6.3 (95% CI 0.8-51) for use of hydrochlorothiazide plus triamterene vs placebo. Three cohort studies and 4 case-control studies found higher risks of gouty arthritis in users compared with nonusers of diuretics.


CONCLUSIONS
There is a trend toward a higher risk for acute gouty arthritis attacks in patients on loop and thiazide diuretics, but the magnitude and independence is not consistent. Therefore, stopping these useful drugs in patients who develop gouty arthritis is not supported by the results of this review.
Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
Berdine A A
BA
Hueskes
Elisabeth A
EA
Roovers
Aukje K
AK
Mantel-Teeuwisse
Hein J E M
HJ
Janssens
Eloy H
EH
van de Lisdonk
Matthijs
M
Janssen
D015210:Arthritis, Gouty / Q000209:etiology*; D015331:Cohort Studies; D004232:Diuretics / Q000009:adverse effects*; D006801:Humans; D012306:Risk
D004232:Diuretics