title: Clinical and genetic features of diuretic-associated gout: a case-control study.
abstract: Hyperuricaemia and gout are well-recognized complications of diuretic use. The aim of this study was to examine the clinical and genetic features of diuretic-associated gout.
  
  
  
  Participants (n = 1365) fulfilling the 1977 ARA gout classification criteria, recruited from primary and secondary care, attended a study visit that included a detailed clinical assessment. Use of diuretic therapy was recorded during the study visit, and was confirmed by electronic dispensing data [n = 426 (31.2%) on diuretics]. Gout-associated single nucleotide polymorphisms were genotyped. Clinical and genetic features of diuretic-associated gout were analysed using a case-control study design (diuretics vs no diuretics).
  
  
  
  In the diuretic group there were more women, higher rates of comorbid conditions, higher BMI and lower estimated glomerular filtration rate compared with those not taking diuretics. Gout disease duration, frequency of gout flares and presence of tophi were similar in the two groups. Patients on diuretics had higher age of gout presentation and higher recorded serum urate. The ABCG2 rs2231142 risk allele was present less frequently in the diuretic group (36.1%) compared with those not on diuretics (47.6%, P = 1.2 × 10(-4)). The differences in ABCG2 were observed in both men and women with gout.
  
  
  
  Diuretic-associated gout represents a medically complex condition. Although age of gout onset is later and serum urate concentrations are higher in those on diuretics, other clinical features of gout are similar. The observed differences in the ABCG2 risk allele frequency suggest that some genetic factors play a less dominant role in diuretic-associated gout compared with primary gout.
authors.affiliation: Department of Medicine, University of Auckland, Auckland.
authors.forename: Sirisha
authors.initials: S
authors.lastname: Mitnala
authors.affiliation: Department of Biochemistry, University of Otago, Dunedin and.
authors.forename: Amanda
authors.initials: A
authors.lastname: Phipps-Green
authors.affiliation: Department of Medicine, University of Auckland, Auckland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Franklin
authors.affiliation: Department of Medicine, University of Auckland, Auckland.
authors.forename: Anne
authors.initials: A
authors.lastname: Horne
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Stamp
authors.affiliation: Department of Biochemistry, University of Otago, Dunedin and.
authors.forename: Tony R
authors.initials: TR
authors.lastname: Merriman
authors.affiliation: Department of Medicine, University of Auckland, Auckland, n.dalbeth@auckland.ac.nz.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2 / Q000097:blood / Q000235:genetics; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000483:Alleles; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D005838:Genotype; D006073:Gout / Q000097:blood / Q000139:chemically induced* / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood
chemical_list: C116614:ABCG2 protein, human; D000070997:ATP Binding Cassette Transporter, Subfamily G, Member 2; D015415:Biomarkers; D004232:Diuretics; D009363:Neoplasm Proteins; D014527:Uric Acid
keywords: ABCG2; diuretics; genetics; gout; urate