How Does Gout Affect Risk of Colon Cancer? Interview with:

Michael Pillinger, MD Professor of Medicine and Biochemistry and Molecular Pharmacology NYU School of Medicine

Dr. Michael Pillinger

Michael Pillinger, MD
Professor of Medicine and Biochemistry and Molecular Pharmacology
NYU School of Medicine What is the background for this study? What are the main findings?

Response: We are interested in the co-morbidities of gout and the fact that gout is accompanied by multiple cardiovascular, renal and other events. The implications of gout for cancer are less clear, but the basic biology suggests that either:

1) the acute and chronic inflammation of gout could contribute to a pro-cancer environment;
2) the anti-oxidant effects of urate could have anti-cancer properties;
3) the ability of uric acid to serve as a “danger signal” released from dying cells (potentially including cancer cells” could promote anti-cancer immunity.

The clinical literature is murky at best. What are the main findings?

We conducted two linked studies.

The first was a cross-sectional prevalence study, by physician diagnosis. The second was a retrospective cohort incidence study of individuals who had undergone colonoscopy.

Both studies showed a decreased rate of colon cancer and/or polyps (but not prostate or lung cancer) among gout patients compared to a control group with osteoarthritis.

This difference could not be accounted for by co-morbidities, gout drug use or NSAID use. Interestingly however, the lower rate of colon cancer was found only among patients undergoing diagnostic, not screening colonoscopy, suggesting that patients with gout and established gastrointestinal complaints (e.g., rectal bleeding) may be less likely to have colon cancer than osteoarthritis patients with similar complaints. It is not clear whether this represents a true biological difference or may be due to an as-yet unrecognized factor. We did find that gout patients undergoing diagnostic colonoscopy were more likely than osteoarthritis patients to be taking NSAIDS, which could lead to colonoscopy for non-cancer reasons. But this NSAID difference was insufficient to account for the magnitude of the effect. What should readers take away from your report?

Response: It is possible that patients with gout have a lower incidence of colon cancer than patients with osteoarthritis, but the observation will need to be validated in additional studies.

Whether this is a true feature of gout, or a consequence of gout management, is uncertain. Screening colonoscopy is strongly advised but may not be sufficient to tease out the potential gout effect. What recommendations do you have for future research as a result of this study?

1. Confirmation in larger as well as prospective studies.
2. Understanding of the role of urate and inflammation in malignant cell development and immune escape. Is there anything else you would like to add?

Response: We would remind the readers that uric acid is a ubiquitous and necessary part of human cellular metabolism and immune responses.

It’s biology is complex and not simply a matter of promoting acute gouty attacks.

We would also remind the readers that gout itself is a chronic disease, with acute and chronic inflammation, and is increasingly appreciated as a condition that may affect targets beyond the musculoskeletal system. As always–further research is needed! Thank you for your contribution to the community.


Decreased Occurrence of Colon Cancer Among Gout Patients: Assessment By Physician Diagnosis and Colonoscopy
Anastasia Slobodnick1,2, Svetlana Krasnokutsky Samuels3, Aaron Lehmann4, Robert Keenan5, Fritz Francois6 and Michael H. Pillinger3,7, 1Medicine/Rheumatology, NYU School of Medicine, New York, NY, 2Medicine/Rheumatology, VA New York Harbor Health Care System, NY Campus, New York, NY, 3VA New York Harbor Health Care System, New York, NY, 4Medicine/Rheumatology, NYU School of Medicine/NYU Hospital for Joint Diseases, New York, NY, 5Division of Rheumatology, Duke University, Durham, NC, 6Medicine/Gastroenterology, NYU School of Medicine, New York, NY, 7NYU School of Medicine, New York, NY
Meeting: November 2016 2016 ACR/ARHP Annual Meeting

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 20, 2016 by Marie Benz MD FAAD