Can a Gout Flare Provoke Venous Thrombosis?

An observational study suggests this possibility.

Because gout is an inflammatory condition that usually involves the lower extremities, one might wonder whether an acute flare predisposes a patient to venous thrombosis — either by creating a local thrombogenic state or by immobilizing the limb due to pain. In this study, U.K. researchers did a “selfcontrolled case series” study of 314 patients who had acute gout flares and episodes of venous thromboembolism (VTE) during the 2 years before or after their gout flares. The goal was to determine whether VTE incidence increased transiently during the 90 days after a gout flare, compared with baseline periods (preflare and >90 days postflare).

Risk for VTE increased significantly within the 30 days after a gout flare, compared with baseline periods (incidence rate ratio, 2.3). Between days 30 and 90, VTE risk remained somewhat higher, but not significantly so (iRR, ≈1.5). To account for numerous potential sources of confounding and bias, the authors conducted a dozen different sensitivity analyses, all of which remained consistent with the primary findings.

This study design can’t give us the absolute risk of VTE following an acute gout flare, but the findings are intriguing. For patients who have acute gout involving the great toe, ankle, or knee with localized soft-tissue swelling and erythema, I wouldn’t routinely check for deep venous thrombosis (DVT) based on this study. But in patients with more-extensive lower-extremity edema during or following a gout attack, these findings would lower my threshold for ultrasonography to exclude superimposed DVT.
— Allan S. Brett, MD

Dr. Brett is Clinical Professor of Medicine at the University of Colorado School of Medicine, Aurora.
Cipolletta E et al. Risk of venous thromboembolism with gout flares. Arthritis Rheumatol 2023 Sep; 75:1638. (