Hyperuricaemia, gout, and diabetic abnormality in Polynesian people

A prospective study of gout in New Zealand Maoris

Results are reported from the first prospective study of gout in New Zealand Maoris based on a sample of 388 males and 378 females. At baseline, high mean levels of serum uric acid (SUA) were found, 0.422 +/- 0.092 mmol/1 (7.05 +/- 1.54 mg/100 ml) in males and 0.350 +/- 0.091 mmol/1 (5.85 +/- 1.52 mg/100 ml) in females. On the basis of traditional criteria (SUA above 0.42 mmol/1 (7.0 mg/100 ml) in males and above 0.36 mmol/1 (6.0 mg/100 ml) in females) the prevalence of hyperuricaemia was 49% in males and 42% in females. The baseline prevalence of gout (8.8% for males and 0.8% for females) and the subsequent 11-year incidence rates (10.3% for males and 4.3% for females) are discussed in relation to specified SUA classes. When traditional, sex-specific criteria for hyperuricaemia were used, no relationship was found between the prevalence of hyperuricaemia and the incidence of gout. There was, however, a sharp increase in the incidence rate of gout in both sexes when SUA levels were above 0.48 mmol/1 (8.0 mg/100 ml). In subjects with a baseline SUA above this level, the age-standardised 11-year incidence rate of gout was 29.1% for males and 37.2% for females. A previously unreported relationship linking muscle size to the incidence of gout in males is presented as a major finding of the study. Other risk factors associated with gout were body mass and blood pressure.

The rheumatologic manifestations of diabetes mellitus

The rheumatologic disorders associated with diabetes mellitus have been reviewed. From the evidence presented, it can be concluded that neuroarthropathy and osteolysis are definitely assoicated with diabetes. Ankylosing hyperostosis and periarthritis probably represent valid associations, and possible, but still unproven associations exist for gout, pseudogout, the carpal tunnel syndrome, osteoarthritis, Dupuytren's contracture and joint contractures. Despite the lack of a proven pathophysiologic basis these interrelationships may be clinically relevant. The discovery of one of these disorders may provide a clue to underlying glucose intolerance, and idabetics should be followed with the knowledge that they are at risk for the development of certain musculoskeletal problems.

Diabetes, prediabetes and uricaemia

Three diabetes surveys carried out at two yearly intervals on 10000 men aged 40 years and over have enabled us to compare four groups of subjects with regard to their serum uric acid level in relation to carbohydrate metabolism. Prediabetics, that is, persons who screened negative at previous surveys and subsequently developed diabetes, had a higher mean uric acid level than normals (p less than 0.001). Their uric acid level was considerably higher than in diabetics, who had a mean value lower than normals (up to p less than 0.001). Men, without diabetes, but having an abnormal GTT were found to have a mean value higher than the normals at each survey.

Gout in Maoris

Historical evidence suggests that the Maori people of New Zealand were virtually untroubled by gout or obesity at a time when these disorders, along with other elements of the gouty diathesis, were rife in the best fed and hardest drinking sections of the Northern European population. By the mid 20th century, however, the apparent decline of the gout in Europe and North America and the breakup of the gouty diathesis in those lands had been more than compensated by their large-scale reappearance in the Maori and in other indigenous inhabitants of the Pacific Basin who, at first sight, appeared to have become one large gouty family. Half the Polynesian population of New Zealand, Rarotonga, Puka Puka, and the Tokelau Islands proved to be hyperuricemic by accepted European and North American standards, the associated gout rate reaching 10.2% in Maori males aged 20 and over. The trends towards hyperuricemia and gout, on the one hand, and towards obesity, diabetes mellitus, hypertension, and associated degenerative vascular disorders, on the other hand, which manifest themselves separately in some Polynesian Pacific Islanders, run together in the Maori and Samoan people, presenting a combined problem of considerable importance to the public health. The appearance of these traits under conditions of plenty in the descendants of hardy and wide-ranging Polynesian voyagers, suggests the emergence of a formerly favorable ancestral polygenic variation through selection for survival under harder conditions. This may now have lost its primitive survival value with a paradoxic shift towards increased prevalence of obesity and the gouty diathesis in more affluent environmental conditions. This may now constitute a genetic load, with recent environmentally determined increase in morbidity and mortality rates from degenerative vascular disorders. There is no satisfactory evidence that overproduction of uric acid differs in mechanism from its European counterparts, although more work remains to be done to determine whether there is any difficulty in renal handling of an increased uric acid load. A high Maori morbidity rate from gout and morbidity and mortality rates from associated components of the gouty diathesis in the face of readily available skilled medical advice and care, indicate the need for greater future attention to help education and health care delivery, at least while conditions of plenty continue. Continuation of previous epidemiologic surveillance may then be required in order to provide a continuing index of the effectiveness of these measures, as well as an opportunity for further research into the interrelationships of these associated disorders.

Uric acid, joint morbidity, and streptococcal antibodies in Maori and European teenagers. Rotorua Lakes study 3

Two hundred and ninety-four New Zealand secondary school students were examined by questionnaire, and physical and biochemical methods. The sample contained almost equal numbers of Maoris and Europeans. The findings related to joint conditions are presented. Past injury and rheumatic disease accounted for some of the reported morbidity, but no important sex or race differences in these factors emerged. There were, however, significant differences in serum uric acid levels with the Maori having higher levels than the Europeans. A significant correlation with body mass was present in both race and sex groups but a correlation with haemoglobin was present only in the European females. While hyperuricaemia was not associated with morbidity in this young sample, ethnic differences anticipated the higher prevalence of gout already observed in Maori men.

A multi-disciplinary catalogue of uric acid literature of interest to behavioural scientists

The research on uric acid encompasses a large number of disciplines and their respective journals. This bibliography (1948 to 1972) was assembled to provide a co-ordinated reference to this source material for behavioural scientists.

Changes in permeability of articular cartilage in experimental lathyrism

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Serum urate concentrations in the Australian aboriginal

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Genetic studies in primary gout. Investigations on the plasma levels of the urate-binding alpha 1-alpha 2-globulin in individuals from two gouty kindreds

The plasma levels of the urate-binding alpha(1)-alpha(2)-globulin, as determined by its urate-binding capacity, have been recorded in 19 individuals from two gouty kindreds. A significantly reduced binding capacity, accounting for 13-30% of the mean value obtained in healthy, unrelated control subjects, was found in all cases of gout and in the single case of essential hyperuricemia included in the present study. In addition, six apparently healthy members of one of these kindreds also exhibited this characteristic. The distribution of the characteristic in three subsequent generations from this kindred further supported the hypothesis that the reduced binding capacity was inherited as an autosomal trait for which affected subjects were heterozygous. Based on the present observation, the mechanisms of inheritance in primary gout are discussed with special emphasis on the possible cooperation of genetic and environmental factors.