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Moukarzel V, Doussière M, Barbier V, Menis J, Le Monnier L, Salomon-Goëb S, Aboudiab M, Goëb V. Interest in daily clinical practice of screening for gouty disease in patients with psoriatic arthritis. Rheumatol Adv Pract 2024; 8:rkae069. [PMID: 38855627 PMCID: PMC11160327 DOI: 10.1093/rap/rkae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives PsA and gout are two prevalent rheumatic diseases, that can be associated as part of a rheumatism known as 'Psout'. Both conditions are associated with cardiovascular (CV) risk, thus their co-occurrence could have significant implications for the management of CV risks and patient care. This study aimed to determine the prevalence of gout within a PsA patient cohort and, consequently, to identify factors associated with this pathological association. Methods This is an observational, descriptive, cross-sectional, single-center study, including patients diagnosed with PsA. Demographic, clinical, biological and imaging data were collected. We identified the proportion of patients simultaneously affected by PsA and gout and compared characteristics between those with and without gout. Results The prevalence of gout among PSA patients was 9.8% (12/122), with a prevalence of 23% for asymptomatic hyperuricemia and 7.4% presenting with specific US signs of gout. Significant associated factors in the univariate analysis included weight, hypertension, diabetes, certain medications (diuretics, aspirin, lipid-lowering agents), impaired renal function, elevated fasting blood glucose, lipid abnormalities and specific US signs of gout. Conclusion Our study has described the existence of patients simultaneously affected by PsA and gout ('Psout'). Performing joint US along with uric acid level measurements in PsA patients can enable personalized therapeutic care.
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Affiliation(s)
- Vanessa Moukarzel
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
| | - Marie Doussière
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
| | - Vincent Barbier
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de Corbie, Corbie, France
| | - Jimmy Menis
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
| | - Laure Le Monnier
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
| | - Sarah Salomon-Goëb
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
- Department of Rheumatology, Clinique Victor Pauchet, Amiens, France
| | - Maxime Aboudiab
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
- Department of Rheumatology, Centre Hospitalier de Beauvais, Beauvais, France
| | - Vincent Goëb
- Department of Rheumatology, University Hospital of Amiens, Amiens, France
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Zhao J, Sha B, Zeng L, Dou Y, Huang H, Liang G, Pan J, Hong K, Zhou G, Yang W, Liu J. J-shaped association of serum uric acid concentrations with all-cause mortality in individuals with osteoarthritis: A prospective cohort study. Joint Bone Spine 2024; 91:105679. [PMID: 38143017 DOI: 10.1016/j.jbspin.2023.105679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the relationship between serum uric acid (SUA) concentrations and all-cause mortality in individuals with osteoarthritis (OA). METHODS All participant data were retrieved from the National Health and Nutrition Examination Survey database. A total of 4671 participants (age range: 20 to 85 years old), including 2988 females and 1683 males, were included in this study. The determination of death outcome was based on the National Death Index (up to December 31, 2019). We explored the nonlinear relationship between SUA concentrations and all-cause mortality in OA patients by establishing a Cox proportional risk model and a two-segment Cox proportional risk model and ran an interaction test to identify the high-risk population for all-cause mortality. RESULTS During 30,645 person-years of follow-up, the number of all-cause deaths for females and males was 736 and 516, respectively. After multivariate adjustment, we found a nonlinear relationship between SUA concentrations and all-cause mortality in both females and males with OA. In addition, we found a J-shaped relationship between SUA concentrations and all-cause mortality. The SUA concentration thresholds for all-cause mortality of females and males were stable at 5.6mg/dl and 6.2mg/dl, respectively. Compared with SUA concentrations below the inflection point, the all-cause mortality risk at higher SUA concentrations in females and males with OA increased by 20% (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.1 to 1.2) and 25% (HR: 1.2, 95% CI: 1.12 to 1.39), respectively. CONCLUSIONS There is a nonlinear relationship between SUA concentrations and all-cause mortality in the American OA population (J-shaped association). The all-cause mortality thresholds for SUA concentrations in females and males are 5.6mg/dl and 6.2mg/dl, respectively.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Bangxin Sha
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Yaoxing Dou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Guihong Liang
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Kunhao Hong
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China
| | - Guanghui Zhou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Weiyi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China.
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China; The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China.
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Pascart T, Wasik KA, Preda C, Chune V, Torterat J, Prud'homme N, Nassih M, Martin A, Le Masson J, Rodière V, Frogier S, Canova G, Pescheux JP, Shan Sei Fan C, Jauffret C, Claeys P, von Baeyer SL, Castel SE, Emde AK, Yerges-Armstrong L, Fox K, Leask M, Vitagliano JJ, Graf S, Norberciak L, Raynal J, Dalbeth N, Merriman T, Bardin T, Oehler E. The gout epidemic in French Polynesia: a modelling study of data from the Ma'i u'u epidemiological survey. Lancet Glob Health 2024; 12:e685-e696. [PMID: 38485432 DOI: 10.1016/s2214-109x(24)00012-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis worldwide, particularly in Pacific regions. We aimed to establish the prevalence of gout and hyperuricaemia in French Polynesia, their associations with dietary habits, their comorbidities, the prevalence of the HLA-B*58:01 allele, and current management of the disease. METHODS The Ma'i u'u survey was epidemiological, prospective, cross-sectional, and gout-focused and included a random sample of adults from the general adult population of French Polynesia. It was conducted and data were collected between April 13 and Aug 16, 2021. Participants were randomly selected to represent the general adult population of French Polynesia on the basis of housing data collected during the 2017 territorial census. Each selected household was visited by a research nurse from the Ma'i u'u survey who collected data via guided, 1-h interviews with participants. In each household, the participant was the individual older than 18 years with the closest upcoming birthday. To estimate the frequency of HLA-B*58:01, we estimated HLA-B haplotypes on individuals who had whole-genome sequencing to approximately 5× average coverage (mid-pass sequencing). A subset of individuals who self-reported Polynesian ancestry and not European, Chinese, or other ancestry were used to estimate Polynesian-ancestry specific allele frequencies. Bivariate associations were reported for weighted participants; effect sizes were estimated through the odds ratio (OR) of the association calculated on the basis of a logistic model fitted with weighted observations. FINDINGS Among the random sample of 2000 households, 896 participants were included, 140 individuals declined, and 964 households could not be contacted. 22 participants could not be weighted due to missing data, so the final weighted analysis included 874 participants (449 [51·4%] were female and 425 [48·6%] were male) representing the 196 630 adults living in French Polynesia. The estimated prevalence of gout was 14·5% (95% CI 9·9-19·2), representing 28 561 French Polynesian adults, that is 25·5% (18·2-32·8) of male individuals and 3·5% (1·0-6·0) of female individuals. The prevalence of hyperuricaemia was estimated at 71·6% (66·7-76·6), representing 128 687 French Polynesian adults. In multivariable analysis, age (OR 1·5, 95% CI 1·2-1·8 per year), male sex (10·3, 1·8-60·7), serum urate (1·6, 1·3-2·0 per 1 mg/dL), uraturia (0·8, 0·8-0·8 per 100 mg/L), type 2 diabetes (2·1, 1·4-3·1), BMI more than 30 kg/m2 (1·1, 1·0-1·2 per unit), and percentage of visceral fat (1·7, 1·1-2·7 per 1% increase) were associated with gout. There were seven heterozygous HLA-B*58:01 carriers in the full cohort of 833 individuals (seven [0·4%] of 1666 total alleles) and two heterozygous carriers in a subset of 696 individuals of Polynesian ancestry (two [0·1%]). INTERPRETATION French Polynesia has an estimated high prevalence of gout and hyperuricaemia, with gout affecting almost 15% of adults. Territorial measures that focus on increasing access to effective urate-lowering therapies are warranted to control this major public health problem. FUNDING Variant Bio, the French Polynesian Health Administration, Lille Catholic University Hospitals, French Society of Rheumatology, and Novartis.
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Affiliation(s)
- Tristan Pascart
- Service de Rhumatologie, Hôpital Saint-Philibert, Lille, France.
| | | | - Cristian Preda
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Valérie Chune
- Department of Biology, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
| | - Jérémie Torterat
- Institut de la Statistique de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Nicolas Prud'homme
- Institut de la Statistique de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Maryline Nassih
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Agathe Martin
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Julien Le Masson
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Vahinetua Rodière
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Sylvain Frogier
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Georges Canova
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Jean-Paul Pescheux
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | | | | | - Patrick Claeys
- Department of Biology, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
| | | | | | | | | | - Keolu Fox
- Global Health Program, Department of Anthropology and Indigenous Futures Institute, Division of Design and Innovation, University of California San Diego, San Diego, CA, USA; Native BioData Consortium, Eagle Butte, SD, USA
| | - Megan Leask
- Division of Clinical Rheumatology and Immunology, University of Alabama, Birmingham, AL, USA; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | | | - Sahara Graf
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Laurène Norberciak
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Jacques Raynal
- Ministère de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony Merriman
- Division of Clinical Rheumatology and Immunology, University of Alabama, Birmingham, AL, USA; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Thomas Bardin
- National Institute of Health and Medical Research U1132, Université Paris-Cité, Hôpital Lariboisière, Paris, France
| | - Erwan Oehler
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
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Pascart T, Ducoulombier V, Jauffret C. Early-onset gout. Joint Bone Spine 2024; 91:105704. [PMID: 38336273 DOI: 10.1016/j.jbspin.2024.105704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Early-onset gout (EOG) is characterized by the occurrence of the first symptoms of gout at an unusually young age, usually <40 years. The aim of this review is to provide an overview of the epidemiology, clinical presentation and prognosis, association with comorbidities and specific management of EOG. A particularly high proportion of patients with EOG come from ethnic groups with stronger genetic factors, such as populations in the Pacific and Taiwan, who therefore have the highest prevalence of gout overall. The clinical presentation and severity of gout are broadly similar between EOG and common gout, although a longer disease duration exacerbates the disease, which more often tends to become polyarticular. Patients suffering from EOG develop metabolic comorbidities commonly associated with gout earlier in life, although those tend to be less frequent at the time of diagnosis. Some international guidelines recommend early treatment of EOG patients with urate-lowering therapies.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France; ETHICS Laboratory, EA7446, Lille Catholic University, Lille, France.
| | - Vincent Ducoulombier
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France
| | - Charlotte Jauffret
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France; University of Lille, ULR 2694 - METRICS, CERIM, Lille, France
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Théau C, Pauline B, Emilie C, Pascal G, François R. From skin to microscope, case report of a rare manifestation of tophaceous gout: Miliary gout. Int J Rheum Dis 2024; 27:e14763. [PMID: 37287378 DOI: 10.1111/1756-185x.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
Joint symptoms associated with gout, mostly characterized by joint flare-ups, are well known. Tophi represent the main cutaneous manifestation of gout, most often associated with a chronic and inadequately controlled disease. On rare occasions, atypical skin manifestations may occur. We present the case of a miliary form of gout in a 36-year-old man known to have hyperuricemia. Microscopic direct analysis of the skin material revealed the presence of monosodium urate (MSU) crystals. Rash disappeared with corticosteroid therapy in parallel with joint symptoms recovery. Knowledge of this unusual gout-related skin disease is essential to diagnosing uncommon presentations of gout, which sometimes occur before joint symptoms. This case highlights the importance of sampling any skin lesion suspected of being tophus, for MSU crystal identification, and provides a definitive diagnosis.
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Affiliation(s)
- Cavillon Théau
- Department of Rheumatology, CHU Rennes, Hôpital sud, Rennes, France
| | - Berthe Pauline
- Department of Dermatology, CHU Rennes, Pontchaillou, Rennes, France
| | - Chotard Emilie
- Department of Rheumatology, CHU Rennes, Hôpital sud, Rennes, France
| | - Guggenbuhl Pascal
- Department of Rheumatology, CHU Rennes, Hôpital sud, Rennes, France
- Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Robin François
- Department of Rheumatology, CHU Rennes, Hôpital sud, Rennes, France
- Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
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Terkeltaub R. Emerging Urate-Lowering Drugs and Pharmacologic Treatment Strategies for Gout: A Narrative Review. Drugs 2023; 83:1501-1521. [PMID: 37819612 DOI: 10.1007/s40265-023-01944-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Hyperuricemia with consequent monosodium urate crystal deposition leads to gout, characterized by painful, incapacitating inflammatory arthritis flares that are also associated with increased cardiovascular event and related mortality risk. This narrative review focuses on emerging pharmacologic urate-lowering treatment (ULT) and management strategies in gout. Undertreated, gout can progress to palpable tophi and joint damage. In oral ULT clinical trials, target serum urate of < 6.0 mg/dL can be achieved in ~ 80-90% of subjects, with flare burden reduction by 1-2 years. However, real-world ULT results are far less successful, due to both singular patient nonadherence and prescriber undertreatment, particularly in primary care, where most patients are managed. Multiple dose titrations commonly needed to optimize first-line allopurinol ULT monotherapy, and substantial potential toxicities and other limitations of approved, marketed oral monotherapy ULT drugs, promote hyperuricemia undertreatment. Common gout comorbidities with associated increased mortality (e.g., moderate-severe chronic kidney disease [CKD], type 2 diabetes, hypertension, atherosclerosis, heart failure) heighten ULT treatment complexity and emphasize unmet needs for better and more rapid clinically significant outcomes, including attenuated gout flare burden. The gout drug armamentarium will be expanded by integrating sodium-glucose cotransporter-2 (SGLT2) inhibitors with uricosuric and anti-inflammatory properties as well as clinically indicated antidiabetic, nephroprotective, and/or cardioprotective effects. The broad ULT developmental pipeline is loaded with multiple uricosurics that selectively target uric acid transporter 1 (URAT1). Evolving ULT approaches include administering selected gut anaerobic purine degrading bacteria (PDB), modulating intestinal urate transport, and employing liver-targeted xanthine oxidoreductase mRNA knockdown. Last, emerging measures to decrease the immunogenicity of systemically administered recombinant uricases should simplify treatment regimens and further improve outcomes in managing the most severe gout phenotypes.
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Affiliation(s)
- Robert Terkeltaub
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA, 92093, USA.
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Timsans J, Kauppi JE, Kerola AM, Lehto TM, Kautiainen H, Kauppi MJ. Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population. BMJ Open 2023; 13:e072110. [PMID: 37137562 PMCID: PMC10163549 DOI: 10.1136/bmjopen-2023-072110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE To establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality. DESIGN Prospective cohort study. SETTING Good Ageing in Lahti Region study, Finland 2002-2012 (mortality data analysed until 2018). PARTICIPANTS 2673 participants (mean age 64 years; 47% men). PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models. METHODS Data from a prospective, population-based study of elderly people (52-76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed. RESULTS Of 2673 elderly Finnish persons included in the study 1197 (48%) were hyperuricaemic. Hyperuricaemia was extremely prevalent in men (60%). There was an association between elevated SUA and mortality which remained after adjustment for potential confounding factors (age, gender, education, smoking status, body mass index, hypertension and dyslipidaemia). The adjusted HR for all-cause mortality among clearly hyperuricaemic individuals with SUA≥420 µmol/L compared with normouricaemic individuals (SUA<360 µmol/L) was 1.32 (95% CI 1.05 to 1.60) in women and 1.29 (95% CI 1.05 to 1.60) in men. In slightly hyperuricaemic individuals (SUA 360-420 µmol/L) the corresponding HRs were 1.03 (95% CI 0.78 to 1.35) and 1.11 (95% CI 0.89 to 1.39). CONCLUSIONS Hyperuricaemia is very prevalent in the elderly Finnish population and is independently associated with increased mortality.
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Affiliation(s)
- Janis Timsans
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | - Jenni Emilia Kauppi
- Unit of Physiatry and Rehabilitation Medicine, Päijät-Häme Central Hospital, Lahti, Finland
- University of Helsinki, Helsinki, Finland
| | - Anne Mirjam Kerola
- University of Helsinki, Helsinki, Finland
- Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Maarit Lehto
- Department of Clinical Chemistry, Fimlab Laboratoriot Oy, Lahti, Finland
| | - Hannu Kautiainen
- University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Markku Jaakko Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- University of Helsinki, Helsinki, Finland
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8
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Yadav S, Khandelwal N, Nath SK, Rai S. A Hospital-Based Cross-Sectional Study of Patients With Plantar Fasciitis: Is Hyperuricemia Screening Needed? Cureus 2023; 15:e37088. [PMID: 37153317 PMCID: PMC10157332 DOI: 10.7759/cureus.37088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Background and aim Generally, asymptomatic hyperuricemia is considered a benign metabolic abnormality with little clinical significance in the absence of gout or renal calculus. However, its clinical association with plantar fasciitis is still not known and is a subject of interest. The study aims to investigate the association between asymptomatic hyperuricemia and plantar fasciitis in otherwise healthy patients. Materials and methods A cross-sectional study was performed, which included 284 patients aged 21-65 years with plantar fasciitis and without any comorbidities between February 2020 and November 2022. One hundred and fifty patients with hyperuricemia who attended the endocrinology and medicine outpatient department without heel pain were included as a control group. Serum uric acid levels were assessed in all cases. Student's t-test, correlation tests, and multiple linear regression were used to ascertain the association between uric acid levels and plantar fasciitis. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 19.0 (Released 2010; IBM Corp., Armonk, New York, United States). Results Among the 284 patients, 189 were female (66.5%) and 95 were male (33.4%). Their mean age was 43 ± 9 years (range: 21-65 years). The p-values of the duration of symptoms, visual analog scale for pain (VAS), and foot function index (FFI) total score were p = 0.061, p = 0.068, and p < 0.001, respectively. The mean uric acid levels were 7.6 ± 1.5 mg/dL in males and 7.3 ± 1.3 mg/dL in females in the sample group, and 8.3 ± 1.8 mg/dL in males and 8.1 ± 1.5 mg/dL in females in the control group. According to a Pearson correlation analysis, there was no correlation between serum uric acid level and BMI, VAS, duration of symptoms, FFI pain, disability sub-scores, or FFI total score. Conclusion Although asymptomatic hyperuricemia is a common metabolic abnormality, the present study did not find any significant association between it and plantar fasciitis. Therefore, we can conclude that routine screening for asymptomatic hyperuricemia is not recommended in plantar fasciitis. Evidence level: II.
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Yip RM, Cheung TT, So H, Chan JP, Ho CT, Tsang HH, Yu CK, Wong PC. The Hong Kong Society of Rheumatology consensus recommendations for the management of gout. Clin Rheumatol 2023:10.1007/s10067-023-06578-9. [PMID: 37014501 DOI: 10.1007/s10067-023-06578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains suboptimal. Like other countries, the treatment goal in Hong Kong usually focuses on relieving symptoms of gout but not treating the serum urate level to target. As a result, patients with gout continue to suffer from the debilitating arthritis, as well as the renal, metabolic, and cardiovascular complications associated with gout. The Hong Kong Society of Rheumatology spearheaded the development of these consensus recommendations through a Delphi exercise that involved rheumatologists, primary care physicians, and other specialists in Hong Kong. Recommendations on acute gout management, gout prophylaxis, treatment of hyperuricemia and its precautions, co-administration of non-gout medications with urate-lowering therapy, and lifestyle advice have been included. This paper serves as a reference guide to all healthcare providers who see patients who are at risk and are known to have this chronic but treatable condition.
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Affiliation(s)
- Ronald Ml Yip
- Tung Wah Group of Hospitals Integrated Diagnostic and Medical Centre, Kwong Wah Hospital, 25, Waterloo Road, Kowloon, Hong Kong.
| | - Tommy T Cheung
- Rheumatology Centre, Department of Medicine, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Julia Ps Chan
- Rheumatology Centre, Department of Medicine, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Carmen Tk Ho
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Helen Hl Tsang
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Carrel Kl Yu
- Hong Kong Autoimmune and Rheumatic Diseases Centre, Central, Hong Kong
| | - Priscilla Ch Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
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10
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Hu S, Terkeltaub R, Sun M, Ji X, Li Z, Ran Z, Li Y, Zhang H, Sun W, Li C, Lu J. Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort. Joint Bone Spine 2022; 89:105435. [PMID: 35777552 DOI: 10.1016/j.jbspin.2022.105435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Urate-lowering therapy (ULT) nonadherence is common and problematic in gout. Since, sociocultural factors affect adherence, we analyzed a Chinese cohort. METHODS We studied 903 Chinese gout patients aged 46.4±14.7 years (mean±SD), uniquely extending to assay of 2-year medication possession ratio (MPR) ≥80% defined as high adherence. Multivariable logistic regression analyses evaluated factors linked with adherence and ULT target attainment. RESULTS Characterization of ULT outcomes in this cohort revealed that after 2 years ULT, MPR ≥80% patients had better target serum urate (SU) achievement (from 23.3% to 71.0%, P <0.001), lower flare frequency and palpable tophi compared to MPR <80%. However, only 44.7% of cohort subjects had MPR ≥80%. Male sex (OR 3.68), gout onset age >60 years (OR 3.51), disease duration >5 years (OR 1.70), more comorbidities (OR 1.74), baseline palpable tophi (OR 1.53), SU <6mg/dL (360μmol/L) (OR 1.92) and more frequent follow-up visits (OR 1.98) were significantly associated with high adherence. Nevertheless, significant independent risk factors for failed SU target achievement included male sex (OR 0.36) and more comorbidities (OR 0.85). CONCLUSION Despite adherence to ULT linked to better outcomes for flares and tophi, the more adherent Chinese male patients and those with more comorbidities had decreased target SU attainment. Differences in adherence of Chinese gout patients compared to several primarily Western studies emphasize the importance of not stereotyping gout patients for projected nonadherence. Results underline the dual importance of identifying gout patients more likely to be ULT-adherent and leveraging adherence to drive treatment to SU target.
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Affiliation(s)
- Shuhui Hu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China
| | - Robert Terkeltaub
- VA San Diego VA Healthcare Center, University of California San Diego, 92093 San Diego, USA
| | - Mingshu Sun
- Department of Rheumatology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Zhiyuan Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Zijing Ran
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Yushuang Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China
| | - Wenyan Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China
| | - Changgui Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China.
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11
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Galozzi P, Oliviero F, Scanu A, Lorenzin M, Ortolan A, Favero M, Doria A, Ramonda R. Acute joint swelling in psoriatic arthritis: Flare or "psout"-A 10-year-monocentric study on synovial fluid. Exp Biol Med (Maywood) 2022; 247:1650-1656. [PMID: 35876168 PMCID: PMC9597207 DOI: 10.1177/15353702221110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a multifaceted inflammatory disease associated with psoriasis that can affect peripheral joints, entheses, and the axial skeleton with a variable clinical course. Acute episodes of joint swelling in PsA patients can have different causes and require specific treatments. We aimed to describe the acute joint swelling in PsA patients via synovial fluid (SF) analyses, assessing in particular the presence of pathogenic crystals, to determine whether it is a flare or an acute episode of gout ("psout") during the course of the disease. This retrospective study was based on the results of SF analysis of samples collected from unselected adult PsA patients referred to our clinic for acute joint swelling. Demographic characteristics, disease involvement, laboratory findings on SF, and treatment options were recorded and reviewed. Among 5,478 SF samples analyzed in a 10-year time span, 213 complete SF records from PsA patients were evaluated. Overall, after adjustment for the degree of synovial inflammation, significant differences were observed in term of sex (p = 0.0017) and ongoing therapy (p = 0.0246). Non-inflammatory SFs, indeed, were mainly described for female PsA patients under therapy. Regarding serum uric acid levels, there were 19/213 (8.9%) PsA with hyperuricemia (HU), who were older, mostly male, patients with mild articular involvement and rare pathogenic crystals in their SF. Although it is known that the risk of gout is higher among patients with PsA ("psout"), monosodium urate crystals were reported only in 5/213 SFs (2.4%) of our cohort and in 2/19 SFs (10.5%) of HU PsA patients. Moreover, hyperuricemia seems not to modify the SF features in PsA patients. This study results seem to suggest that the convergence of gout and PsA, involving the role of urate crystals, is a more intricate relationship, which needs further insights to be unraveled.
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Affiliation(s)
- Paola Galozzi
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Medicina Interna I, Ca’ Foncello
Hospital, 31100 Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Roberta Ramonda.
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12
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Badii M, Gaal O, Popp RA, Crisan TO, Joosten LAB. Trained immunity and inflammation in rheumatic diseases. Joint Bone Spine 2022; 89:105364. [DOI: 10.1016/j.jbspin.2022.105364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
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13
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Widawski L, Fabacher T, Spielmann L, Gottenberg JE, Sibilia J, Duret PM, Messer L, Felten R. Psoriatic arthritis with hyperuricemia: more peripheral, destructive, and challenging to treat. Clin Rheumatol 2022; 41:1421-1429. [PMID: 35059880 PMCID: PMC9056476 DOI: 10.1007/s10067-022-06061-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/19/2022]
Abstract
Objective To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA). Methods Retrospective bicentric case–control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L. Results We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10−6) with higher body mass index (30.9 vs 28.7 kg/m2, p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15–7.75; p = 0.025) and less good response to treatment (0.35; 0.15–0.87; p = 0.024). Conclusion Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients.
Key Points • Gout and psoriatic arthritis (PsA) can co-exist in the same patient. • Monosodium urate crystals might have a deleterious impact on PsA. • Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA. • PsA with hyperuricemia should lead to more personalized medicine. |
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Affiliation(s)
- L Widawski
- Rheumatology Department, Colmar Civil Hospital, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
| | - T Fabacher
- Department of Epidemiology and Public Health, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - L Spielmann
- Rheumatology Department, Colmar Civil Hospital, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
| | - J E Gottenberg
- Rheumatology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares RESO, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France
| | - J Sibilia
- Rheumatology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares RESO, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France
| | - P M Duret
- Rheumatology Department, Colmar Civil Hospital, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
| | - L Messer
- Rheumatology Department, Colmar Civil Hospital, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
- UMR 7367, MISHA, Allée du Général Rouvillois, Dynamiques Européennes, 67083, Strasbourg Cedex, France
| | - R Felten
- Rheumatology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares RESO, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France.
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14
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Abstract
PURPOSE OF REVIEW This review aims to summarize recent evidence regarding the complex relationship between uric acid (UA), gout, and brain diseases. RECENT FINDINGS Observational studies have suggested that patients with hyperuricemia or gout might have a decreased risk of neurodegenerative diseases. Conversely, they may be at increased risk of cerebrovascular disease. Mendelian randomization (MR) studies use a genetic score as an instrumental variable to address the causality of the association between a risk factor (here, UA or gout) and an outcome. So far, MR analyses do not support a causal relationship of UA or gout with Alzheimer's disease and dementia, and of UA with Parkinson's disease or stroke. Observation studies indicate a U-shaped association between UA and brain diseases, but MR studies do not support that this association is causal. Further studies should address the causal role of gout as well as the impact of urate-lowering therapy on these outcomes.
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15
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Cheng Z, Zheng T, Zhang D, Yang J, Hu X, Yin C, Ren X, Li J, Shi D, Li N, Zheng S, Wang M, Bai Y. High-level uric acid in asymptomatic hyperuricemia could be an isolated risk factor of cardio-cerebrovascular diseases: A prospective cohort study. Nutr Metab Cardiovasc Dis 2021; 31:3415-3425. [PMID: 34663537 DOI: 10.1016/j.numecd.2021.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Whether the asymptomatic hyperuricemia (AH) raise the cardiovascular disease risk with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH. METHODS AND RESULTS In this prospective cohort study, multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Baseline serum uric acid beyond normouricemia (357 mmol/L) was quarterly stratified based on the distribution of healthy populations without CVD onset. 1062 CVD first-attack cases were collected among the 29,974 study population (age range: 18-91, mean age: 47.2 ± 13.9 years-old) with a mean follow-up duration of 5.78 ± 0.83 years. The AH showed overall non-association with the CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.42, 1.21-1.68; stroke: 1.27, 1.06-1.41), male (CHD: 1.26, 1.12-1.55), female (CHD: 1.34, 1.04-2.02; stroke: 2.06, 1.13-3.77) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2-3 times higher than the normouricemia population. After excluded 14,464 baseline population with diabetes, dyslipidemia, and hypertension, consistent results were also observed in the AH population in absence of comorbidities (CHD: 1.51, 1.22-2.25; stroke: 1.68, 1.13-2.39). CONCLUSION Asymptomatic hyperuricemia patients exposed to a higher level of uric acid (>=428 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.
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Affiliation(s)
- Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology of China, Shenzhen, Guangdong 518055, China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02901, USA
| | - Desheng Zhang
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Jingli Yang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Xiaobin Hu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Chun Yin
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Xiaowei Ren
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Juansheng Li
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Dian Shi
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02901, USA; School of Basic Medical Science, Lanzhou University, Lanzhou, Gansu, 73000, PR China
| | - Na Li
- Workers' Hospital of Jinchuan Corporation, Jinchuan Group CO., LTD, Jinchang, Gansu, 737100, PR China
| | - Shan Zheng
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Minzhen Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Yana Bai
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, PR China.
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16
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Bardin T, Magnat E, Clerson P, Richette P, Rouchon B. Epidemiology of gout and hyperuricemia in New Caledonia. Joint Bone Spine 2021; 89:105286. [PMID: 34601114 DOI: 10.1016/j.jbspin.2021.105286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES New Caledonia is a Pacific island of 270,000 inhabitants with mixed ethnicities, including Polynesians (10.2%), people from European ancestry (27.2%), and Melanesians (39.1%),. This study aimed at determining the prevalence of gout and hyperuricemia in the general population and the various ethnicities of New Caledonia. METHODS A 3-degree random sample of the population aged 18 to 60 years was adjusted according to the 2014 New Caledonia census. Face-to-face planned interviews and physical measurements were performed by trained nurses. All consenting participants underwent capillary measurement of creatinine; all consenting men and only women older than 40 years underwent point-of-care uricemia testing. Gout was defined by a validated algorithm. Two definitions of hyperuricemia were used: capillary level equivalent to plasma uric acid level>360μmol/l (6mg/dl) and>420μmol/l (7mg/dl) and/or urate-lowering drug treatment for both thresholds. RESULTS We included 1144 participants (adjusted mean age 37.7±12.0 years; adjusted sex ratio 50.4% men). The adjusted prevalence of gout was 3.3% (95% confidence interval 2.2-4.9). Prevalence was 6.7% (2.5-16.8), 4.1% (1.8-8.9), and 2.6% (1.4-4.7) for Polynesians, Europeans and Melanesians, respectively, and 1.9% (0.5-6.6) for other ethnicities. Prevalence of hyperuricemia, determined in 658 participants, was 67.0% (61.9-71.6) and 37.0% (32.3-42.0) for the 360- and 420-μmol/l thresholds, respectively, and was significantly greater for Polynesians and Melanesians than Europeans for both thresholds. CONCLUSIONS The prevalence of gout and hyperuricemia in New Caledonia was high, including in patients of European descent.
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Affiliation(s)
- Thomas Bardin
- Department of Rheumatology, Lariboisière hospital APHP Paris Nord, and Université de Paris, INSERM U1132, Paris, France.
| | | | | | - Pascal Richette
- Department of Rheumatology, Lariboisière hospital APHP Paris Nord, and Université de Paris, INSERM U1132, Paris, France
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Diez-Lopez C, Perez-Contreras J, Andres M. Urate levels and clearance in renal patients under peritoneal dialysis. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2021; 40:720-731. [PMID: 34085590 DOI: 10.1080/15257770.2021.1934482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hemodialysis adequately controls serum uric acid (UA) levels, making UA-lowering drugs unnecessary; scant data are available for peritoneal dialysis (PD). We analyzed blood, 24 h urine and dialysis fluid from twenty patients under PD, to assess UA levels and clearances, and factors associated with better performance and maintenance of target levels (<6mg/dL). Median serum UA was 5.4 mg/dL (p25-75 4.4-5.8), mainly achieved through peritoneal clearance (3.0 mL/min/1.73m2, 71.2% of total UA clearance); 75% of participants was on UA targets. Continuous cycling peritoneal dialysis showed highest UA clearance and target achievements. These findings may be of interest for end-stage renal patients with gout.
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Affiliation(s)
- Claudia Diez-Lopez
- Nephrology Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - Javier Perez-Contreras
- Nephrology Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain.,Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain
| | - Mariano Andres
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Rheumatology Section, General University Hospital of Alicante-ISABIAL, Alicante, Spain
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Del Pinto R, Viazzi F, Pontremoli R, Ferri C, Carubbi F, Russo E. The Urrah study. Panminerva Med 2021; 63:416-423. [PMID: 33765764 DOI: 10.23736/s0031-0808.21.04357-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Uric acid has long been considered responsible for a single specific disease, namely gout. In recent years, novel knowledge has emerged linking serum uric acid with a variety of conditions and related risk factors, from hypertension, metabolic syndrome, and type 2 diabetes, to fatal/nonfatal cardiovascular diseases and all-cause death, with the underlying mechanisms involving disrupted neurohormonal and metabolic signaling as well as oxidative stress and inflammation. Importantly, the cut-off value of serum uric acid predicting the risk of incident events is within the range of normality and below the threshold for increased risk of gout. A large contribution to the advancement in knowledge in the cardiovascular implications of uric acid derives from the Italian study URic acid Right for heArt Health (URRAH). This review summarizes the mechanisms linking uric acid with cardiovascular risk and the major findings of the URRAH study. The need for a reappraisal of the definition of range of normality for uric acid is discussed.
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Affiliation(s)
- Rita Del Pinto
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Roberto Pontremoli
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Claudio Ferri
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy -
| | - Francesco Carubbi
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Elisa Russo
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
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19
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Ong SG, Ding HJ. A single-centre experience of febuxostat as a second-line urate-lowering therapy. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:50-55. [PMID: 33948142 PMCID: PMC8088732 DOI: 10.51866/oa0892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The purpose of this study was to describe the local experience in terms of drug efficacy and safety using a new xanthine oxidase inhibitor, febuxostat, as a second-line urate-lowering therapy (ULT) in gout patients with normal renal function and chronic kidney disease. METHODS This cross-sectional study included all gout patients who attended the rheumatology clinic from January 2013 to June 2018 and had received febuxostat as a second-line ULT. Analysis focused on the proportion of gout patients who achieved target serum urate (sUA) of <360 μmol/L, duration taken to achieve target sUA, and febuxostat dosage at achievement of target sUA. Safety assessments included comparison of serum creatinine, estimated glomerular filtration rate (eGFR), and serum alanine aminotransferase (ALT) at baseline, at achievement of target sUA, and at 12-monthly intervals. RESULTS Majority (90.9%) of patients achieved target sUA. Median duration required to achieve target sUA was 5.5 months with IQR (interquartile range) of 8.5. Five (22.7%) patients achieved target sUA within one month of therapy with febuxostat 40 mg per day. Eleven (55%) patients achieved target sUA within six months and 16 (80%) by 12 months. Equal proportion of patients achieved target sUA with febuxostat 40 mg per day and 80 mg per day, respectively. There was no significant difference in the changes in serum creatinine level, eGFR and ALT from baseline and at achievement of target sUA, nor at 12-monthly intervals throughout the duration of febuxostat therapy. Apart from three patients who developed hypersensitivity reactions to febuxostat, no other adverse events were reported. CONCLUSION A significant proportion of gout patients with CKD managed to achieve target sUA with a lower dose of febuxostat at 40 mg per day and it is reasonable to maintain this dose for up to six months before considering dose escalation.
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Affiliation(s)
- Swee Gaik Ong
- MD, MRCP, Rheumatology Unit, Department of Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Hui Jen Ding
- MBChB, MRCP, Rheumatology Unit, Department of Medicine, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur, Malaysia
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20
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Bernal JA, García-Campos J, Marco-LLedó J, Andrés M. Gouty Involvement of Foot and Ankle: Beyond Flares. REUMATOLOGIA CLINICA 2021; 17:106-112. [PMID: 32067922 DOI: 10.1016/j.reuma.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
The foot and ankle are common locations of deposition of monosodium urate (MSU) crystals, as indicated by the clinical manifestations presented by patients with gout, which are not limited to the acute inflammation of the big toe. We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life. Cumulative reports indicate that gout, even at the non-tophaceous stage, could cause pain, gait impairment and limit the mobility at lower limbs. These patients may present difficulties in some activities of daily living such as choosing footwear, thus leading to an impaired quality of life. Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations, especially when structural damage has already occurred. Furthermore, a collaboration between rheumatologists and podiatrists seems helpful to understand, relieve these symptoms and improve the quality of life in gouty patients.
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Affiliation(s)
- José-Antonio Bernal
- Sección de Reumatología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | - Jonatan García-Campos
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Javier Marco-LLedó
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández, Alicante, Spain
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
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Niu Y, Yang P, Li H, Li Q, Lin H, Gao L, Li L. Olsalazine Sodium Increases Renal Urate Excretion by Modulating Urate Transporters in Hyperuricemic Animals. Biol Pharm Bull 2020; 43:1653-1659. [PMID: 32863294 DOI: 10.1248/bpb.b20-00362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperuricemia is mainly the result of relative underexcretion of urate. Urate is mainly eliminated by kidney and several important transporters expressed on the membrane of renal tubular cells involved in urate excretion. Olsalazine sodium was screened from 3167 authorized small compounds/drugs, targeting xanthine oxidoreductase. In previous study, we reported that olsalazine sodium significantly reduced the serum urate levels, and the anti-hyperuricemic activity linked with inhibiting urate formation by reducing the activity of xanthine oxidoreductase. The current research aimed to assess olsalazine sodium renal urate excretion and likely molecular mechanism. The results showed that administration of olsalazine sodium 5.0 mg/kg decreased the levels of serum urate in hyperuricemic rats, and noticeably improved the fractional excretion of urate and urate clearance, exhibiting an uricosuric action. Moreover, olsalazine sodium (2.5, 5.0, 10.0 mg/kg) reduced the level of blood urea nitrogen in rats. Further study showed that olsalazine sodium reduced the mRNA expression of urate reabsorptive transporter glucose transporter 9 (GLUT9), increased the mRNA expression of urate secretory transporters, organic anion transporter 1 (OAT1), OAT3 and type 1 sodium-dependent phosphate transporter (NPT1) as well as the protein expression of OAT3 in the kidney in hyperuricemic mice. In conclusion, olsalazine sodium exhibited a promotion of urate excretion in kidney by increasing the expression of OAT3.
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Affiliation(s)
- Yanfen Niu
- Biomedical Engineering Research Center, Kunming Medical University
| | - Pingfen Yang
- Biomedical Engineering Research Center, Kunming Medical University
| | - Hongjian Li
- Department of Computer Science and Engineering, Chinese University of Hong Kong.,School of Biomedical Sciences, Chinese University of Hong Kong
| | - Qiang Li
- Biomedical Engineering Research Center, Kunming Medical University
| | - Hua Lin
- Biomedical Engineering Research Center, Kunming Medical University
| | - Lihui Gao
- Biomedical Engineering Research Center, Kunming Medical University
| | - Ling Li
- Biomedical Engineering Research Center, Kunming Medical University
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Urits I, Smoots D, Anantuni L, Bandi P, Bring K, Berger AA, Kassem H, Ngo AL, Abd-Elsayed A, Manchikanti L, Urman R, Kaye AD, Viswanath O. Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review. Pain Ther 2020; 9:129-142. [PMID: 32100225 PMCID: PMC7203307 DOI: 10.1007/s40122-020-00158-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. METHODS A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "hand pain", "injection techniques", "steroid injection", "chronic pain", "osteoarthritis", "rheumatoid arthritis", "carpal tunnel syndrome", "De Quervain's tenosynovitis", "ganglion cyst", "gout", "Raynaud's", and "stenosing tenosynovitis". RESULTS Hand pain is a common condition with 9.7% prevalence in men and 21.6% in women and can cause significant morbidity and disability. It also carries a significant cost to the individuals and the healthcare system, totaling in $4 billion dollars in 2003. Injection therapy is an alternative when conservative treatment fails. Osteoarthritis is the most common chronic hand pain syndrome and affects about 16% of the population. Its mechanism is largely mechanic, and as such, there is controversy if steroid injections are of benefit. Hyaluronic acid (HA) appears to provide substantial relief of pain and may increase functionality. More studies of HA are required to make a definite judgment on its efficacy. Similarly, steroid ganglion cyst injection may confer little benefit. Carpal tunnel syndrome is a compressive neuropathy, and only temporarily relieved with injection therapy. US-guidance provides significant improvement and, while severe cases may still require surgery, can provide a valuable bridge therapy to surgery when conservative treatment fails. Similar bridging treatments and increased efficacy under US-guidance are effective for stenosing tenosynovitis ("trigger finger"), though, interestingly, inflammatory background is associated with decreased effect in this case. When the etiology of the pain is inflammatory, such as in RA, corticosteroid (CS) injections provide significant pain relief and increased functionality. They do not, however, change the course of disease (unlike DMARDs). Another such example is De-Quervain tenosynovitis that sees good benefit from CS injections, and an increased efficacy with US-guidance, and similarly are CS injections for gout. For Raynaud's phenomenon, Botox injections have encouraging results, but more studies are needed to determine safety and efficacy, as well as the possible difference in effect between primary and secondary Raynaud's. CONCLUSIONS Chronic hand pain is a prevalent and serious condition and can cause significant morbidity and disability and interferes with independence and activities of daily living. Conservative treatment remains the first line of treatment; however, when first-line treatments fail, steroid injections can usually provide benefit. In some cases, HA or Botox may also be beneficial. US-guidance is increasing in hand injection and almost ubiquitously provides safer, more effective injections. Hand surgery remains the alternative for refractory pain.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Smoots
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Lekha Anantuni
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Prudhvi Bandi
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Katie Bring
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Anh L Ngo
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Richard Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Pascart T, Latourte A, Flipo RM, Chalès G, Coblentz-Baumann L, Cohen-Solal A, Ea HK, Grichy J, Letavernier E, Lioté F, Ottaviani S, Sigwalt P, Vandecandelaere G, Richette P, Bardin T. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine 2020; 87:395-404. [PMID: 32422338 DOI: 10.1016/j.jbspin.2020.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop French Society of Rheumatology-endorsed recommendations for the management of urate-lowering therapy (ULT). METHODS Evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and two Delphi rounds to finalize them. RESULTS A set of 3 overarching principles and 5 recommendations was elaborated. The overarching principles emphasize the importance of patient education, especially the need for explaining the objective of lowering serum urate (SU) level to obtain crystal dissolution, clinical symptoms disappearance and avoidance of complications. ULT is indicated as soon as the diagnosis of gout is established. SU level must be decreased below 300μmol/l (50mg/l) in all gout patients or at least below 360μmol/l (60ml/l) when the 300μmol/l target cannot be reached, and must be maintained at these targets and monitored life-long. The choice of the ULT primarily relies on renal function: in patients whose estimated glomerular filtration rate (eGFR) is above 60ml/min/1.73m2, first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m2, allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m2, allopurinol must be avoided and febuxostat should be preferred. Prophylaxis of ULT-induced gout flares involves progressive increase of ULT dosage and low-dose colchicine for at least 6 months. Cardiovascular risk factors and diseases, the metabolic syndrome and chronic kidney disease must be screened and managed. CONCLUSION These recommendations aim to provide simple and clear guidance for the management of ULT in France.
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Affiliation(s)
- Tristan Pascart
- Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France
| | - Augustin Latourte
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | - René-Marc Flipo
- Service de rhumatologie, université de Lille, CHU de Lille, Lille, France
| | | | | | - Alain Cohen-Solal
- Service de cardiologie, hôpital Lariboisière, AP-HP, Paris, France; Inserm U942 MASCOT, université de Paris, Paris, France
| | - Hang-Korng Ea
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Emmanuel Letavernier
- Service de physiologie, hôpital Tenon, AP-HP, Paris, France; Inserm U1155, UPMC Université Paris 6, Sorbonne Universités, Paris, France
| | - Frédéric Lioté
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Pierre Sigwalt
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | | | - Pascal Richette
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France
| | - Thomas Bardin
- Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
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Liu XY, Wu QY, Chen ZH, Yan GY, Lu Y, Dai HJ, Li Y, Yang PT, Yuan H. Elevated triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio increased risk of hyperuricemia: a 4-year cohort study in China. Endocrine 2020; 68:71-80. [PMID: 31940133 DOI: 10.1007/s12020-019-02176-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Previous studies revealed that high serum uric acid (SUA) levels correlated with increased triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. However, evidence is lacking regarding whether TG/HDL-C is an independent risk factor or just a simple marker of hyperuricemia. We aimed to investigate the relationship between TG/HDL-C and the risk of hyperuricemia in Chinese population. METHODS This retrospective cohort study involved 15,198 subjects (43.14 ± 13.13 years, 54.9% men) who were free of hyperuricemia at baseline. The association between TG/HDL-C and the risk of hyperuricemia, in the total sample and stratified by subgroups, was examined by multiple logistic regression analyses. RESULTS During 4 years follow-up, hyperuricemia occurred in 2365 (15.6%) participants. The cumulative incidence of hyperuricemia was significantly elevated with increasing TG/HDL-C quartiles (5.9, 10.8, 18.4, and 27.5%, respectively). After multivariate adjustment, the odds ratio for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.80 (95% confidence interval [CI] 1.49, 2.18), and each SD increment of TG/HDL-C ratio caused a 10% additional risk for hyperuricemia. Moreover, subgroup analyses showed that the association between TG/HDL-C and the risk of hyperuricemia was more pronounced in women and normal-weight adults. The results were consistent when analyses were restricted to participants without metabolic syndrome. CONCLUSIONS TG/HDL-C ratio was positively related to the risk of hyperuricemia in Chinese population, particularly in women and normal-weight individuals. These findings suggested the potential of TG/HDL-C ratio to serve as an independent risk indicator in the prevention of hyperuricemia.
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Affiliation(s)
- Xin-Yao Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Qiao-Yu Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Zhi-Heng Chen
- Department of Health Examination Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Guang-Yu Yan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Yao Lu
- Key Laboratory of Medical Information Research, Central South University, Changsha, Hunan, PR China
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hai-Jiang Dai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ying Li
- Department of Health Examination Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ping-Ting Yang
- Department of Health Examination Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hong Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
- Key Laboratory of Medical Information Research, Central South University, Changsha, Hunan, PR China.
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
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Management of Patients with Asymptomatic Hyperuriсemia – to Treat or not to Treat? Fam Med 2019. [DOI: 10.30841/2307-5112.5-6.2019.193365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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Szekanecz Z, Szamosi S, Kovács GE, Kocsis E, Benkő S. The NLRP3 inflammasome - interleukin 1 pathway as a therapeutic target in gout. Arch Biochem Biophys 2019; 670:82-93. [DOI: 10.1016/j.abb.2019.01.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
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Chen J, Qiu SH, Guo HJ, Li W, Sun ZL. Increased urinary glucose excretion is associated with a reduced risk of hyperuricaemia. Diabet Med 2019; 36:902-907. [PMID: 30920678 DOI: 10.1111/dme.13956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association of urinary glucose excretion with levels of serum uric acid in adults with newly diagnosed diabetes. METHODS A total of 597 people with newly diagnosed diabetes, confirmed in an oral glucose tolerance test, were included in the present study. The participants were divided into two groups: 142 participants with low urinary glucose excretion and 455 with high urinary glucose excretion. Demographic characteristics and clinical variables were evaluated. The association of urinary glucose excretion with uric acid was analysed using multivariable regression analysis. RESULTS The low urinary glucose excretion group had a significantly higher prevalence of hyperuricaemia than the high urinary glucose excretion group. Moreover, urinary glucose excretion was negatively associated with uric acid level. The correlation remained significant after adjusting for potential confounders, including gender, age, fasting plasma glucose, 2-h plasma glucose and BMI. The results also showed that participants with high urinary glucose excretion were at decreased risk of hyperuricaemia (odds ratio 0.47, 95% CI 0.27-0.80; P = 0.006). CONCLUSION Urinary glucose excretion was independently associated with uric acid level in participants with newly diagnosed diabetes. In addition to lowering blood glucose, promoting urinary glucose excretion may also be an effective approach to reducing serum uric acid levels, especially for people with diabetes complicated with hyperuricaemia.
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Affiliation(s)
- J Chen
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - S-H Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - H-J Guo
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - W Li
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Z-L Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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Reference interval and upper decission limit for serum uric acid – an evidence-based approach on Romanian population using an a posteriori method. REV ROMANA MED LAB 2019. [DOI: 10.2478/rrlm-2019-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Abstract
Introduction. There is accumulating evidence that high normal serum uric acid (SUA) levels of 6-7 mg/dL are associated with cardiovascular morbidity and metabolic syndrome (MetS), hence the need to redefine its upper limit of normal (ULN). We aimed to derive ULN based on statistics and evidence in a representative sample of the population and to observe its relation to MetS components.
Methods. All SUA measurements form a university rheumatology hospital were extracted between January 5th 2010 and March 21st 2018. SUA levels were measured by a single biochemist a unique type of commercially available kit. Follow-up measurements, patients with diagnoses influencing SUA levels and outlying measurements were excluded. ULNs were studied using least square analysis.
Results. Of the 22503 SUA measurements in the database, only 3318 came from normal individuals: 33.3% men (n=1105), 66.7% women (n = 2213). Least square analysis revealed the following SUA reference intervals (RI): 3.43-6.19 mg/dL for the combined sample; 4.44-7.01 mg/dL for men, 3.28-5.56 mg/dL for women. The values corresponding to the 66th percentile of each group presented lower ULNs: 5.36 mg/dL for all, 6.10 mg/dL for men, 4.90 mg/dL for women. The prevalence of hyperuricemia increased from 13.8% (manufacturer’s gender-specific ULN) to 19.9% (derived ULN). Mean SUA levels significantly increased with the number of MetS components.
Conclusion. We recommend that hyperuricemia should be defined using a statistical approach of ULN selection corresponding to the genderand population-specific 66th percentile of data range.
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Alqarni NA, Hassan AH. Knowledge and practice in the management of asymptomatic hyperuricemia among primary health care physicians in Jeddah, Western Region of Saudi Arabia. Saudi Med J 2019; 39:1218-1225. [PMID: 30520504 PMCID: PMC6344656 DOI: 10.15537/smj.2018.12.23715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To assess knowledge and practice levels in asymptomatic hyperuricemia (AH) and investigate predictors of urate-lowering therapy (ULT) misprescribing among primary health care (PHC) physicians. Methods: A cross-sectional study was conducted among 201 PHC physicians from December 2017 to May 2018. A based clinical guidelines for hyperuricemia management from American Professional Organizations, a semi-structured questionnaire was administered to collect demographic and professional data; knowledge and practice levels in management of AH; and barriers to the management of hyperuricemia and gout, with focus of the misprescribing of ULT in AH. A 2-stage stratified sampling technique was used to select 4 PHC centers were from each of the 5 advisory sectors in Jeddah, Kingdom of Saudi Arabia; and to recruit a minimum of 10 eligible participants per primary health care center (PHCC). Binary logistic regression was used to analyze predictors of ULT misuse in AH. Results: Only 32.8% participating physicians had adequate knowledge about AH. Regarding practice, while majority (88.1%) correctly recommended a low-purine diet and lifestyle changes to patients, almost half misprescribed ULT and 10.9% misprescribed non-steroid anti-inflammatory drugs. Lack of knowledge and awareness about guidelines were the most frequently self-reported barriers to adequate practice. Predictors of ULT misuse included the percentage of patients having gout (1-10%: OR=5.40, p=0.047) or receiving ULT (>10-20%: OR=20.02, p=0.001)among patients seen in clinic, attendance of rheumatology conferences (OR=2.55, p=0.017), and having a close relative with hyperuricemia or gout (OR=2.45, p=0.026). Conclusion: There are inadequate levels of knowledge regarding AH among Saudi PHC physicians increasing risk of malpractice including misprescription of ULT and anti-inflammatory medications.
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Affiliation(s)
- Norah A Alqarni
- Joint Program of Family Medicine, King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Abstract
The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available.
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Affiliation(s)
- Gérard Chalès
- Faculté de Médecine de Rennes, 2, avenue du professeur Léon-Bernard, 35000 Rennes, France.
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Chen X, Wang Z, Duan N, Cui W, Ding X, Jin T. The benchmark dose estimation of reference levels of serum urate for gout. Clin Rheumatol 2018; 37:2887-2891. [DOI: 10.1007/s10067-018-4273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/01/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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Pascart T, Richette P. Investigational drugs for hyperuricemia, an update on recent developments. Expert Opin Investig Drugs 2018; 27:437-444. [DOI: 10.1080/13543784.2018.1471133] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
| | - Pascal Richette
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France
- Department of Rheumatology, INSERM U1132 and University Paris-Diderot, Paris, France
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Sun M, Vazquez AI, Reynolds RJ, Singh JA, Reeves M, Merriman TR, Gaffo AL, Los Campos GD. Untangling the complex relationships between incident gout risk, serum urate, and its comorbidities. Arthritis Res Ther 2018; 20:90. [PMID: 29720278 PMCID: PMC5932762 DOI: 10.1186/s13075-018-1558-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/06/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many gout comorbidities (e.g., hypertension) are correlated with serum urate. In this investigation, we identified risk factors (e.g., systolic blood pressure [SBP]), that (1) are associated with incident gout, (2) have effects on gout risk that cannot be fully explained by correlated differences in serum urate, and (3) may modulate the relationship between gout and serum urate. METHODS Using data from the Atherosclerosis Risk in Communities (ARIC) study, we estimated the unadjusted associations between gout and risk factors by calculating ORs and using chi-square tests. The adjusted associations were analyzed using logistic regression by sequentially adding (1) one risk factor at a time or (2) all risk factors, to a baseline model that includes serum urate only. Stepwise selection was used to select main effects. Two-way interactions of variables from the main effects model were also analyzed. RESULTS Average gout incidence was 2.7 per 1000 people per year. Serum urate was highly associated with incident gout, with odd ratios of 3.16 [95% CI 2.11, 4.76] and 25.9 [95% CI 17.2, 38.4] for moderately high (6-8 mg/dl) and high serum urate (> 8 mg/dl), relative to normal serum urate (< 6 mg/dl), respectively. Ethnicity and SBP were independently and additively associated with gout after accounting for serum urate levels. No significant interactions were found between serum urate and ethnicity or SBP. CONCLUSIONS Ethnicity and hypertension are predictive of gout risk, and the associations cannot be fully explained by serum urate. For serum urate levels near the crystallization threshold (6-8 mg/dl) African Americans and people with hypertension are at two to three times greater risk for developing gout. The gout risk for this group appears to increase before the onset of severe hyperuricemia.
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Affiliation(s)
- Mengying Sun
- Department of Epidemiology and Biostatistics, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA.,The Institute for Quantitative Health Science and Engineering, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA
| | - Ana I Vazquez
- Department of Epidemiology and Biostatistics, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA.,The Institute for Quantitative Health Science and Engineering, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA
| | - Richard J Reynolds
- Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham (UAB), 1825 University Blvd., Birmingham, AL 35294, USA
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham (UAB), 1825 University Blvd., Birmingham, AL 35294, USA
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA
| | - Tony R Merriman
- Biochemistry Department, School of Biomedical Sciences, University of Otago, 710 Cumberland St., Dunedin, 9054, New Zealand
| | - Angelo L Gaffo
- Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham (UAB), 1825 University Blvd., Birmingham, AL 35294, USA
| | - Gustavo de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA. .,The Institute for Quantitative Health Science and Engineering, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA. .,Department of Probability and Statistics, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA.
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Maravic M, Hincapie N, Pilet S, Flipo RM, Lioté F. Persistent clinical inertia in gout in 2014: An observational French longitudinal patient database study. Joint Bone Spine 2018; 85:311-315. [DOI: 10.1016/j.jbspin.2017.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/31/2017] [Indexed: 12/27/2022]
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Waldman B, Ansquer JC, Sullivan DR, Jenkins AJ, McGill N, Buizen L, Davis TME, Best JD, Li L, Feher MD, Foucher C, Kesaniemi YA, Flack J, d'Emden MC, Scott RS, Hedley J, Gebski V, Keech AC. Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study. Lancet Diabetes Endocrinol 2018; 6:310-318. [PMID: 29496472 DOI: 10.1016/s2213-8587(18)30029-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gout is a painful disorder and is common in type 2 diabetes. Fenofibrate lowers uric acid and reduces gout attacks in small, short-term studies. Whether fenofibrate produces sustained reductions in uric acid and gout attacks is unknown. METHODS In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, participants aged 50-75 years with type 2 diabetes were randomly assigned to receive either co-micronised fenofibrate 200 mg once per day or matching placebo for a median of 5 years follow-up. We did a post-hoc analysis of recorded on-study gout attacks and plasma uric acid concentrations according to treatment allocation. The outcomes of this analysis were change in uric acid concentrations and risk of on-study gout attacks. The FIELD study is registered with ISRCTN, number ISRCTN64783481. FINDINGS Between Feb 23, 1998, and Nov 3, 2000, 9795 patients were randomly assigned to fenofibrate (n=4895) or placebo (n=4900) in the FIELD study. Uric acid concentrations fell by 20·2% (95% CI 19·9-20·5) during the 6-week active fenofibrate run-in period immediately pre-randomisation (a reduction of 0·06 mmol/L or 1 mg/dL) and remained -20·1% (18·5-21·7, p<0·0001) lower in patients taking fenofibrate than in those on placebo in a random subset re-measured at 1 year. With placebo allocation, there were 151 (3%) first gout events over 5 years, compared with 81 (2%) among those allocated fenofibrate (HR with treatment 0·54, 95% CI 0·41-0·70; p<0·0001). In the placebo group, the cumulative proportion of patients with first gout events was 7·7% in patients with baseline uric acid concentration higher than 0·36 mmol/L and 13·9% in those with baseline uric acid concentration higher than 0·42 mmol/L, compared with 3·4% and 5·7%, respectively, in the fenofibrate group. Risk reductions were similar among men and women and those with dyslipidaemia, on diuretics, and with elevated uric acid concentrations. For participants with elevated baseline uric acid concentrations despite taking allopurinol at study entry, there was no heterogeneity of the treatment effect of fenofibrate on gout risk. Taking account of all gout events, fenofibrate treatment halved the risk (HR 0·48, 95% CI 0·37-0·60; p<0·0001) compared with placebo. INTERPRETATION Fenofibrate lowered uric acid concentrations by 20%, and almost halved first on-study gout events over 5 years of treatment. Fenofibrate could be a useful adjunct for preventing gout in diabetes. FUNDING None.
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Affiliation(s)
- Boris Waldman
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jean-Claude Ansquer
- Centre Hospitalier Universitaire de Dijon, Dijon, France; Clinsciences, Dijon, France
| | - David R Sullivan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Neil McGill
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Luke Buizen
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy M E Davis
- School of Medicine, University of Western Australia, Fremantle, WA, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Imperial College London, London, UK
| | - Liping Li
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael D Feher
- Lipid Clinic, Chelsea and Westminster Hospital Foundation Trust, London, UK; Department of Clinical and Experimental Medicine, University of Surrey, Surrey, UK
| | | | - Y Antero Kesaniemi
- Oulu Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jeffrey Flack
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Michael C d'Emden
- Endocrine Research Unit, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - John Hedley
- Department of Internal Medicine, Wairau Hospital, Blenheim, New Zealand
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
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Desideri G, Virdis A, Casiglia E, Borghi C. Exploration into Uric and Cardiovascular Disease: Uric Acid Right for heArt Health (URRAH) Project, A Study Protocol for a Retrospective Observational Study. High Blood Press Cardiovasc Prev 2018; 25:197-202. [PMID: 29427170 DOI: 10.1007/s40292-018-0250-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
The relevance of cardiovascular role played by levels of serum uric acid is dramatically growing, especially as cardiovascular risk factor potentially able to exert either a direct deleterious impact or a synergic effect with other cardiovascular risk factors. At the present time, it still remains undefined the threshold level of serum uric acid able to contribute to the cardiovascular risk. Indeed, the available epidemiological case studies are not homogeneous, and some preliminary data suggest that the so-called "cardiovascular threshold limit" may substantially differ from that identified as a cut-off able to trigger the acute gout attack. In such scenario, there is the necessity to clarify and quantify this threshold value, to insert it in the stratification of risk algorithm scores and, in turn, to adopt proper prevention and correction strategies. The clarification of the relationship between circulating levels of uric acid and cardio-nephro-metabolic disorders in a broad sample representative of general population is critical to identify the threshold value of serum uric acid better discriminating the increased risk associated with uric acid. The Uric acid Right for heArt Health (URRAH) project has been designed to define, as primary objective, the level of uricemia above which the independent risk of cardiovascular disease may increase in a significantly manner in a general Italian population.
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Affiliation(s)
- Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Abstract
INTRODUCTION Gout is a common disease responsible for recurrent flares triggered by the deposition of monosodium urate crystals secondary to longstanding hyperuricaemia. The management of gout implies both the treatment of flares and the treatment of hyperuricaemia itself. Recent improvement in the understanding of the disease led to the development of new drugs. Areas covered: This review covers data related to 'old' treatments of flares and hyperuricaemia, evidence on the recently approved drugs and emerging therapies in development. Expert opinion: Recent data provide a good grasp of the optimal use of colchicine, corticosteroids and NSAIDs for the treatment of flares. Interleukin-1 blocking therapies have an increasing role in the management of difficult-to-treat gout. Sub-optimal use of allopurinol is common and its potency to reduce serum uric acid (SUA) levels is underestimated. Febuxostat effectively reduces SUA levels. New uricosurics, notably lesinurad and arhalofenate, in combination with xanthine oxidase inhibitors, offer promising perspectives to help a greater number of patients achieve sufficient SUA reduction.
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Affiliation(s)
- Tristan Pascart
- a Department of Rheumatology, Lille Catholic Hospitals , University of Lille , Lomme , France.,b EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires , University of Lille , Lille , France
| | - Pascal Richette
- c Department of Rheumatology, Assistance Publique-Hôpitaux de Paris , Hôpital Lariboisiere , Paris , France.,d INSERM U1132 and University Paris-Diderot , Paris , France
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Metabolic syndrome, serum uric acid and renal risk in patients with T2D. PLoS One 2017; 12:e0176058. [PMID: 28423036 PMCID: PMC5396926 DOI: 10.1371/journal.pone.0176058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/04/2017] [Indexed: 01/08/2023] Open
Abstract
Background and aims Metabolic Syndrome (Mets) and increased serum uric acid (SUA), are well known renal risk predictors and often coexist in patients with type 2 diabetes (T2D). Whether they independently contribute to the onset of CKD is at present unclear. Methods and results Within the AMD Annals database we identified patients with T2D and normal renal function and urine albumin excretion at baseline and regular follow-up visits during a 4-year period. Blood pressure, BMI, HDL, triglycerides, and SUA were available in 14,267 patients. The association between Mets and/or hyperuricemia (HU, top fifth gender specific quintile) and the occurrence of renal outcomes were evaluated. Results At baseline 59% of patients (n = 8,408) showed Mets and 18% (n = 2,584) HU. Over the 4-year follow-up, 14% (n = 1,990) developed low eGFR (i.e. below 60 mL/min/1.73 m2), and 26% (n = 3,740) albuminuria. After adjustment for confounders, BP≥130/85, low HDL, triglycerides ≥150 and HU were independently related to the development of low eGFR (1.57, P<0.001; 1.13, P = 0.056; 1.18, P = 0.008; 1.26, P = 0.001) and of albuminuria (1.35, P<0.001; 1.18, P = 0.001; 1.15, P = 0.002; 1.24, P = 0.001), respectively. The incidence of low eGFR was higher in patients with HU independent of the presence or absence of Mets (21%, OR 1.30, p = 0.009 and 20%, 1.57, p<0.000 respectively), while albuminuria occurred more frequently in those with Mets and HU (32%, OR 1.25, p = 0.005) as compared to the reference group. Conclusions HU and Mets are independent predictors of CKD and its individual components in patients with T2D.
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Flais J, Bardou-Jacquet E, Deugnier Y, Coiffier G, Perdriger A, Chalès G, Ropert M, Loréal O, Guggenbuhl P. Hyperferritinemia increases the risk of hyperuricemia in HFE-hereditary hemochromatosis. Joint Bone Spine 2016; 84:293-297. [PMID: 27659401 DOI: 10.1016/j.jbspin.2016.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/24/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Hyperuricemia is becoming increasingly frequent in the population, and is known to be sometimes the cause of gout. The impact of uric acid is still not clearly understood, however. The iron metabolism may interact with the uric acid metabolism. The aim of this study was to examine the relationship between the serum uric acid and serum ferritin levels in a cohort of hemochromatosis patients who were homozygous for the HFE p.Cys282Tyr mutation. METHODS 738 patients with the HFE gene mutation Cys282Tyr in the homozygous state were included in the study. The variables measured during the initial evaluation were compared in univariate analysis by Student's t test. In multivariate analysis, linear stepwise regression was used. RESULTS In the group of hyperuricemic patients, ferritinemia was significantly higher than in the group of non-hyperuricemic patients (1576.7±1387.4μg/l vs. 1095.63±1319.24μg/l, P<0.005). With multivariate analysis, only ferritin and BMI independently explained the uricemia (R2=0.258) after adjustment for age, glycemia and CRP. The correlation between uricemia and log(ferritin) with partial regression correlation coefficients was 0.307 (P<0.01). CONCLUSIONS The increase in uricemia is associated with the increase in ferritin in a population of patients who were homozygous for the HFE gene mutation p.Cys282Tyr and this independently of factors commonly associated with hyperuricemia. The increase in uric acid associated with hyperferritinemia, could be a response to the visceral toxicity of excess non-transferrin bound iron linked to oxidative stress via the antioxidant properties of uric acid.
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Affiliation(s)
- Jérémy Flais
- Rheumatology Department, Rennes University Hospital, 16, bd de Bulgarie, 35203 Rennes, France.
| | - Edouard Bardou-Jacquet
- INSERM UMR 991, 35000 Rennes, France; University Rennes 1, Medicine Faculty, 35043 Rennes, France; Reference Centre for Rare Genetic Iron Overload Disorders, Clinic for Liver Disorders, Rennes University Hospital, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Yves Deugnier
- University Rennes 1, Medicine Faculty, 35043 Rennes, France; Reference Centre for Rare Genetic Iron Overload Disorders, Clinic for Liver Disorders, Rennes University Hospital, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, Rennes University Hospital, 16, bd de Bulgarie, 35203 Rennes, France; University Rennes 1, Medicine Faculty, 35043 Rennes, France
| | - Aleth Perdriger
- Rheumatology Department, Rennes University Hospital, 16, bd de Bulgarie, 35203 Rennes, France; University Rennes 1, Medicine Faculty, 35043 Rennes, France
| | - Gérard Chalès
- Rheumatology Department, Rennes University Hospital, 16, bd de Bulgarie, 35203 Rennes, France; University Rennes 1, Medicine Faculty, 35043 Rennes, France
| | - Martine Ropert
- INSERM UMR 991, 35000 Rennes, France; Reference Centre for Rare Genetic Iron Overload Disorders, Clinic for Liver Disorders, Rennes University Hospital, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Olivier Loréal
- INSERM UMR 991, 35000 Rennes, France; Reference Centre for Rare Genetic Iron Overload Disorders, Clinic for Liver Disorders, Rennes University Hospital, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Pascal Guggenbuhl
- Rheumatology Department, Rennes University Hospital, 16, bd de Bulgarie, 35203 Rennes, France; INSERM UMR 991, 35000 Rennes, France; University Rennes 1, Medicine Faculty, 35043 Rennes, France
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Lioté F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016; 76:29-42. [DOI: 10.1136/annrheumdis-2016-209707] [Citation(s) in RCA: 817] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/14/2016] [Accepted: 06/29/2016] [Indexed: 12/22/2022]
Abstract
BackgroundNew drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.MethodsThe EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.ResultsThree overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.ConclusionsThese recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.
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New therapeutic approach to hyperuricemia and gout in the light of recommendations. Joint Bone Spine 2016; 83:376-80. [DOI: 10.1016/j.jbspin.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 12/27/2022]
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Jansen TL. Rational pharmacotherapy (RPT) in goutology: Define the serum uric acid target & treat-to-target patient cohort and review on urate lowering therapy (ULT) applying synthetic drugs. Joint Bone Spine 2015; 82:225-9. [DOI: 10.1016/j.jbspin.2014.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/06/2014] [Indexed: 10/23/2022]
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