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Legrand J, Marzin C, Neogi T, Norberciak L, Budzik JF, Pascart T. Associations of Changes in Knee Hyaline Cartilage Composition Measured With Dual-Energy Computed Tomography in Gout, Aging and Osteoarthritis. Cartilage 2024; 15:283-292. [PMID: 37312537 PMCID: PMC11418446 DOI: 10.1177/19476035231172152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout. DESIGN Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of interest were defined in the femorotibial hyaline cartilage. Five DECT parameters were obtained: CT numbers in Hounsfield units (HU) at 80 and 140 kV, the electron density (Rho), the effective atomic number (Zeff), and the dual-energy index (DEI). Zones were compared between patients with gout, with and without knee OA, and between patients with gout and comparators without gout, after adjustment for confounders. RESULTS A total of 113 patients with gout (mean age 63.5 ± 14.3 years) and 15 comparators without gout (mean age 75.8 ± 11.5 years) were included, n = 65 (51%) had knee OA, and 466 zones of hyaline cartilage were analyzed. Older age was associated with lower attenuations at 80 kV (P < 0.01) and 140 kV (P < 0.01), and with Rho (P < 0.01). OA was characterized by lower attenuation at 140 kV (P = 0.03), but the lower Rho was nonsignificant after adjustment for confounders. In gout, hyaline cartilage exhibited lower Rho values (adjusted P = 0.04). Multivariable coefficients of association with Rho were -0.21 [-0.38;-0.04] (P = 0.014) for age, -4.15 [-9.0;0.7] (P = 0.093) for OA and 0.73 [-0.1;1.56] (P = 0.085) for monosodium urate volume. CONCLUSION Gout was associated with DECT-detected changes in cartilage composition, similar to those observed in older patients, with some similarities and some differences to those seen in OA. These results suggest the possibility of potential DECT biomarkers of OA.
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Affiliation(s)
- Julie Legrand
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- Imaging Department, Saint-Philibert Hospital, Lomme, France
| | - Claire Marzin
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
| | - Tristan Pascart
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
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Buruian A, Angelo S, Seiça E, Fernandes F, Mendes A. Advanced Erosive Gouty Arthropathy of the Knee. Cureus 2024; 16:e51432. [PMID: 38298291 PMCID: PMC10828979 DOI: 10.7759/cureus.51432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
A 57-year-old male, with chronic bilateral knee pain and a history of poorly controlled hyperuricemia leading to gouty attacks, underwent orthopedic assessment. Radiographic and MRI findings confirmed chronic gouty arthropathy with erosive bony defects, the most significant on the right proximal tibia. Total knee arthroplasty (TKA) was performed without any complications, addressing the bony defect with cement and a semi-constrained prosthesis. However, a gouty attack led to prolonged wound discharge and periprosthetic infection postoperatively, prompting revision surgery with debridement, antibiotics, and implant retention (DAIR). Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus (MSSA). The treatment included vancomycin and rifampicin. Two years post-surgery, the patient walked pain-free with a knee range of motion of 0-90º. This report highlights the complexity of treating gout-related knee osteoarthritis, emphasizing early intervention to mitigate risks of extensive surgical procedures and infections.
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Affiliation(s)
- Alexei Buruian
- Orthopaedics and Trauma, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | - Susana Angelo
- Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | - Emanuel Seiça
- Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | - Fábio Fernandes
- Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | - António Mendes
- Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
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3
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The Effects of Gout Following total Knee Arthroplasty: A Retrospective Analysis. J Arthroplasty 2023:S0883-5403(23)00083-9. [PMID: 36764406 DOI: 10.1016/j.arth.2023.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The prevalence of gout is increasing along with the number of total knee arthroplasties (TKA) performed annually. The purpose of this study was to evaluate the incidence of gout following TKA in patients who had a previous history of gout and to determine if it is associated with an increased rate of postoperative joint complications. METHODS Patients who did and did not have a preoperative diagnosis of gout and underwent a primary TKA were identified from a national database. The gout patients were matched 1:1 to patients who did not have gout and rates of postoperative gout diagnoses within 2 years of surgery were compared. Complication rates at mean 1 and 2 years were then compared for both patient cohorts using multivariable logistic regressions. A total of 17,463 patients with a prior diagnosis of gout were matched with 17,463 controls. RESULTS There were 53.8% of patients who had previous gout and had a recurrence of gout within 2 years versus 3.6% of controls (Odds Ratios [OR]: 30.86). At mean 1-year, patients who had gout were significantly more likely to experience prosthetic joint infections (PJIs) and revision procedures. At mean 2 years, gout patients were at increased risk of prosthetic loosening, PJI, revision, and incision and debridement procedures. CONCLUSION This study suggests that patients who had a prior diagnosis of gout are significantly more likely to experience recurrent episodes of gout after TKA. Gout attacks after TKA are associated with an increase in the rate of joint complications. LEVEL OF EVIDENCE Level III.
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Go DJ, Kim DH, Kim JY, Guermazi A, Crema MD, Hunter DJ, Kim HA. Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study. Rheumatology (Oxford) 2021; 60:4581-4590. [PMID: 33493331 DOI: 10.1093/rheumatology/keab048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Emerging evidence suggests a potential link between OA and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout. METHODS In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren-Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models. RESULTS Serum UA levels were not associated with radiographic progression after adjusting for age, sex and BMI. There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70 per 1 mg/dl increase, 95% CI: 0.49, 0.98). CONCLUSION In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.
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Affiliation(s)
- Dong Jin Go
- Division of Rheumatology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul
| | - Dong Hyun Kim
- Department of Social and Preventive Medicine, Hallym Research Institute of Clinical Epidemiology, Hallym University, Chuncheon
| | - Jie Young Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang.,Institute for Skeletal Aging, Hallym University, Chuncheon, Republic of Korea
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Michel Daoud Crema
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang.,Institute for Skeletal Aging, Hallym University, Chuncheon, Republic of Korea
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Huang YY, Ye Z, Gu SW, Jiang ZY, Zhao L. The efficacy and tolerability of febuxostat treatment in a cohort of Chinese Han population with history of gout. J Int Med Res 2021; 48:300060520902950. [PMID: 32363973 PMCID: PMC7221481 DOI: 10.1177/0300060520902950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To measure the effect of febuxostat on the serum levels of uric acid (sUA)
and the proinflammatory cytokines interleukin (IL)-6, IL-17 and tumour
necrosis factor-α (TNF-α) in Chinese Han patients with gout and
hyperuricaemia. Methods This randomized, double-blind, placebo-controlled pilot study enrolled
patients with gout and hyperuricaemia (sUA ≥ 8 mg/dl). Patients were
randomized to receive either febuxostat 80 mg or placebo once daily for 24
weeks. The serum levels of sUA, IL-6, IL-17 and TNF-α were measured at weeks
0 (baseline), 2, 4, 8, 12, 16 and 24. Baseline clinical and demographic
characteristics were recorded for all patients. Results A total of 156 patients were randomized: placebo group
(n = 78) and febuxostat group (n = 78).
The febuxostat group showed a significantly greater reduction in sUA
compared with the placebo group. Serum uric acid concentration was reduced
below 8 mg/dl in 46 of 61 patients (75.4%) by week 24. There were also
reductions in the serum levels IL-6, IL-17 and TNF-α in the febuxostat
group. In the febuxostat group, 10 of 78 patients (12.82%) discontinued
treatment due to adverse drug reactions. Conclusion Febuxostat reduced the levels of sUA, TNF-α, IL-6 and IL-17, but there were
some side-effects.
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Affiliation(s)
- Yuan-Yuan Huang
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin Province, China.,Outpatient Department of Paediatrics, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhuang Ye
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - San-Wei Gu
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhen-Yu Jiang
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ling Zhao
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin Province, China.,The Laboratory of Biomedicine, Jilin University of Pharmaceutical Sciences, Changchun, Jilin Province, China
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Bradley AT, King CA, Cohen-Rosenblum A, Sculco PK, Landy DC. Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications. Knee 2021; 28:45-50. [PMID: 33296742 DOI: 10.1016/j.knee.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gout is a common synovial pathology, but its prevalence in patients undergoing total knee arthroplasty (TKA) and potential association with complications such as periprosthetic infection (PJI) and revision are unknown. METHODS Medicare data from 2009 to 2013 was retrospectively reviewed using PearlDiver. All patients 65 years of age or older and undergoing primary TKA with at least 3 years of pre-TKA records were included. The prevalence of gout was based on ICD-9 codes. Univariable associations of gout with PJI and revision at 1 year were assessed using odds ratios with 95% confidence intrervals (C.I.). To control for potential confounding, patients with a history of gout were matched on age, gender, smoking history, and Elixhauser Comorbidity Index (ECI) to patients without gout and associations reassessed. RESULTS The prevalence of gout in Medicare patients undergoing primary TKA was 5.7%. On univariable analysis, patients with a history of gout were more likely to develop PJI (O.R., 1.58; 95% C.I., 1.45-1.72) and undergo revision (O.R., 1.33; 95% C.I., 1.25-1.41) at 1 year. After matching for confounders, a history of gout was no longer associated with developing PJI (O.R., 0.98; 95% C.I., 0.90-1.06) or undergoing revision (O.R., 0.94; 95% C.I., 0.89-1.00) at 1 year. CONCLUSIONS Gout is a relatively common pathology in patients undergoing TKA. While gout is associated with increased complications, this appears to be driven by confounding through its association with other medical comorbidities. Gout does not appear to be an independent risk factor for complications following TKA.
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Affiliation(s)
- Alexander T Bradley
- University of Chicago Medicine, Department of Orthopaedic Surgery, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
| | - Connor A King
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA.
| | - Anna Cohen-Rosenblum
- Louisiana State University, Department of Orthopaedic Surgery, New Orleans, LA, USA.
| | - Peter K Sculco
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement Service, 535 East 70th Street, New York, NY 10021, USA.
| | - David C Landy
- University of Kentucky, Department of Orthopaedic Surgery, 740 S. Limestone, Lexington, KY, 40536, USA.
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Thuraisingam S, Dowsey M, Manski-Nankervis JA, Spelman T, Choong P, Gunn J, Chondros P. Developing prediction models for total knee replacement surgery in patients with osteoarthritis: Statistical analysis plan. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100126. [PMID: 36474876 PMCID: PMC9718256 DOI: 10.1016/j.ocarto.2020.100126] [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] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Approximately 12-20% of those with osteoarthritis (OA) in Australia who undergo total knee replacement (TKR) surgery do not report any clinical improvement. There is a need to develop prediction tools for use in general practice that allow early identification of patients likely to undergo TKR and those unlikely to benefit from the surgery. First-line treatment strategies can then be implemented and optimised to delay or prevent the need for TKR. The identification of potential non-responders to TKR may provide the opportunity for new treatment strategies to be developed and help ensure surgery is reserved for those most likely to benefit. This statistical analysis plan (SAP) details the statistical methodology used to develop such prediction tools. Objective To describe in detail the statistical methods used to develop and validate prediction models for TKR surgery in Australian patients with OA for use in general practice. Methods This SAP contains a brief justification for the need for prediction models for TKR surgery in general practice. A description of the data sources that will be linked and used to develop the models, and estimated sample sizes is provided. The planned methodologies for candidate predictor selection, model development, measuring model performance and internal model validation are described in detail. Intended table layouts for presentation of model results are provided. Conclusion Consistent with best practice guidelines, the statistical methodologies outlined in this SAP have been pre-specified prior to data pre-processing and model development.
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Key Words
- ABS, Australian Bureau of Statistics
- AIHW, Australian Institute of Health and Welfare
- AOANJRR, Australian Orthopaedic Association National Joint Replacement Registry
- ATC, Anatomical Therapeutic Chemical
- BMI, Body Mass Index
- CPT, clinical prediction tool
- Clinical prediction tools
- DQA, data quality assessment
- EMR, electronic medical record
- Electronic health record
- Electronic medical record
- GP, General Practitioner
- General practice
- KOS-ADLS, Knee Outcome Survey-Activities of Daily Living Subscale
- Knee replacement
- NDI, National Death Index
- NPS, National Prescribing Service
- OA, osteoarthritis
- OARSI, Osteoarthritis Research Society International
- OMERACT, Outcome Measures in Rheumatology
- Prediction models
- Primary care
- SAP, statistical analysis plan
- SF-12, 12-Item Short Form Survey
- SF-36, 36-Item Short Form Health Survey
- Statistical analysis plan
- TKR, total knee replacement
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Affiliation(s)
- Sharmala Thuraisingam
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, Victoria 3065, Australia
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, Victoria 3065, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, Victoria 3010, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Karolinska Institute, Solnavagen 1, 171 77 Solna, Sweden
| | - Peter Choong
- Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy, Victoria 3065, Australia
| | - Jane Gunn
- Faculty of Medicine Dentistry & Health Sciences, Level 2, Alan Gilbert Building, Carlton, Victoria 3053, Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Parkville, Victoria 3010, Australia
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Zhu J, Wang Y, Chen Y, Li X, Yang Z, Li H. Association between hyperuricemia, gout, urate lowering therapy, and osteoarthritis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21610. [PMID: 32872016 PMCID: PMC7437763 DOI: 10.1097/md.0000000000021610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA), a chronic and degenerative joint disease characterized by articular cartilage degeneration, sclerosis of subchondral bone, and osteophyte formation, is deemed a leading cause of activity limitation and disability among the elderly people. Serum uric acid (UA) is a terminal metabolite of purine compound, while hyperuricemia (HU) and UA crystals are recognized causes of gout. Several studies have investigated the correlations between HU, gout and OA, but the findings are inconclusive. We are also concerned whether the urate lowering therapy (ULT) can become a potential treatment for OA and intend to undertake this meta-analysis to clarify the related hypotheses. METHODS Systematic literature search will be conducted on PubMed, Embase, and Web of Science to identify relevant studies up to February 2020 using appropriate search strategies. All citations and abstracts retrieved from literature search will be assessed by two reviewers independently. The Newcastle-Ottawa Scale or the Cochrane risk of bias assessment tool will be used as appropriate to assess the quality and the risk of bias of the included studies. The heterogeneity and the publication bias of the studies will be investigated accordingly. RESULTS We propose to undertake this meta-analysis as a feasible approach to clarify the associations between HU, gout or ULT, and OA. DISCUSSIONS This meta-analysis will help to strengthen our knowledge of the pathogenesis of OA and promote the development of preventive or treatment strategies. REGISTRATION PROSPERO registration number CRD42020168769.
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Affiliation(s)
- Junyu Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University
| | - Yuhao Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury
| | - Zidan Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University
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Neogi T, Krasnokutsky S, Pillinger MH. Urate and osteoarthritis: Evidence for a reciprocal relationship. Joint Bone Spine 2019; 86:576-582. [PMID: 30471419 PMCID: PMC6531371 DOI: 10.1016/j.jbspin.2018.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/17/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
Hyperuricemia is a common condition, and in a subset of patients leads to gout, the most common inflammatory arthritis. Osteoarthritis is the most common form of arthritis overall, and gout and osteoarthritis frequently coexist in the same patient. However, the relationship between the two remains poorly defined. More particularly, the impact of osteoarthritis on the development of gout, and the impact of gout on the development of osteoarthritis, remain to be determined. Additionally, whether hyperuricemia mediates osteoarthritis in the absence of gout is uncertain. Here, we review the evidence linking gout and osteoarthritis, with a special focus on the role of hyperuricemia in the presence or absence of gout. Since disease modifying agents are currently available for hyperuricemia and gout but not for osteoarthritis, a contributory role for urate in the pathogenesis of osteoarthritis could have important clinical implications.
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Affiliation(s)
- Tuhina Neogi
- Sections of Clinical Epidemiology and Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Svetlana Krasnokutsky
- Rheumatology Section, Department of Medicine, New York Harbor Health Care System, New York Campus, US Department of Veterans Affairs, New York, NY, 10003, USA; Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine/NYU Langone Health, New York, NY, 10016, USA
| | - Michael H Pillinger
- Rheumatology Section, Department of Medicine, New York Harbor Health Care System, New York Campus, US Department of Veterans Affairs, New York, NY, 10003, USA; Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine/NYU Langone Health, New York, NY, 10016, USA; NYU Langone Orthopedic Hospital, 301 East 17th Street, Suite 1410, New York, NY 10003, USA.
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10
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Wang S, Pillinger MH, Krasnokutsky S, Barbour KE. The association between asymptomatic hyperuricemia and knee osteoarthritis: data from the third National Health and Nutrition Examination Survey. Osteoarthritis Cartilage 2019; 27:1301-1308. [PMID: 31158484 PMCID: PMC6702067 DOI: 10.1016/j.joca.2019.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/02/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In vitro and clinical studies suggest that urate may contribute to osteoarthritis (OA) risk. We tested the associations between hyperuricemia and knee OA, and examined the role of obesity, using a cross-sectional, nationally representative dataset. METHOD National Health and Nutrition Examination Survey (NHANES) III used a multistage, stratified probability cluster design to select USA civilians from 1988 to 1994. Using NHANES III we studied adults >60 years, with or without hyperuricemia (serum urate > 6.8 mg/dL), excluding individuals with gout (i.e., limiting to asymptomatic hyperuricemia (AH)). Radiographic knee OA (RKOA) was defined as Kellgren-Lawrence grade ≥ 2 in any knee, and symptomatic radiographic knee osteoarthritis (RKOA) (sRKOA) was defined as RKOA plus knee pain (most days for 6 weeks) in the same knee. RESULTS AH prevalence was 17.9% (confidence interval (CI) 15.3-20.5). RKOA prevalence was 37.7% overall (CI 35.0-40.3), and was 44.0% for AH vs 36.3% for normouricemic adults (p = 0.056). symptomatic radiographic knee osteoarthritis (sRKOA) was more prevalent in AH vs normouricemic adults (17.4% vs 10.9%, p = 0.046). In multivariate models adjusting for obesity, model-based associations between AH and knee OA were attenuated (for RKOA, prevalence ratio (PR) = 1.14, 95% CI 0.95, 1.36; for sRKOA, PR = 1.40, 95% CI 0.98, 2.01). In stratified multivariate analyses, AH was associated with sRKOA in adults without obesity (PR = 1.66, 95% CI 1.02, 2.71) but not adults with obesity (PR = 1.21, 95% CI 0.66, 2.23). CONCLUSIONS Among adults aged 60 or older, AH is associated with knee OA risk that is more apparent in adults without obesity.
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Affiliation(s)
- Shudan Wang
- Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY,Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA,VA New York Harbor Health Care System, New York Campus, New York, NY, USA
| | - Michael H. Pillinger
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA,VA New York Harbor Health Care System, New York Campus, New York, NY, USA
| | - Svetlana Krasnokutsky
- Crystal Diseases Study Group, Division of Rheumatology, New York University School of Medicine, New York, NY, USA
| | - Kamil E. Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fernández-Torres J, Martínez-Nava GA, Oliviero F, López-Reyes AG, Martínez-Flores K, Garrido-Rodríguez D, Francisco-Balderas A, Zamudio-Cuevas Y. Common gene variants interactions related to uric acid transport are associated with knee osteoarthritis susceptibility. Connect Tissue Res 2019; 60:219-229. [PMID: 29855200 DOI: 10.1080/03008207.2018.1483359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of genetic variants in uric acid (UA) transporters can be associated with hyperuricemia, and therefore with an increased risk of monosodium urate (MSU) crystal precipitation. The inflammatory process triggered by these crystals leads to cartilage damage, which, in turn, could promote knee osteoarthritis (KOA). OBJECTIVE To determine whether genetic polymorphisms of the UA transporters and their interactions are associated with KOA. MATERIALS AND METHODS Two hundred forty-three unrelated Mexican-mestizo individuals were recruited for this case-control study. Ninety-three of them were KOA patients but without gout, and one hundred and fifty healthy individuals with no symptoms or signs of KOA were recruited as controls. Forty-one single-nucleotide polymorphisms (SNPs) involved in the UA transporters were genotyped with OpenArray technology in a QuantStudio 12K flex-System with both cases and controls. RESULTS After adjusting by age, gender, BMI, and ancestry, significant associations were found for eight SNPs: rs1260326 (GCKR), rs780093 (GCKR), rs17050272 (INHBB), rs1471633 (PDZK1), rs12129861 (PDZK1), rs7193778 (IGF1R), rs17786744 (STC1), and rs1106766 (R3HDM2). With respect to gene-gene interactions, the pairwise interactions of rs112129861 (PDZK1) and rs7193778 (IGF1R); rs17050272 (INHBB) and rs1106766 (R3HDM2); rs1106766 (R3HDM2) and rs780093 (GCKR); rs1260326 (GCKR) and rs17786744 (STC1); and rs17786744 (STC1) and rs1106766 (R3HDM2) make it possible to visualize the synergistic or antagonistic effect of their genotypes or alleles on KOA development. CONCLUSIONS Our preliminary results show that the common gene variants related to UA transport are associated with KOA in the Mexican population. Further studies must be carried out to corroborate it.
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Affiliation(s)
- Javier Fernández-Torres
- a Musculoskeletal and Rheumatic Diseases Division , Synovial Fluid Laboratory, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" , Mexico City , Mexico
| | - Gabriela Angélica Martínez-Nava
- a Musculoskeletal and Rheumatic Diseases Division , Synovial Fluid Laboratory, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" , Mexico City , Mexico
| | - Francesca Oliviero
- b Rheumatology Unit, Department of Medicine - DIMED , University of Padova , Padova , Italy
| | - Alberto Gabriel López-Reyes
- a Musculoskeletal and Rheumatic Diseases Division , Synovial Fluid Laboratory, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" , Mexico City , Mexico
| | - Karina Martínez-Flores
- a Musculoskeletal and Rheumatic Diseases Division , Synovial Fluid Laboratory, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" , Mexico City , Mexico
| | - Daniela Garrido-Rodríguez
- c CIENI , Center for Research in Infectious Diseases, National Institute of Respiratory Diseases , Mexico City , Mexico
| | - Adriana Francisco-Balderas
- d Graduate Studies Department , Escuela Superior de Medicina, Instituto Politécnico Nacional. Salvador Díaz Mirón esq. Plan de San Luis S/N, Miguel Hidalgo, Casco de Santo Tomas , Mexico City , Mexico
| | - Yessica Zamudio-Cuevas
- a Musculoskeletal and Rheumatic Diseases Division , Synovial Fluid Laboratory, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" , Mexico City , Mexico
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12
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Checa A. Consistency of the Sonographic Image (Double Contour Sign) in Patients with Gout after Ambulation. J Med Ultrasound 2019; 27:40-42. [PMID: 31031534 PMCID: PMC6445031 DOI: 10.4103/jmu.jmu_77_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/08/2018] [Indexed: 11/04/2022] Open
Abstract
The aim of this study was to know whether or not any crystal shedding occurs after ambulation in patients with gout and how it affects the consistency of the sonographic image of crystal deposition on hyaline cartilage. A total of 18 consecutive patients (29 knees), 11 with early gout (17 knees) and seven with chondrocalcinosis (12 knees), were prospectively scanned by ultrasound. Examination at rest and after ambulation was performed in each patient. Crystal aggregates were measured in a transverse view. Crystal shedding after ambulation was noted in two patients (two knees) with gout. However, crystal deposits on the surface of the articular cartilage in gout kept invariable size. In patients with chondrocalcinosis, crystal shedding by ambulation was absent. The conclusion of this study is that the size of crystal deposits on the hyaline cartilage in gout and chondrocalcinosis assessed by ultrasound is not modifiable by ambulation.
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Affiliation(s)
- Angel Checa
- Lourdes Medical Center of Burlington County, Endoscopy Unit, Willingboro, New Jersey, USA.,Former Research Faculty of the Division of Rheumatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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13
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Singh JA, Cleveland JD. Gout is associated with increased healthcare utilization after knee arthroplasty. Ann Rheum Dis 2019; 78:1146-1148. [DOI: 10.1136/annrheumdis-2018-214934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/20/2019] [Indexed: 12/25/2022]
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Singh JA, Cleveland JD. Gout and healthcare utilization and complications after hip arthroplasty: a cohort study using the US National Inpatient Sample (NIS). Clin Rheumatol 2019; 38:1213-1216. [PMID: 30671748 DOI: 10.1007/s10067-019-04434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/30/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
Little is known about the effect of gout on in-hospital complications and healthcare utilization after total hip arthroplasty (THA). We used the 1998-2014 U.S. National Inpatient Sample (NIS) to examine this question using cohort study design. Multivariable-adjusted Cox regression analyses included age, race, gender, underlying diagnosis, Deyo-Romano comorbidity index, insurance payer, and income. In adjusted analyses, we found that gout was associated with 9-20% higher healthcare utilization and 6% higher hazard of transfusion after primary THA. These findings can inform surgeons and patients of gout-associated complications post-THA.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA. .,Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. .,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA.
| | - John D Cleveland
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA
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15
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George J, Jawad M, Curtis GL, Samuel LT, Klika AK, Barsoum WK, Higuera CA. Utility of Serological Markers for Detecting Persistent Infection in Two-Stage Revision Arthroplasty in Patients With Inflammatory Arthritis. J Arthroplasty 2018; 33:S205-S208. [PMID: 29395719 DOI: 10.1016/j.arth.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used for the diagnosis of persistence of infection after the first stage of 2-stage revision arthroplasty for periprosthetic joint infection (PJI). As both ESR and CRP are markers of systemic inflammation, the utility of these tests to monitor infection clearance in patients with inflammatory arthritis is unclear. METHODS From 2001 to 2016, 44 two-stage revision total hip or knee arthroplasties in patients with an inflammatory arthritis diagnosed by a rheumatologist were identified. Persistence of infection at the time of planned second stage was defined as satisfying the Musculoskeletal Infection Society criteria for PJI (14 infected, 30 noninfected). ESR and CRP values were compared between the stages using nonparametric tests. Receiver operating characteristic analysis was performed to obtain the diagnostic parameters. RESULTS ESR and CRP decreased between the stages in the noninfected group (ESR: mean decrease = 31.6 mm/h [19.2-44.0], P < .001; CRP: mean decrease = 5.2 mg/dL [2.1-8.2], P < .001), but remained elevated in the infected group (ESR: mean decrease = 7.7 [-23.1 to 36.6], P = .572; CRP: mean decrease = 1.5 [-2.2 to 5.1], P = .258). Optimal thresholds for persistent infection were 29.5 mm/h and 2.8 mg/dL, respectively, for ESR and CRP. The sensitivity and specificity at the optimal thresholds were 64% and 77% for ESR, and 64% and 90% for CRP. CONCLUSION ESR and CRP responded to the treatment of PJI in patients with inflammatory arthritis and had reasonably high specificities with moderate sensitivities. ESR and CRP appear to be useful tools in diagnosing persistent infection even in patients with inflammatory arthritis.
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Affiliation(s)
- Jaiben George
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael Jawad
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Gannon L Curtis
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Linsen T Samuel
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Wael K Barsoum
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
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16
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George J, Zhang Y, Jawad M, Faour M, Klika AK, Bauer TW, Higuera CA. Diagnostic Utility of Histological Analysis for Detecting Ongoing Infection During Two-Stage Revision Arthroplasty in Patients With Inflammatory Arthritis. J Arthroplasty 2018; 33:S219-S223. [PMID: 29352690 DOI: 10.1016/j.arth.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis. METHODS From 2001 to 2016, 47 planned second-stage revision total hip arthroplasty and total knee arthroplasty in patients with inflammatory arthritis were identified. Revisions were classified as having persistent infection if they were Musculoskeletal Infection Society positive at the time of second stage. PS or FS was considered to be positive for infection when at least one of the specimens demonstrated an acute inflammation. Receiver operating characteristic analysis was performed to obtain the diagnostic parameters. RESULTS There were 9 (19%) persistent infections. Both PS and FS had very high specificity (PS = FS = 94.7%). Sensitivity of PS was higher than FS, although not statistically significant (PS = 88.9%, FS = 55.6%, P = .083). Overall, PS had a better diagnostic utility than FS (area under the curve: PS vs FS = 0.92 vs 0.75, P = .045). Four specimens had discrepancies between PS and FS histology. In all 4 instances, the specimens were read as positive (infected) by PS, but negative by FS. CONCLUSION Histological analysis is recommended at the time of re-implantation surgery even in patients with inflammatory arthritis. PS had a better diagnostic utility than FS suggesting that areas of acute inflammation may be scattered and may not always be captured in the specimens taken for FS.
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Affiliation(s)
- Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Yaxia Zhang
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Michael Jawad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Mhamad Faour
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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Ma CA, Leung YY. Exploring the Link between Uric Acid and Osteoarthritis. Front Med (Lausanne) 2017; 4:225. [PMID: 29326934 PMCID: PMC5733531 DOI: 10.3389/fmed.2017.00225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/27/2017] [Indexed: 01/11/2023] Open
Abstract
Both gout and osteoarthritis (OA) are common forms of arthritis that inflict a huge burden to an aging population with the increasing prevalence of obesity. Clinicians have long observed the link between these two conditions. In this review, we summarize the evidence from epidemiologic and immunological studies that described the possible relationship between the two conditions. The recent new understanding on monosodium uric acid crystal-induced inflammation has given insight into probable shared pathogenesis pathways for both conditions. We describe the potential therapeutic implications, particularly regarding the possibility of repurposing traditional gout medications for use in OA.
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Affiliation(s)
| | - Ying Ying Leung
- Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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