1
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Song S, Cai X, Hu J, Zhu Q, Shen D, Ma H, Zhang Y, Ma R, Zhou P, Yang W, Hong J, Zhang D, Li N. Plasma aldosterone concentrations elevation in hypertensive patients: the dual impact on hyperuricemia and gout. Front Endocrinol (Lausanne) 2024; 15:1424207. [PMID: 39140032 PMCID: PMC11319118 DOI: 10.3389/fendo.2024.1424207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024] Open
Abstract
Background Prior research has highlighted the association between uric acid (UA) and the activation of the renin-angiotensin-aldosterone system (RAAS). However, the specific relationship between aldosterone, the RAAS's end product, and UA-related diseases remains poorly understood. This study aims to clarify the impact of aldosterone on the development and progression of hyperuricemia and gout in hypertensive patients. Methods Our study involved 34534 hypertensive participants, assessing plasma aldosterone concentration (PAC)'s role in UA-related diseases, mainly hyperuricemia and gout. We applied multiple logistic regression to investigate the impact of PAC and used restricted cubic splines (RCS) for examining the dose-response relationship between PAC and these diseases. To gain deeper insights, we conducted threshold analyses, further clarifying the nature of this relationship. Finally, we undertook subgroup analyses to evaluate PAC's effects across diverse conditions and among different subgroups. Results Multivariate logistic regression analysis revealed a significant correlation between the occurrence of hyperuricemia and gout and the elevation of PAC levels. Compared to the first quartile (Q1) group, groups Q2, Q3, and Q4 all exhibited a significantly increased risk of occurrence. Moreover, the conducted RCS analysis demonstrated a significant nonlinear dose-response relationship, especially when PAC was greater than 14 ng/dL, with a further increased risk of hyperuricemia and gout. Finally, comprehensive subgroup analyses consistently reinforced these findings. Conclusion This study demonstrates a close association between elevated PAC levels and the development of UA-related diseases, namely hyperuricemia and gout, in hypertensive patients. Further prospective studies are warranted to confirm and validate this relationship.
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Affiliation(s)
- Shuaiwei Song
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Xintian Cai
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Junli Hu
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Qing Zhu
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Di Shen
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Huimin Ma
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Yingying Zhang
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Rui Ma
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Pan Zhou
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Wenbo Yang
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Jing Hong
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Delian Zhang
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Nanfang Li
- Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
- NHC Key Laboratory of Hypertension Clinical Research, Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
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2
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Sansone A, Reisman Y, Jannini EA. Relationship between hyperuricemia with deposition and sexual dysfunction in males and females. J Endocrinol Invest 2022; 45:691-703. [PMID: 34997558 PMCID: PMC8741558 DOI: 10.1007/s40618-021-01719-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The association between gout, the most common crystal arthropathy, and sexual dysfunctions has often been investigated by studies in the last decades. Despite the presence of shared risk factors and comorbidities and the possible effects on sexual health of long-term gout complications, awareness of this association is severely lacking and the pathogenetic mechanisms have only partially been identified. In the present review, we aimed to investigate the current evidence regarding the potential mechanisms linking sexual dysfunctions and gout. METHODS A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the association between gout and sexual dysfunctions. RESULTS Gout and sexual dysfunctions share several risk factors, including diabesity, chronic kidney disease, hypertension, metabolic syndrome, and peripheral vascular disease. Gout flares triggered by intense inflammatory responses feature severe pain and disability, resulting in worse sexual function, and some, but not all, treatments can also impair sexual health. Long-term gout complications can result in persistent pain and disability due to joint deformity, fractures, or nerve compression, with negative bearing on sexual function. The presence of low-grade inflammation impairs both sex steroids synthesis and endothelial function, further advancing sexual dysfunctions. The psychological burden of gout is another issue negatively affecting sexual health. CONCLUSIONS According to currently available evidence, several biological and psychological mechanisms link sexual dysfunctions and gout. Addressing risk factors and providing adequate treatment could potentially have beneficial effects on both conditions. Appropriate clinical evaluation and multidisciplinary approach are recommended to improve patient care.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Y Reisman
- Flare-Health, Amstelveen, The Netherlands
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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3
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Zha X, Yang B, Xia G, Wang S. Combination of Uric Acid and Pro-Inflammatory Cytokines in Discriminating Patients with Gout from Healthy Controls. J Inflamm Res 2022; 15:1413-1420. [PMID: 35250292 PMCID: PMC8896041 DOI: 10.2147/jir.s357159] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/21/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Xuwen Zha
- Department of Rheumatology and Immunology, The First People's Hospital of Hefei, Binhu Hospital of Hefei, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Bo Yang
- Department of Burn & Plastic Surgery, The First People's Hospital of Hefei, Binhu Hospital of Hefei, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
| | - Guangyun Xia
- Department of Rheumatology and Immunology, The First People's Hospital of Hefei, Binhu Hospital of Hefei, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
- Correspondence: Guangyun Xia; Shan Wang, Department of Rheumatology and Immunology, The First People's Hospital of Hefei, Binhu Hospital of Hefei, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China, Email ;
| | - Shan Wang
- Department of Rheumatology and Immunology, The First People's Hospital of Hefei, Binhu Hospital of Hefei, The Third Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
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4
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Wang J, Zhang L, Rao J, Yang L, Yang X, Liao F. Design of Bacillus fastidious Uricase Mutants Bearing Long Lagging Phases Before Exponential Decreases of Activities Under Physiological Conditions. Protein J 2021; 40:765-775. [PMID: 34014494 DOI: 10.1007/s10930-021-09999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Under physiological conditions, Bacillus fastidious uricase (BFU) activity shows negligible lagging phase before the exponential decrease; mutants are thus designed for long lagging phases before exponential activity decreases. On homodimer surface of BFU (4R8X.pdb), the last fragment ANSEYVAL at the C-terminus forms a loop whose Y319 is H-bonded by the buried D257 in the same monomer. Within 1.5 nm from the α-carboxyl group of the last leucine (L322), E30, K26, D257, R258, E311, K312 and E318 from the same monomer plus D126 and K127 from a monomer of the other homodimer generate an electrostatic interaction network. Within 1.5 nm from Y319, D307 and R310 in the same monomer interact with ionized residues around the inter-chain β-sheet in the same homodimer. Mutagenesis of Y319R is designed to strengthen the original interactions and concomitantly generate new electrostatic attractions between homodimers. Under physiological conditions, the mutant V144A/Y319R showed an approximately 4 week lagging phase before the exponential activity decrease, an apparent half-life of activity nearly three folds of mutant V144A, but comparable activity. The introduction of ionizable residues into the C-terminus contacting the other homodimer for additional and/or stronger electrostatic attractions between homodimers may be a universal approach to thermostable mutants of uricases.
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Affiliation(s)
- Jiaqi Wang
- Chongqing Key Laboratory of Medicinal Chemistry & Molecular Pharmacology, Chongqing University of Technology, Chongqing, 400054, China.,School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Luyao Zhang
- Chongqing Key Laboratory of Medicinal Chemistry & Molecular Pharmacology, Chongqing University of Technology, Chongqing, 400054, China.,School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Jingjing Rao
- Key Laboratory of Medical Laboratory Diagnostics of the Education Ministry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Li Yang
- Chongqing Key Laboratory of Medicinal Chemistry & Molecular Pharmacology, Chongqing University of Technology, Chongqing, 400054, China.,School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Xiaolan Yang
- Key Laboratory of Medical Laboratory Diagnostics of the Education Ministry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China.
| | - Fei Liao
- Chongqing Key Laboratory of Medicinal Chemistry & Molecular Pharmacology, Chongqing University of Technology, Chongqing, 400054, China. .,School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China. .,Key Laboratory of Medical Laboratory Diagnostics of the Education Ministry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China.
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5
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Huo S, Wang H, Yan M, Xu P, Song T, Li C, Tian R, Chen X, Bao K, Xie Y, Xu P, Zhu W, Liu F, Mao W, Shao C. Urinary Proteomic Characteristics of Hyperuricemia and Their Possible Links with the Occurrence of Its Concomitant Diseases. ACS OMEGA 2021; 6:9500-9508. [PMID: 33869930 PMCID: PMC8047722 DOI: 10.1021/acsomega.0c06229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Hyperuricemia (HUA), a chronic disease caused by metabolic disorders of purine, is often accompanied by other diseases such as gout, type 2 diabetes mellitus (T2DM), and hyperlipidemia. However, little is known about the relationship between HUA and these diseases on the protein level. We performed label-free liquid chromatography MS/MS spectrometry analysis of urine samples from 26 HUA patients and 25 healthy controls, attempting to establish the possible protein links between HUA and these diseases by profiling urine proteome. A total of 2119 proteins were characterized in sample proteomes. Among them, 11 were found decreased and 2 were found increased in HUA samples. Plausible pathways found by enrichment analysis of these differentially expressed proteins (DEPs) include the processes for insulin receptor recycling and lipid metabolism, suggesting potential links between HUA and T2DM and hyperlipidemia. The abundance changes of three key proteins (VATB1, CFAD, and APOC3) involved in these processes were validated by enzyme-linked immunosorbent assay (ELISA). In conclusion, our result provides proteomic evidence, for the first time, that the aberrant pathways enriched by described key DEPs are closely related to the incidence of HUA and its concomitant diseases.
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Affiliation(s)
- Shuai Huo
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Henan Provincial People’s
Hospital, Department of Nephrology of Central China Fuwai Hospital, Zhengzhou, Henan 450003, China
| | - Hongxin Wang
- State
Key Laboratory of Proteomics, Beijing Proteome Research Center, National
Center for Protein Sciences (Beijing), Beijing
Institute of Lifeomics, Beijing 102206, China
- Key
Laboratory of Zoological Systematics and Application of Hebei Province,
College of Life Sciences, Hebei University, Baoding 071002, China
| | - Meixia Yan
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
| | - Peng Xu
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Guangdong Provincial Hospital
of Chinese Medicine, Guangzhou 510120, China
- Guangdong
Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
- Guangdong
Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment
of Refractory Chronic Diseases, Department of Pediatrics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Tingting Song
- State
Key Laboratory of Proteomics, Beijing Proteome Research Center, National
Center for Protein Sciences (Beijing), Beijing
Institute of Lifeomics, Beijing 102206, China
| | - Chuang Li
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Guangdong Provincial Hospital
of Chinese Medicine, Guangzhou 510120, China
- Guangdong
Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
- Guangdong
Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment
of Refractory Chronic Diseases, Department of Pediatrics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Ruimin Tian
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Guangdong Provincial Hospital
of Chinese Medicine, Guangzhou 510120, China
- Guangdong
Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
- Guangdong
Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment
of Refractory Chronic Diseases, Department of Pediatrics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Xiaoling Chen
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
| | - Kun Bao
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Guangdong Provincial Hospital
of Chinese Medicine, Guangzhou 510120, China
- Guangdong
Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
- Guangdong
Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment
of Refractory Chronic Diseases, Department of Pediatrics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Ying Xie
- State
Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau (SAR) 999078, China
| | - Ping Xu
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- State
Key Laboratory of Proteomics, Beijing Proteome Research Center, National
Center for Protein Sciences (Beijing), Beijing
Institute of Lifeomics, Beijing 102206, China
- Key
Laboratory of Zoological Systematics and Application of Hebei Province,
College of Life Sciences, Hebei University, Baoding 071002, China
| | - Weimin Zhu
- State
Key Laboratory of Proteomics, Beijing Proteome Research Center, National
Center for Protein Sciences (Beijing), Beijing
Institute of Lifeomics, Beijing 102206, China
| | - Fengsong Liu
- Key
Laboratory of Zoological Systematics and Application of Hebei Province,
College of Life Sciences, Hebei University, Baoding 071002, China
| | - Wei Mao
- State
Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University
of Chinese Medicine, Guangzhou 510120, China
- The
Second Clinical Medical College, Guangzhou
University of Chinese Medicine,Guangzhou 510405, China
- Department
of Nephrology, Guangdong Provincial Hospital
of Chinese Medicine, Guangzhou 510120, China
- Guangdong
Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China
| | - Chen Shao
- State
Key Laboratory of Proteomics, Beijing Proteome Research Center, National
Center for Protein Sciences (Beijing), Beijing
Institute of Lifeomics, Beijing 102206, China
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6
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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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Abstract
Gout is a chronic disease caused by monosodium urate (MSU) crystal deposition. Gout typically presents as an acute, self-limiting inflammatory monoarthritis that affects the joints of the lower limb. Elevated serum urate level (hyperuricaemia) is the major risk factor for MSU crystal deposition and development of gout. Although traditionally considered a disorder of purine metabolism, altered urate transport, both in the gut and the kidneys, has a key role in the pathogenesis of hyperuricaemia. Anti-inflammatory agents, such corticosteroids, NSAIDs and colchicine, are widely used for the treatment of gout flare; recognition of the importance of NLRP3 inflammasome activation and bioactive IL-1β release in initiation of the gout flare has led to the development of anti-IL-1β biological therapy for gout flares. Sustained reduction in serum urate levels using urate-lowering therapy is vital in the long-term management of gout, which aims to dissolve MSU crystals, suppress gout flares and resolve tophi. Allopurinol is the first-line urate-lowering therapy and should be started at a low dose, with gradual dose escalation. Low-dose anti-inflammatory therapies can reduce gout flares during initiation of urate-lowering therapy. Models of care, such as nurse-led strategies that focus on patient engagement and education, substantially improve clinical outcomes and now represent best practice for gout management.
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8
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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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9
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Scirè CA, Rossi C, Punzi L, Genderini A, Borghi C, Grassi W. Change gout: how to deal with this "silently-developing killer" in everyday clinical practice. Curr Med Res Opin 2018; 34:1411-1417. [PMID: 29553292 DOI: 10.1080/03007995.2018.1454896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging. REVIEW This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient's risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout. CONCLUSIONS Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.
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Affiliation(s)
- Carlo Alberto Scirè
- a Epidemiology Unit , Italian Society for Rheumatology , Milan , Italy
- b Rheumatology Unit, Department of Medical Sciences , University of Ferrara , Italy
| | - Cristina Rossi
- c Italian College of General Practitioners and Primary Care , La Spezia , Italy
| | - Leonardo Punzi
- d Rheumatology Unit, Department of Medicine DIMED , University of Padova , Italy
| | - Augusto Genderini
- e Unit of Nephrology and Dialysis , Luigi Sacco University Hospital-Campus , Milan , Italy
| | - Claudio Borghi
- f Ospedale Policlinico S.Orsola-Malpighi , University of Bologna , Bologna , Italy
| | - Walter Grassi
- g Clinica Reumatologica , Università Politecnica delle Marche , Ancona , Italy
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Réplica a «Tratamiento de la hiperuricemia asintomática». Rev Clin Esp 2017; 217:244. [DOI: 10.1016/j.rce.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/20/2022]
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Puig JG, Beltrán LM, Mejía-Chew C, Tevar D, Torres RJ. Ultrasonography in the diagnosis of asymptomatic hyperuricemia and gout. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2017; 35:517-523. [PMID: 27906639 DOI: 10.1080/15257770.2015.1124999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sonography has detected urate deposits in 34%-42% of the patients with asymptomatic hyperuricemia. This may prompt reclassification of asymptomatic hyperuricemia into "asymptomatic gout" and consideration of urate lowering therapy (ULT) to resolve urate deposits. In patients with gout and no visible tophi, sonography has detected urate deposits in half of the patients. This may allow diagnosing "tophaceous gout" and influencing the serum urate target level, prophylaxis to avoid acute gout flares during ULT, and clinical follow-up. Current accessibility to sonography may better classify patients with hyperuricemia and gout and contribute to delineate therapeutic objectives and clinical guidance.
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Affiliation(s)
- J G Puig
- a Metabolic-Vascular Unit, Division of Internal Medicine , Madrid , Spain
| | - L M Beltrán
- a Metabolic-Vascular Unit, Division of Internal Medicine , Madrid , Spain
| | - C Mejía-Chew
- a Metabolic-Vascular Unit, Division of Internal Medicine , Madrid , Spain
| | - D Tevar
- a Metabolic-Vascular Unit, Division of Internal Medicine , Madrid , Spain
| | - R J Torres
- b Clinical Investigator, Hospital Universitario La Paz , IdiPAZ, Madrid , Spain
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García Puig J, Beltrán L, Mejía Chew C, Torres R, Tebar Márquez D, Pose Reino A. Ultrasound in the diagnosis of asymptomatic hyperuricemia and gout. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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García Puig J, Beltrán L, Mejía Chew C, Torres R, Tebar Márquez D, Pose Reino A. La ecografía en el diagnóstico de la hiperuricemia asintomática y la gota. Rev Clin Esp 2016; 216:445-450. [DOI: 10.1016/j.rce.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/02/2023]
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Benchmark dose of alcohol consumption for development of hyperuricemia in Japanese male workers: An 8-year cohort study. Alcohol 2016; 56:9-14. [PMID: 27814794 DOI: 10.1016/j.alcohol.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND To estimate the benchmark dose (BMD) and their 95% lower confidence limits (BMDL) of alcohol consumption as the reference level for the development of hyperuricemia based on the dose-response relationship. METHODS An 8-year prospective cohort study was conducted in 8097 male workers at a Japanese steel company who received annual health check-ups between 2002 and 2009. The endpoints for development of hyperuricemia were defined as a uric acid ≥7 mg/dL or taking any anti-hyperuricemic medication. The dose-response relationship of alcohol consumption was investigated using multivariate-pooled logistic regression analyses adjusted for other potential covariates. We estimated the BMD and BMDL of alcohol consumption for the development of hyperuricemia, using the parameters obtained by pooled logistic regression with a benchmark response (BMR) of 5% or 10%. RESULTS Mean observed years per person was 3.86 years. The incidence rate per 1000 person-years was 61.1. The odds ratio calculated for the development of hyperuricemia was 1.29 [95% confidence interval, (1.22-1.36)] with an increase in alcohol consumption per 1 gou/day (1 gou/day = alcohol 22 g/day). The estimated BMDL/BMD with a BMR of 5% was 2.5/2.8 gou/day (54.5/61.8 g/day) and with a BMR of 10% was 4.0/4.6 gou/day (88.9/100.9 g/day). CONCLUSIONS The present study showed that alcohol consumption of 2.5 gou/day (=ethanol 55 g/day) caused a distinct increase in the risk of hyperuricemia. Valuable information for preventing alcohol-induced hyperuricemia was obtained by a long-term follow-up study of a large cohort.
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García Puig J, de Miguel E. Hiperuricemia y gota: impacto de la ecografía. Med Clin (Barc) 2016; 146:67-8. [DOI: 10.1016/j.medcli.2015.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/18/2023]
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