Atherogenic serum lipid profile is an independent predictor for gouty flares in patients with gouty arthropathy

Quantitative Assessment of Baseline Serum HDL-C to Predict Gout Flares During Urate-Lowering Therapy Initiation: A Prospective Cohort Study

Purpose

Previous studies have linked high-density lipoprotein cholesterol (HDL-C) to gout, but little is known about the dose-effect relationship between serum HDL-C levels and gout flares. This study aimed to quantify the association between the two during urate-lowering therapy initiation and develop a regression equation to predict gout flares.

Patients and Methods

We conducted a prospective, observational, single-center cohort study of men with gout. Patients were identified and grouped according to the level of serum HDL-C (1.16 mmol/L) at baseline and followed-up every four weeks until 12 weeks.

Results

A total of 394 participants completed the study (203 in the low HDL-C group; 191 in the high HDL-C group). The proportion of participants with gout flares in the low HDL-C group was significantly higher than in the high HDL-C group after 12 weeks follow-up (52.2% versus 35.6%, P=0.001). Patients with lower serum HDL-C level had higher risk of gout flares analyzed by restricted cubic spline and when serum HDL-C level = 1.15mmol/L, flareHR = 1. When combined with well-known risk factors, serum HDL-C predicted gout flares with an area under curve (AUC) of 0.75 (95% CI=0.70-0.80). Based on the logistic regression coefficients, we derived the following regression equation: Logit (P)= -2.282+0.05× [disease duration]+1.015× [recurrent flares in the last year]+0.698× [palpable tophus]+0.345× [serum urate]-1.349×[serum HDL-C].

Conclusion

Patients with gout presented a negative linear relationship between serum HDL-C and gout flares. Together with common clinical indicators, the AUC for gout flare prediction increased to 0.75. For patients with gout, remaining serum HDL-C level above 1.15 mmol/L may reduce the risk of gout flares.

Regulating Lipid Metabolism in Gout: A New Perspective with Therapeutic Potential

Gout is a metabolic disease characterized by inflammatory arthritis caused by abnormal uric acid metabolism. It is often complicated with cardio-renal damage and vascular lesions. In recent years, the relationship between lipid metabolism and gout has attracted increasing attention. Changes in blood lipids in gout patients are often clinically detectable and closely related to uric acid metabolism and inflammatory response in gout. With the development of lipidomics, the changes in small lipid molecules and their metabolic pathways have been gradually discovered, yielding a greater understanding of the lipid metabolism changes in gout patients and their potential role in gout development. Through searching the literature on lipid metabolism in gout since 2000 in PubMed and Web of Science, this article reviewed lipid metabolism changes in gout patients and their role in the risk of gout, uric acid metabolism, inflammatory response, and comorbidities. Additionally, the strategies to regulate the abnormal lipid metabolism in gout have also been summarized from the aspects of drugs, diet, and exercise. These will provide a new perspective for understanding gout pathogenesis and its treatment and management.

Elevated serum CA72-4 predicts gout flares during urate lowering therapy initiation: a prospective cohort study

OBJECTIVE

Gout flares during urate-lowering therapy (ULT) initiation are common, but predictors of these flares are poorly understood. The aim of this study was to determine whether serum CA72-4 is an independent predictor for gout flares during ULT initiation.

METHODS

A prospective cohort study was conducted between March 2021 and January 2022. Men with gout, at least one gout flare in the past year, and at least three serum CA72-4 measurements in the previous six months were enrolled. Participants were grouped according to their highest recorded serum CA72-4 levels (above or within the normal range). All participants took oral febuxostat 20 mg daily without flare prophylaxis therapy, and attended face-to-face visits every four weeks until 24 weeks. The incidence of gout flare was compared between the two groups. Backward stepwise logistic regression analyses were used to identify risk factors associated with flares. Receiver operating characteristic curve analysis was used to evaluate prediction efficacy.

RESULTS

A total of 193 completed the study (79 with high CA72-4; 114 with normal CA72-4). The cumulative incidence of at least one gout flare was 48.1% (62.1% in the high CA72-4 group, 38.4% in the normal CA72-4 group, P = 0.001), and recurrent (≥2) flares was 33.0% (47.1% in the high CA72-4 group, 23.2% in the normal CA72-4, P < 0.001). High CA72-4, disease duration, intra-articular tophus size, glucose, high-density lipoprotein-cholesterol and ESR were independent risk factors for gout flares. Serum CA72-4 alone predicted recurrent flares with an area under the curve of 0.63 (95% CI = 0.54, 0.71), and 0.78 (95% CI = 0.71, 0.85) when combined with other independent variables.

CONCLUSION

High serum CA72-4 predicts the risk of gout flares during ULT initiation.

TRIAL REGISTRATION

ChiCTR; https://www.chictr.org.cn/; ChiCTR2100043573.

Association of urate deposition shown by ultrasound and frequent gout attacks

BACKGROUND

There are few data demonstrating the association between urate burden assessed by ultrasound (US) and gout flares. The aim of this study was to determine the association of urate deposition shown by US and frequent gout attacks.

MATERIALS AND METHODS

Patients with gout were divided into two groups according to the frequency of gout attacks in the previous 12 months: frequent (>2 attacks) and infrequent (0-2 attacks). Urate deposition in the hands, knees, and feet was assessed by US.

RESULTS

Overall, 106 patients were enrolled in this study, of whom 32 (30.1%) had had frequent gout attacks (>2 attacks) in the previous 12 months (the average number of gout attacks was 4.7, range 3-12). Those with frequent gout attacks had significantly longer gout duration, a higher serum urate level, and more urate deposition shown by US than those with infrequent gout attacks (P < 0.05). In both univariate and logistic regression analyses, frequent gout attacks were correlated with gout duration, serum urate level, and urate deposition as shown by US (P < 0.05).

CONCLUSION

These findings indicate that urate deposition shown by US is independently associated with frequent gout attacks. Special attention should be given to the prevention of flares in patients with an initially high urate burden as assessed by US.

Seasonal Variations and Associated Factors of Gout Attacks: a Prospective Multicenter Study in Korea

BACKGROUND

We purposed to evaluate the seasonality and associated factors of the incidence of gout attacks in Korea.

METHODS

We prospectively enrolled patients with gout attacks who were treated at nine rheumatology clinics between January 2015 and July 2018 and followed them for 1-year. Demographic data, clinical and laboratory features, and meteorological data including seasonality were collected.

RESULTS

Two hundred-five patients (men, 94.1%) were enrolled. The proportion of patients with initial gout attacks was 46.8% (n = 96). The median age, body mass index, attack duration, and serum uric acid level at enrollment were 50.0 years, 25.4, 5.0 days, and 7.4 mg/dL, respectively. Gout attacks were most common during spring (43.4%, P < 0.001) and in March (23.4%, P < 0.001). A similar pattern of seasonality was observed in the group with initial gout attacks. Alcohol was the most common provoking factor (39.0%), particularly during summer (50.0%). The median diurnal temperature change on the day of the attack was highest in the spring (9.8°C), followed by winter (9.3°C), fall (8.6°C), and summer (7.1°C) (P = 0.027). The median change in humidity between the 2 consecutive days (the day before and the day of the attack) was significantly different among the seasons (3.0%, spring; 0.3%, summer; -0.9%, fall; -1.2%, winter; P = 0.015). One hundred twenty-five (61%) patients completed 1-year follow-up (51% in the initial attack group). During the follow-up period, 64 gout flares developed (21 in the initial attack group). No significant seasonal variation in the follow-up flares was found.

CONCLUSION

In this prospective study, the most common season and month of gout attacks in Korea are spring and March, respectively. Alcohol is the most common provoking factor, particularly during summer. Diurnal temperature changes on the day of the attack and humidity changes from the day before the attack to the day of the attack are associated with gout attack in our cohort.

Potential of IL-33 for Preventing the Kidney Injury via Regulating the Lipid Metabolism in Gout Patients

Interleukin-33 (IL-33), the most recently discovered member of the IL-1 superfamily, has been linked to several human pathologies including autoimmune diseases, sepsis, and allergy through its specific IL-1 receptor ST2. However, there is little information regarding the role of IL-33 in gout. In this study, we investigated the potential role of IL-33 in gout patients. The serum level of IL-33 was measured by ELISA, and the clinical and laboratory parameters, serum creatinine, urea, and lipid, were extracted from medical record system. The serum IL-33 expression was predominantly increased in gout patients compared to healthy controls, and the IL-33 levels were higher in patients without kidney injury. Furthermore, IL-33 showed a negative correlation with biomarkers of kidney injury, such as CRE and urea. The lipid metabolism dysfunction, tophi, and hypertension are the common reasons for kidney injury in gout. Interestingly, inverse and positive correlation of IL-33 expression was observed in LDL and HDL, respectively. However, there was no significant alteration in the gout patients with hypertension and tophi. These data suggested that IL-33 might act as a protective role in kidney injury through regulating the lipid metabolism in gout.

Seasonality of gout in Korea: a multicenter study

The object of this study was to evaluate the seasonality of gout in Korea. We retrospectively examined data from 330 patients seen at nine rheumatology clinics, treated with urate lowering therapy (ULT) more than one year after stopping prophylactic medication. Demographic data, clinical and laboratory features, and seasonality of gout onset and flares were collected. Season was classified in three-month intervals. The mean age was 52.2 yr and mean disease duration was 26.8 months. The male to female count was 318:12. The onset of acute gouty attacks was obtained in 256 patients. Gout developed most commonly in summer season (36.7%) (P<0.001) and in June (15.6%, P=0.002). During ULT, there were 147 (male 97.3%) gout flares. Although there was no statistically significant difference, gout flares were more common in summer (30.6%). Aggravating factors were identified in 57 flares: alcohol (72.0%) was most common. In the patients who attained target serum uric acid (<6 mg/dL) at the end of prophylaxis, gout flares were high in fall (35.8%) and September (17.0%). In Korea, the summer is most common season of gout onset and there is a tendency for gout flares to increase during ULT in summer/fall season.

Lipid profile in Tunisian patients with rheumatoid arthritis

This study aims to assess the prevalence of dyslipidaemia in Tunisian patients with active RA and to investigate the clinical and biological associated factors. A cross-sectional study was conducted on 92 unselected patients with active RA (77 females and 15 males, aged 49.1 ± 12.5 years) and 82 healthy subjects (68 females and 14 males, aged 50.8 ± 13.3 years). We recorded the patients' characteristics and the results of a lipid profile test (total cholesterol, TC; high-density lipoprotein cholesterol, HDL-c; low-density lipoprotein cholesterol, LDL-c; triglyceride, TG; lipoprotein (a), Lp (a); apolipoprotein A-1, apo A-1 and apolipoprotein B, apo B). In comparison to the control group, RA patients showed a higher prevalence of associated dyslipidaemia (95.7% versus 65.9% of cases, p < 0.001). Sera of patients showed higher TC (4.86 ± 1.07 versus 3.98 ± 0.73 mmol/L, p < 0.001), LDL-c (3.49 ± 0.98 versus 1.99 ± 0.62 mmol/L, p < 0.001), Lp (a) (288.04 ± 254.59 versus 187.94 ± 181.37 mmol/L, p = 0.004) and lower HDL-c (0.66 ± 0.24 versus 1.12 ± 0.3 mmol/L, p < 0.001). TC/HDL-c, LDL-c/HDL-c and non-HDL-c/HDL-c were also higher in RA patients; they were 8.24 ± 3.20 versus 3.76 ± 1.26 (p < 0.001), 5.91 ± 2.48 versus 1.92 ± 0.99 (p < 0.001) and 7.24 ± 3.20 versus 2.76 ± 1.26 (p < 0.001), respectively. Apo A-1 was correlated to Lp (a) (r = 0.291, p = 0.005). Corticoid dose was not associated to dyslipidaemia, but in multiple regression models, corticoid dose may be negatively related to some atherogenic markers, in particular non-HDL-c. Tunisian patients with markedly active RA experience substantially reduced serum HDL-c and increased TC, LDL-c and Lp (a) concentrations as well as increased TC/HDL-c, LDL-c/HDL-c and non-HDL-c/HDL-c ratios.