Acute gouty arthritis is seasonal: possible clues to understanding the pathogenesis of gouty arthritis

Seasonal residual activity in adult familial Mediterranean fever: a longitudinal observational study

Although it is assumed that cold exposure triggers inflammation in patients with familial Mediterranean fever (FMF), seasonal differences in FMF have not yet been investigated. This study aims to investigate the association of seasonal changes with the frequency of attacks, disease severity, and subclinical inflammation in FMF. This longitudinal study examined adult patients with FMF on an established treatment followed up for at least 1 year in Istanbul. Clinical characteristics, medications, intraseasonal attacks counts, arthralgia and arthritis, disease severity, and the subclinical inflammation parameters were recorded covering four seasons. Friedman's and Cochran's Q tests were used to analyze changes in the above-mentioned data over seasons. Additionally, all attacks experienced in each season were added, and interseasonal differences were compared with the Chi-square goodness-of-fit test. Data for 240 observations (60 patients) were analyzed. The mean age and disease duration were 39.78 (SD 11.91) and 10 (IQR 6-22.75) years, respectively. The comparison of medians for four seasons did not show any statistical differences in terms of attack frequency, disease severity parameters, markers of subclinical inflammation, and the presence of arthralgia and arthritis. The total number of intraseasonal attacks experienced by patients differed among the seasons (p = 0.023), with a higher count in winter. Adult individuals with established FMF are more likely to experience attacks in winter than summer, but this difference may not be seen in the general parameters of disease activity/severity. This result supports the notion that there is a pronounced residual activity in winter.

SEASONAL VARIATIONS AND BEHÇET’S DISEASE ACTIVITY

Behçet’s disease (BD) is a systemic vasculitis with mucocutaneous manifestations such as recurrent oral ulcers and genital ulcers in addition to major organ involvements including the vascular and central nervous systems. Many studies have found that the prevalence of clinical symptoms of BD varies by geographical region. The course of BD is characterized by relapses and remissions. Infectious agents and altered microbiomes have been blamed for exacerbations of the disease. Stress, physical exhaustion, mechanical oral trauma, and hormonal effects have been specifically associated with flare-ups. A seasonal pattern in the activation of certain diseases, such as rheumatoid arthritis and systemic lupus erythematosus, has been reported. However, the relationship, if any, between the seasonal changes and the symptoms and organ involvements of BD has yet to be determined. In this review, we discussed whether clinical findings in BD patients are related to the seasons in terms of activation.

Association between non-optimal temperature and hospitalizations for gout in Anqing, China: a time-series analysis

Previous studies have found that non-optimal temperature influences the development of gout, but the results have been inconsistent. The present study aimed to explore the effects of high temperature and high temperature variation on hospitalizations for gout in Anqing, China. We collected daily data on air pollutants, meteorological factors, and hospitalizations for gout between 1January 2016 and 31 December 2020 in Anqing City, China. We used Poisson generalized linear regression model and a distributed lag non-linear model (DLNM) to explore the relationship of high temperature, diurnal temperature range (DTR), and temperature change between neighboring days (TCN) with hospitalizations for gout. Stratified analysis by gender (male, female) and age (<65 years, ≥65 years) was conducted. Hospitalizations for gout attributed to high temperature, high DTR, and high TCN were also quantified. A total of 8675 hospitalized patients with gout were reported during the study period. We observed that exposure to high temperature was linked with an increased risk of hospitalizations for gout (lag 0, RR: 1.081, 95% confidence interval (CI): 1.011, 1.155). Exposure to high DTR was also associated with increased risk of hospitalizations for gout (lag9, RR: 1.017, 95% CI: 1.001,1.035). A large drop in temperature between neighboring days was associated an increased risk of hospitalizations for gout (lag 0-2 days, RR: 1.234, 95% CI: 1.017, 1.493). Stratified analysis results revealed that older adults and men were more sensitive to high-level DTR exposure than their counterparts. Nearly 15% of hospitalizations for gout could be attributable to high temperature (attributable fraction: 14.93%, 95% CI: 5.99%, 22.11%). This study suggests that high temperature and high temperature variation may trigger hospitalizations for gout, indicating that patients with gout need to take proactive actions in the face of days with non-optimal temperature.

The Protective Effects of Lactobacillus plantarum KLDS 1.0344 on LPS-Induced Mastitis In Vitro and In Vivo

Cow mastitis, which significantly lowers milk quality, is mainly caused by pathogenic bacteria such as E. coli. Previous studies have suggested that lactic acid bacteria can have antagonistic effects on pathogenic bacteria that cause mastitis. In the current study, we evaluated the in vitro and in vivo alleviative effects of L. plantarum KLDS 1.0344 in mastitis treatment. In vitro antibacterial experiments were performed using bovine mammary epithelial cell (bMEC), followed by in vivo studies involving mastitis mouse models. In vitro results indicate that lactic acid was the primary substance inhibiting the E. coli pathogen. Meanwhile, treatment with L. plantarum KLDS 1.0344 can reduce cytokines' mRNA expression levels in the inflammatory response of bMEC induced by LPS. In vivo, the use of this strain reduced the secretion of inflammatory factors IL-6, IL-1β, and TNF-α, and decreased the activity of myeloperoxidase (MPO), and inhibited the secretion of p-p65 and p-IκBα. These results indicate that L. plantarum KLDS 1.0344 pretreatment can reduce the expression of inflammatory factors by inhibiting the activation of NF-κB signaling pathway, thus exerting prevent the occurrence of inflammation in vivo. Our findings show that L. plantarum KLDS 1.0344 has excellent properties as an alternative to antibiotics and can be developed into lactic acid bacteria preparation to prevent mastitis disease.

Interstitial Lung Disease in Connective Tissue Disease: A Common Lesion With Heterogeneous Mechanisms and Treatment Considerations

Connective tissue disease (CTD) related interstitial lung disease (CTD-ILD) is one of the leading causes of morbidity and mortality of CTD. Clinically, CTD-ILD is highly heterogenous and involves rheumatic immunity and multiple manifestations of respiratory complications affecting the airways, vessels, lung parenchyma, pleura, and respiratory muscles. The major pathological features of CTD are chronic inflammation of blood vessels and connective tissues, which can affect any organ leading to multi-system damage. The human lung is particularly vulnerable to such damage because anatomically it is abundant with collagen and blood vessels. The complex etiology of CTD-ILD includes genetic risks, epigenetic changes, and dysregulated immunity, which interact leading to disease under various ill-defined environmental triggers. CTD-ILD exhibits a broad spectra of clinical manifestations: from asymptomatic to severe dyspnea; from single-organ respiratory system involvement to multi-organ involvement. The disease course is also featured by remissions and relapses. It can range from stability or slow progression over several years to rapid deterioration. It can also present clinically as highly progressive from the initial onset of disease. Currently, the diagnosis of CTD-ILD is primarily based on distinct pathology subtype(s), imaging, as well as related CTD and autoantibodies profiles. Meticulous comprehensive clinical and laboratory assessment to improve the diagnostic process and management strategies are much needed. In this review, we focus on examining the pathogenesis of CTD-ILD with respect to genetics, environmental factors, and immunological factors. We also discuss the current state of knowledge and elaborate on the clinical characteristics of CTD-ILD, distinct pathohistological subtypes, imaging features, and related autoantibodies. Furthermore, we comment on the identification of high-risk patients and address how to stratify patients for precision medicine management approaches.

Classical Disease-Specific Autoantibodies in Systemic Sclerosis: Clinical Features, Gene Susceptibility, and Disease Stratification

Systemic sclerosis (SSc) is an autoimmune disease characterized by abnormalities in microcirculation, extracellular matrix accumulation, and immune activation. Autoantibodies are markers of immune abnormalities and provide diagnostic and predictive value in SSc. Anti-topoisomerase antibodies (ATAs), anticentromere antibodies (ACAs), and anti-RNA polymerase antibodies (ARAs) are the three classical specific antibodies with the highest availability and stability. In this review, we provide an overview of the recent progress in SSc research with respect to ATAs, ACAs, and ARAs, focusing on their application in distinguishing clinical phenotypes, such as malignancy and organ involvement, identifying genetic background in human leukocyte antigen (HLA) or non-HLA alleles, and their potential roles in disease pathogenesis based on the effects of antigen-antibody binding. We finally summarized the novel analysis using ATAs, ACAs, and ARAs on more detailed disease clusters. Considering these advantages, this review emphasizes that classical SSc-specific autoantibodies are still practical and have the potential for patient and risk stratification with applications in precise medicine for SSc.

Seasonal variation in the onset of acute calcific tendinitis of rotator cuff

Background

Calcific tendinitis of the rotator cuff is a disorder that causes acute onset of shoulder pain when spontaneous resorption of the calcification occurs. However, factors that trigger calcium resorption have not been clarified. The present study aimed to investigate the association between the onset of calcium resorption in calcific tendinitis and the season of onset.

Methods

We retrospectively reviewed 195 patients (female, 116; male, 79; mean age, 62.6 ± 14.2 years; median age, 62 [52, 73] years) diagnosed with the postcalcification stage of calcific tendinitis, which was defined as acute calcific tendinitis in this study, between 2006 and 2018. The onset date of acute calcific tendinitis for each patient was collected from clinical notes. We evaluated the incidence of acute calcific tendinitis in each season and month. Furthermore, we investigated the correlation between the incidence of acute calcific tendinitis and the mean monthly temperature or humidity levels for each year.

Results

The most common season of acute calcific tendinitis onset was summer (35.4%), followed by spring (24.6%), autumn (24.1%), and winter (15.9%) (P = 0.002). Monthly analyses showed the highest peak of onset was in July (15.4%) and the lowest peak was in February (3.1%) (P = 0.022). The incidence of acute calcific tendinitis had a weak association with mean monthly temperature (R² = 0.066; P = 0.001) but was not associated with mean monthly humidity levels (R² = 0.018; P = 0.099).

Conclusions

This study provides new information on seasonal variation of acute calcific tendinitis onset. The results of this study indicated that the onset of calcium resorption occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed.

Level of evidence

Level III.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03773-6.

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.

Seasonal variation in acute gouty arthritis: data from Nationwide Inpatient Sample

INTRODUCTION

Studies describing seasonal variations in acute gouty arthritis note seasonal variation, but disagree on timing, with most showing a peak in spring months while others show peaks later in the year. Various theories on the effect of weather and immune system changes on the chronobiology of monosodium urate crystals' equilibrium and precipitation have been proposed. We aimed to shed light on this question by examining the seasonal variation in the incidence of acute gouty arthritis in the USA using a large inpatient database.

METHODS

We used the Nationwide Inpatient Sample (NIS) database to identify patients aged ≥18 years with primary diagnosis of acute gouty arthritis (International Classification of Diseases, 9th Revision, Clinical Modification code 274.01) from 2009-2011 during hospitalization. We used the Edwards recognition and estimation of cyclic trend method to study the seasonal variation of the incidence of acute gout and z-test to compare the seasonal incidences.

RESULTS

A total of 28,172 hospitalizations with primary diagnosis of acute gouty arthritis were reported in the USA from 2009-2011. The peak incidence of acute gout was seen in November (peak/low ratio 1.34, 95 % CI 1.29-1.38, p < 0.05). The highest number of hospitalizations was observed in autumn months while the lowest incidence was observed in spring (28.12 vs. 23.13 %, p < 0.001).

CONCLUSION

The peak incidence of acute gout seems to be in the fall with its peak in the month of November. This seasonality may shed light into the pathophysiology of acute attacks and better management of patients with gout who are at risk of acute attacks.

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.

Is there any relationship between season/weather and oral ulcer in Behçet's disease?

OBJECTIVE

Some rheumatic diseases are being influenced by weather conditions. We examined the relationship between oral ulcers and weather/season in Behçet's disease (BD) patients and evaluated the oral ulcers' characteristics by the patients' perspectives.

MATERIAL AND METHODS

Patients with BD were evaluated using a self-questionnaire, including patients' clinical and demographical characteristics and detailed characteristics of oral ulcers and the association with season.

RESULTS

The most common site of oral ulcers was the tongue (89%). Of 90 patients, there were predisposing factors in oral ulcers. Among patients with BD, 30 believed that seasonal variation aggravated their oral ulcers, especially in winter and autumn.

CONCLUSION

The exacerbation of oral ulcers in patients with BD may be related to the seasons. The weather changes in our study are based on the patients' impression; these should be confirmed by objective findings and clinical assessment in further studies.