Effects of Urate-Lowering Therapy on Risk of Hyperlipidemia in Gout by a Population-Based Cohort Study and on In Vitro Hepatic Lipogenesis-Related Gene Expression

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.

Gout comorbidities: results from the Korean National Health and Nutrition Examination Survey

OBJECTIVES

Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities.

METHODS

Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population.

RESULTS

The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population.

CONCLUSIONS

Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population.

Statin use associated with a reduced risk of hip fracture in patients with gout

Studies show that statins users are at reduced risk of fracture and improved bone mineral density. However, the clinical effectiveness of statin use in patients with gout has not been investigated. This retrospective cohort study used data from Taiwan's National Health Insurance Research Database, consisting of 3443 patients with gout using statins aged 50 years and above and 6886 gout patients of non-statin users matched by sex, age and propensity score. The Cox proportional hazards regression analysis showed that statin use was associated with a reduced risk of hip fracture (adjusted hazard ratio [aHR] = 0.78, 95 % confidence interval [CI] = 0.64-0.94) after controlling for potential confounding factors. The association was significant in both genders aged 50-64 years, with aHRs of near 0.35, but not in the elderly. In addition, women aged 50-64 years who used statins also exhibited a lower risk of vertebral fracture (aHR = 0.70, 95 % CI = 0.50-0.99), but not men. In conclusion, the stating use in gout patients could reduce fracture risk for younger patients. Further research is warranted to confirm these findings.

Nonlinear association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hyperuricemia in cancer patients: evidence from NHANES 2007-2018

BACKGROUND

Evidence shows that cancer patients are more likely to have hyperuricemia (HUA) compared to the general population, with lipid metabolism playing a significant role. However, it is still unclear whether there is a non-linear relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and HUA in these patients. This study aims to explore the association between NHHR and HUA in cancer patients.

METHODS

This study included participants from the NHANES database from 2007 to 2018. We used multivariable logistic regression, restricted cubic splines (RCS) analysis, and subgroup analysis to examine the association between NHHR and HUA and gout in cancer patients, as well as to investigate differences in this association among specific subgroups.

RESULTS

A total of 2826 participants were included, with a HUA prevalence of 24.30%. Weighted multivariable logistic regression showed that for each unit increase in NHHR, the odds of HUA in cancer patients increased by 16% (95% confidence interval [CI]: 1.06, 1.29, P = 0.002). When NHHR was divided into tertiles, those in the highest tertile (Q3) had a 1.84 times higher odds of developing HUA compared to those in the lowest tertile (Q1) (95% CI: 1.32, 2.58, P < 0.001). However, there was no significant association with gout. RCS analysis further revealed a significant non-linear positive association, particularly among males. Subgroup analysis and interaction tests indicated a stronger association in cancer patients who did not have a history of stroke.

CONCLUSION

There is a non-linear association between NHHR and HUA in cancer patients.

[Huangqin Qingrechubi Capsule alleviates inflammation and uric acid and lipid metabolism imbalance in rats with gouty arthritis by inhibiting the PTEN/PI3K/AKT signaling pathway]

OBJECTIVE

To investigate the effects of Huangqin Qingrechubi Capsule (HQC) on inflammation and uric acid and lipid metabolism in rats with gouty arthritis (GA) and its mechanism.

METHODS

SD rat models of GA established by injecting monosodium urate into the right ankle joint were treated with saline, colchicine and HQC at low, medium and high doses (n=10) by gavage for 7 days. Toe swelling of the rats was detected at 4, 8, 24, 48 and 72 h after modeling, and synovial histological changes were observed with HE staining. Serum levels of interleukin-10 (IL-10), IL-18, tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), adiponectin, leptin, resistin and visfatin were measured by ELISA, and the levels of high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), total cholesterol (TC), and uric acid (BUA) were detected. RTqPCR and Western blotting were used to detect the mRNA expressions of phosphatase and tensin homolog (PTEN), phosphatidylinositol-3-kinase (PI3K) and protein kinase B (AKT) and the protein expressions of PTEN, PI3K, p-PI3K, AKT and p-AKT.

RESULTS

The rat models of GA showed obvious toe swelling, which reached the peak level at 48 h. HE staining revealed massive inflammatory cell infiltration and synovial tissue hyperplasia. The rat models showed significantly increased expressions of TNF-α, TGF-β1, IL-18, TC, TG, leptin, resistin and visfatin, BUA, p-PI3K, and p-AKT and lowered levels of IL-10, APN, HDL-C, and PTEN. Treatment with HQC and colchicine obviously improved these changes and alleviated synovial pathologies and toe swelling in the rat models.

CONCLUSION

HQC can improve inflammation and correct the imbalance of uric acid and lipid metabolism in GA rats possibly by inhibiting the PTEN/PI3K/AKT signaling pathway.

Association between serum uric acid levels of patients with gout and their complications and examination fees: A cross-sectional analysis

OBJECTIVE

Correlation influence factor analysis of gout patients' serum uric acid (SUA) levels, their examination fees, and various complications were explored.

METHODS

From January 2017 to December 2021, 17 666 patients with gout were obtained. Conduct quartile grouping according to gout patients' SUA levels was used to compare the differences between groups in terms of examination fees and complications. Kernel density estimation method was adopted to analyze the data distribution, Spearman and Mantel-Haenszel χ² tests were used to analyze the correlation between SUA levels and examination fees and complications. Binary logistic regression analysis was used to analyze the correlation influence factor between SUA levels and complications.

RESULTS

Of the 17 666 gout cases, 85.46% were male. Among them, 7637 (43.23%) were inpatients and 10 029 (56.77%) were outpatients. Compared with outpatients, age, SUA levels, and examination fees were significantly higher, and there were more complications among inpatients (P < 0.05). Correlation analysis revealed that outpatients and SUA levels of patients with gout were positively correlated with examination fees, cardiovascular diseases, pulmonary diseases, liver diseases, and kidney diseases (P < 0.01). Binary logistic regression analysis showed that SUA level is an independent influence factor for cardiovascular diseases, pulmonary diseases, liver diseases, and kidney diseases (odds ratio [95% confidence interval]: 1.002 [1.002-1.002], 1.001 [1.000-1.001], 1.003 [1.002-1.003], and 1.001 [1.001-1.002], respectively).

CONCLUSIONS

As SUA levels increased, examination fees, cardiovascular disease, pulmonary disease, liver disease, and kidney disease complications increased. SUA level is an independent influence factor for the combination of gout with cardiovascular diseases, pulmonary diseases, liver diseases, and kidney diseases.

Trends in risk factor control in patients with gout: data from the National Health and Nutrition Examination Survey, 2007-2018

OBJECTIVES

To explore trends in risk factor control (hypertension, diabetes mellitus, hyperlipidaemia) in patients with gout and medication use among those whose risk factor control targets were not achieved.

METHODS

We used the data from National Health and Nutrition Examination Survey (NHANES) between 2007-2008 and 2017-2018 for analyses. The study samples were weighted so that they could be representative of the non-institutionalized US population. We conducted a cross-sectional analysis to assess trends in risk factor control and medication use, and employed logistic regression analyses to explore patient characteristics associated with risk factor control.

RESULTS

The prevalence of participants in whom blood pressure control target was achieved decreased from 64.6% in 2007-2008 to 55.3% in 2017-2018 (P-value for trend = 0.03). The percentage of participants whose glycaemic, lipid or all three risk factor control targets were achieved remained stable temporally (P > 0.05). Some patient characteristics were significantly related to risk factor control, including age 45-64, age ≥65, Asian Americans, non-Hispanic Blacks, higher family income, and being overweight and obese. A trend towards increased use of glucose-lowering medication was found (from 71.0% in 2007-2008 to 94.7% in 2017-2018, P < 0.01), while the prevalence of taking blood pressure-lowering and lipid-lowering medications remained stable (P > 0.05).

CONCLUSION

Based on NHANES data, a significant trend towards decreased blood pressure control was observed in patients with gout, while glycaemic and lipid control levelled off. These findings emphasize that more endeavours are needed to improve management of cardiovascular risk factors in patients with gout.

Inflammatory-associated apoptotic markers: are they the culprit to rheumatoid arthritis pain?

BACKGROUND

Rheumatoid arthritis (RA) is a prolonged inflammatory disease resulting from autoimmune reactions that leads to local and systemic bone erosion, joint defects and functional impairment. Although the inflammation is subsided through the prescription of anti-inflammatory therapeutics, the patients persistently complained of sleepless nights due to flare pain. This indicates the possible contribution of other pathways besides inflammation in leading to RA pain. This review aims to uncover the roles and involvement of several inflammatory-associated apoptotic markers in facilitating pain transmission and processing during the pathogenesis of RA.

MATERIALS AND METHODS

This narrative review focused on the reports from the previous literature based on the search string of "apoptotic marker AND inflammation AND 'chronic pain' OR 'neuropathic pain' and apoptosis AND 'rheumatoid arthritis' OR arthritis from the databases including Science Direct and Scopus, considering the exclusion criteria of the published abstracts, proceedings or articles on other neuropathic pain types such as painful bowel syndrom, insterstitial cystitis, fibrosis and so on.

RESULTS

Several studies in the literature demonstrate a close association between imbalanced apoptotic regulations and an increased number of synovial fibroblasts and inflammatory cells in RA. Cell death or specific cell survival has been linked with increased central hypersensitivity in various types of chronic and neuropathic pain.

CONCLUSION

The RA-related flare pain is possibly contributed by the abnormal regulation of apoptosis through several inflammatory-related pathways, and further studies need to modulate these pathways for the putative anti-nociceptive benefits.

Association between Gout and Dyslipidemia: A Nested Case-Control Study Using a National Health Screening Cohort

The association between lipid levels and uric acid disorders remains controversial. We evaluated the association between dyslipidemia and gout in a large cohort from the Korean National Health Insurance Service-Health Screening Cohort. Among the 514,866 participants aged ≥40 years, 16,679 gout participants were selected and matched with 66,716 control participants for income, region of residence, sex, and age. We used the ICD-10 codes to define dyslipidemia (E78) and gout (M10) and diagnosis was confirmed when each was reported ≥2 times. The odds ratios (ORs) of dyslipidemia history were calculated using conditional logistic regression in crude, partial, and fully adjusted models. The days of statin use, systolic and diastolic blood pressure, fasting glucose level, total cholesterol, obesity, Charlson comorbidity index, alcohol consumption, and smoking were used as covariates. Patients with gout had a significantly higher dyslipidemia history than those without gout (33.1% vs. 24.0%, p < 0.001). The association was significant after adjustment (OR in partial adjusted model = 1.50, 95% confidence interval (CI) = 1.44−1.57; OR in fully adjusted model = 1.43, 95% CI = 1.37−1.49). These findings were consistent with the subgroup analysis. Our findings suggest that dyslipidemia history is more likely in patients with gout aged ≥40 years than in healthy controls among Korean population.