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Hsu CM, Hsu CC, Wu RW, Huang CC, Chen YC. Interplay between fat, muscle, bone mass, and oteophytes and risk for tophaceous gout. J Investig Med 2023; 71:58-61. [PMID: 36316064 DOI: 10.1136/jim-2022-002407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 01/21/2023]
Abstract
Tophaceous gout is a common arthritis caused by the deposition of urate crystals and is related to limited joint function. Although there are reports that uric acid (UA) is associated with bone mineral density (BMD), little is known about the relationship between UA, osteophytes, and muscle. This cross-sectional case-control study was performed in patients with tophaceous gout. The control group included patients without gout. All subjects underwent BMD and body composition analyses. Age, sex, alcohol consumption, smoking, and radiography of both knees were recorded. Adjusted ORs for tophaceous gout were calculated using the logistical regression models. A total of 150 male patients were enrolled, including 65 individuals with tophaceous gout and 85 without gout. The mean age of the patients with tophaceous gout was 59.94±12.40 years, while that of individuals without gout was 61.29±11.57 years (p=0.492). Patients with tophaceous gout have a higher mean body mass index, fat mass, appendicular lean mass, BMD, and osteophytes. Multiple logistic regression analysis revealed that fat mass (OR 2.01, 95% CI 1.27 to 3.18), appendicular lean mass (OR 4.27, 95% CI 1.86 to 9.83), and osteophytes (OR 5.88, 95% CI 1.72 to 20.13) were significantly associated with tophaceous gout. In the current study, higher fat mass, high muscle mass, and osteophyte formation were found to increase the risk of tophaceous gout, as the association is the most than can be inferred from a cross-sectional study. Therefore, reducing body fat and weight management may prevent tophaceous gout.
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Affiliation(s)
- Chieh-Min Hsu
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Cheng Hsu
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Re-Wen Wu
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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2
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Jia E, Li Z, Geng H, Zhu H, Wang Y, Lin F, Jiang Y, Zhang J. Neutrophil extracellular traps induce the bone erosion of gout. BMC Musculoskelet Disord 2022; 23:1128. [PMID: 36567343 PMCID: PMC9791768 DOI: 10.1186/s12891-022-06115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the relationships between monosodium urate (MSU) crystals -induced neutrophil extracellular traps (NETs) and bone erosion in gout. METHODS Animal models were used to study the relationship between NETs induced by MSU crystals and bone erosion. Neutrophils were treated with MSU crystals to induce NETs. The osteoblasts-like cells (OB) were then treated with NETs, and the supernatant was co-incubated with osteoclasts-like cells (OC). The NETs were digested with DNase, and the neutrophil elastase (NE) was inhibited with sivelestat sodium. Cell viability, mRNA, and protein expression were also assessed. RESULTS After treating OB with NETs, the cell viability decreased. Yet, after digesting the DNA and inhibiting NE, the viability was moderately improved. The expression level of osteoprotegerin (OPG) and alkaline phosphatase (ALP) was up-regulated, while the expression level of receptor activator of nuclear factor kappa-B ligand (RANKL) was down-regulated in the sivelestat sodium + MSU group compared with MSU group. The number of OC was significantly elevated. In contrast, the number of OB was not increased in the tibia after establishing the gout model. The supernatant obtained from OB was treated with NETs promoting OC differentiation. The expression level of receptor activator of nuclear factor kappa-B (RANK), tartrate-resistant acid phosphatase (TRAP), and cathepsin K (Cst K) was up-regulated in the MSU group compared with the normal control (NC) group. CONCLUSION NETs induced by MSU crystals could inhibit osteoblasts viability and enhance the activity of osteoclasts.
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Affiliation(s)
- Ertao Jia
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China ,grid.411866.c0000 0000 8848 7685The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital; and the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China
| | - Zhiling Li
- grid.411866.c0000 0000 8848 7685The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hongling Geng
- grid.411866.c0000 0000 8848 7685The Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haiqiong Zhu
- grid.410745.30000 0004 1765 1045Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, China
| | - Yadong Wang
- The Department of Urology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Feng Lin
- The Department of Urology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yubao Jiang
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jianyong Zhang
- grid.411866.c0000 0000 8848 7685The Department of Rheumatology, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1, Fuhua Road, Futian District, Shenzhen, 518033 Guangdong China ,The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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3
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Naot D, Pool B, Chhana A, Gao R, Munro JT, Cornish J, Dalbeth N. Factors secreted by monosodium urate crystal-stimulated macrophages promote a proinflammatory state in osteoblasts: a potential indirect mechanism of bone erosion in gout. Arthritis Res Ther 2022; 24:212. [PMID: 36064735 PMCID: PMC9442999 DOI: 10.1186/s13075-022-02900-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tophi are lesions commonly present at sites of bone erosion in gout-affected joints. The tophus comprises a core of monosodium urate (MSU) crystals surrounded by soft tissue that contains macrophages and other immune cells. Previous studies found that MSU crystals directly reduce osteoblast viability and function. The aim of the current study was to determine the indirect, macrophage-mediated effects of MSU crystals on osteoblasts. METHODS Conditioned medium from the RAW264.7 mouse macrophage cell line cultured with MSU crystals was added to the MC3T3-E1 mouse osteoblastic cell line. Conditioned medium from the THP-1 human monocytic cell line cultured with MSU crystals was added to primary human osteoblasts (HOBs). Matrix mineralization was assessed by von Kossa staining. Gene expression was determined by real-time PCR, and concentrations of secreted factors were determined by enzyme-linked immunosorbent assay. RESULTS In MC3T3-E1 cells cultured for 13 days in an osteogenic medium, the expression of the osteoblast marker genes Col1a1, Runx2, Sp7, Bglap, Ibsp, and Dmp1 was inhibited by a conditioned medium from MSU crystal-stimulated RAW264.7 macrophages. Mineral staining of MC3T3-E1 cultures on day 21 confirmed the inhibition of osteoblast differentiation. In HOB cultures, the effect of 20 h incubation with a conditioned medium from MSU crystal-stimulated THP-1 monocytes on osteoblast gene expression was less consistent. Expression of the genes encoding cyclooxygenase-2 and IL-6 and secretion of the proinflammatory mediators PGE2 and IL-6 were induced in MC3T3-E1 and HOBs incubated with conditioned medium from MSU crystal-stimulated macrophages/monocytes. However, inhibition of cyclooxygenase-2 activity and PGE2 secretion from HOBs indicated that this pathway does not play a major role in mediating the indirect effects of MSU crystals in HOBs. CONCLUSIONS Factors secreted from macrophages stimulated by MSU crystals attenuate osteoblast differentiation and induce the expression and secretion of proinflammatory mediators from osteoblasts. We suggest that bone erosion in joints affected by gout results from a combination of direct and indirect effects of MSU crystals.
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Affiliation(s)
- Dorit Naot
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand
| | - Bregina Pool
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand
| | - Ashika Chhana
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand
| | - Ryan Gao
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jacob T Munro
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.
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4
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Jia E, Zhu H, Geng H, Zhong L, Qiu X, Xie J, Xiao Y, Jiang Y, Xiao M, Zhang Y, Wei J, Tang D, Zhang J. The Inhibition of Osteoblast Viability by Monosodium Urate Crystal-Stimulated Neutrophil-Derived Exosomes. Front Immunol 2022; 13:809586. [PMID: 35655781 PMCID: PMC9152014 DOI: 10.3389/fimmu.2022.809586] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/22/2022] [Indexed: 12/27/2022] Open
Abstract
Background and Objective Bone erosion is common in patients with gout. The role of neutrophil-derived exosomes in gouty bone erosion remains elusive. This study aimed to investigate the functions of the neutrophil-derived exosomes in the development of bone erosion in gout. Methods Neutrophil-derived exosomes were collected and assessed by transmission electron microscopy and nanoparticle tracking analysis. Cell counting kit-8 assay was applied to evaluate cell viability, and cell apoptosis was assessed by flow cytometry. In addition, quantitative Real-time PCR and Western blotting were used to determine the expression levels of alkaline phosphatase (ALP), osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL). Neutrophil-derived exosomes were tagged with PKH67. The miRNA expression profiles of exosomes and human fetal osteoblasts (hFOB) were compared using high-throughput sequencing. Functional miRNAs transfected into hFOB after co-incubation with exosomes were selected and validated by preliminary qPCR. Results Neutrophil-derived exosomes were stimulated by monosodium urate (MSU). The exosomes could inhibit the viability of the hFOB, and the expression levels of ALP and OPG were down-regulated, while the expression level of RANKL was up-regulated. However, there was no significant difference in the viability of osteoclasts and the expression of nuclear factor of activated T cells 1. Exosomes were observed in the cytoplasm under a confocal microscopy, confirming that exosomes could be taken up by hFOB. In total, 2590 miRNAs were found, of which 47 miRNAs were differentially expressed. Among the delivered miRNAs, miR-1246 exhibited the highest level of differential expression. The viability of hFOB was reduced by miR-1246 mimics and increased by miR-1246 inhibitors. There was no significant difference in hFOB apoptosis rate between the miR-1246 mimic and miR-1246 inhibitor group. MiR-1246 overexpression decreased the expression levels of ALP and OPG, whereas increasing the expression level of RANKL. In contrast, miR-1246 inhibitor increased the expression levels of ALP and OPG, while decreasing the expression level of RANKL. Neutrophil-derived exosomes stimulated by MSU could increase the expression of miR-1246. Conclusion Neutrophil-derived exosomes stimulated by MSU could inhibit the viability of osteoblasts.
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Affiliation(s)
- Ertao Jia
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Haiqiong Zhu
- Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, China
| | - Hongling Geng
- The Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Zhong
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xia Qiu
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jingjing Xie
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yuya Xiao
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yubao Jiang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Min Xiao
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yanying Zhang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiaxin Wei
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Dabin Tang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jianyong Zhang
- The Department of Rheumatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,The Department of Rheumatology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
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5
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Dalbeth N, Becce F, Botson JK, Zhao L, Kumar A. Dual-energy CT assessment of rapid monosodium urate depletion and bone erosion remodelling during pegloticase plus methotrexate co-therapy. Rheumatology (Oxford) 2022; 61:4898-4904. [PMID: 35293984 PMCID: PMC9707016 DOI: 10.1093/rheumatology/keac173] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pegloticase rapidly lowers serum urate in uncontrolled/refractory gout patients, with ≥1 tophus resolution in 70% of pegloticase responders and 28% of non-responders. Dual-energy computed tomography (DECT) non-invasively detects MSU deposition, including subclinical deposition, quantifies MSU volumes and depicts bone erosions. This report presents DECT findings in MIRROR open-label trial participants receiving pegloticase+MTX co-therapy. METHODS Serial DECT scans were obtained during pegloticase (8 mg biweekly infusions)+oral MTX (15 mg/week) co-therapy. Bilateral hand/wrist, elbow, foot/ankle and knee images were analysed with default post-processing settings. MSU volumes were quantified and bone erosions were identified and evaluated for remodelling (decreased size, sclerosis, new bone formation). DECT and physical examination findings were compared. RESULTS 2 patients underwent serial DECT. Patient 1 (44-year-old male) completed 52 weeks of pegloticase+MTX co-therapy (26 infusions). Baseline examination detected 4 tophus-affected joints while DECT identified 73 MSU-affected joints (total MSU volume: 128.76 cm3). At end-of-treatment, there were no clinically-affected joints and 4 joints with DECT-detected MSU deposition. MSU volume decreased by 99% and bone erosion remodelling was evident. Patient 2 (51-year-old male) had 10 weeks of therapy (5 infusions), discontinuing because of urate-lowering response loss. Baseline examination detected 7 tophus-affected joints while DECT identified 55 MSU-affected joints (total MSU volume: 59.20 cm3). At end-of-treatment, there were 5 clinically affected joints and 42 joints with DECT-detected MSU deposition. MSU volume decreased by 58% and bone erosion remodelling was evident. CONCLUSION DECT detected subclinical MSU deposition and quantified changes over time. Rapid tophus resolution and bone erosion remodelling occurred during pegloticase+MTX co-therapy. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03635957.
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Affiliation(s)
- Nicola Dalbeth
- Correspondence to: Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waipapa Taumata Rau, Room 502-201D, 85 Park Road, Grafton, Auckland 1023, New Zealand. E-mail:
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Lin Zhao
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
| | - Ada Kumar
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
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Sung KY, Lee S, Jeong Y, Lee SY. Ossifying pilomatricoma and a novel hypothesis for its pathogenesis: A case report and comprehensive literature review. Medicine (Baltimore) 2022; 101:e28753. [PMID: 35147098 PMCID: PMC8830851 DOI: 10.1097/md.0000000000028753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/17/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pilomatricoma is a benign skin appendageal tumor derived from hair follicle matrix cells that commonly affects the head, neck, and upper extremities of the pediatric population. Since the original tumor description, diverse variants have been reported in the literature. Pilomatricoma with florid osseous metaplasia is described as an ossifying pilomatricoma and is recognized as a distinct variant of this benign tumor. However, the pathogenesis of this variant remains unclear. In this study, we present an uncommon case of ossifying pilomatricoma and address the pathogenesis of metaplastic ossification through a comprehensive literature review. PATIENT CONCERNS A 14-year-old boy presented with an asymptomatic protuberant mass in the preauricular region. DIAGNOSIS Based on its clinicopathological features, we diagnosed the lesion as an ossifying pilomatricoma. INTERVENTIONS AND OUTCOMES The lesion was surgically removed under local anesthesia. The postoperative course was uneventful during the 6-month postoperative follow-up. LESSONS We suggest that metaplastic ossification in ossifying pilomatricoma represents another feature of foreign body reaction to keratinous materials containing shadow cells in old lesions and a walling-off phenomenon to prevent exposure of surrounding tissues to keratinous materials.
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Affiliation(s)
- Kun-Yong Sung
- Department of Plastic and Reconstructive Surgery, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seungkoo Lee
- Department of Anatomic Pathology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Yeonjin Jeong
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sang-Yeul Lee
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Republic of Korea
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7
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Bardin T, Nguyen QD, Hieu NL, Tran KM, Dalbeth N, Do MD, Ea HK, Richette P, Resche-Rigon M, Bousson V. The shrinking toe sign in gout. Semin Arthritis Rheum 2022; 53:151981. [DOI: 10.1016/j.semarthrit.2022.151981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 12/27/2022]
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Accart N, Dawson J, Obrecht M, Lambert C, Flueckiger M, Kreider J, Hatakeyama S, Richards PJ, Beckmann N. Degenerative joint disease induced by repeated intra-articular injections of monosodium urate crystals in rats as investigated by translational imaging. Sci Rep 2022; 12:157. [PMID: 34997110 PMCID: PMC8742129 DOI: 10.1038/s41598-021-04125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022] Open
Abstract
The objective of this work was to assess the consequences of repeated intra-articular injection of monosodium urate (MSU) crystals with inflammasome priming by lipopolysaccharide (LPS) in order to simulate recurrent bouts of gout in rats. Translational imaging was applied to simultaneously detect and quantify injury in different areas of the knee joint. MSU/LPS induced joint swelling, synovial membrane thickening, fibrosis of the infrapatellar fat pad, tidemark breaching, and cartilage invasion by inflammatory cells. A higher sensitivity to mechanical stimulus was detected in paws of limbs receiving MSU/LPS compared to saline-injected limbs. In MSU/LPS-challenged joints, magnetic resonance imaging (MRI) revealed increased synovial fluid volume in the posterior region of the joint, alterations in the infrapatellar fat pad reflecting a progressive decrease of fat volume and fibrosis formation, and a significant increase in the relaxation time T2 in femoral cartilage, consistent with a reduction of proteoglycan content. MRI also showed cyst formation in the tibia, femur remodeling, and T2 reductions in extensor muscles consistent with fibrosis development. Repeated intra-articular MSU/LPS injections in the rat knee joint induced pathology in multiple tissues and may be a useful means to investigate the relationship between urate crystal deposition and the development of degenerative joint disease.
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Affiliation(s)
- Nathalie Accart
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Janet Dawson
- Autoimmunity, Transplantation & Inflammation Department, Novartis Institutes for BioMedical Research, Lichtstr. 35, WSJ-386.6.08.18, CH-4056, Basel, Switzerland
| | - Michael Obrecht
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Christian Lambert
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Manuela Flueckiger
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Julie Kreider
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Shinji Hatakeyama
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Peter J Richards
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland
| | - Nicolau Beckmann
- Musculoskeletal Diseases Department, Novartis Institutes for BioMedical Research, Fabrikstr. 28.3.04, CH-4056, Basel, Switzerland.
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9
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Son CN, Cai K, Stewart S, Ferrier J, Billington K, Tsai YJJ, Bardin T, Horne A, Stamp LK, Doyle A, Dalbeth N. Development of a radiographic scoring system for new bone formation in gout. Arthritis Res Ther 2021; 23:296. [PMID: 34876237 PMCID: PMC8653557 DOI: 10.1186/s13075-021-02683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Features of new bone formation (NBF) are common in tophaceous gout. The aim of this project was to develop a plain radiographic scoring system for NBF in gout. Methods Informed by a literature review, scoring systems were tested in 80 individual 1st and 5th metatarsophalangeal joints. Plain radiography scores were compared with computed tomography (CT) measurements of the same joints. The best-performing scoring system was then tested in paired sets of hand and foot radiographs obtained over 2 years from an additional 25 patients. Inter-reader reproducibility was assessed using intraclass correlation coefficients (ICC). NBF scores were correlated with plain radiographic erosion scores (using the gout-modified Sharp-van der Heijde system). Results Following a series of structured reviews of plain radiographs and scoring exercises, a semi-quantitative scoring system for sclerosis and spur was developed. In the individual joint analysis, the inter-observer ICC (95% CI) was 0.84 (0.76–0.89) for sclerosis and 0.81 (0.72–0.87) for spur. Plain radiographic sclerosis and spur scores correlated with CT measurements (r = 0.65–0.74, P < 0.001 for all analyses). For the hand and foot radiograph sets, the inter-observer ICC (95% CI) was 0.94 (0.90–0.98) for sclerosis score and 0.76 (0.65–0.84) for spur score. Sclerosis and spur scores correlated highly with plain radiographic erosion scores (r = 0.87 and 0.71 respectively), but not with change in erosion scores over 2 years (r = −0.04–0.15). Conclusion A semi-quantitative plain radiographic scoring method for the assessment of NBF in gout is feasible, valid, and reproducible. This method may facilitate consistent measurement of NBF in gout. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02683-9.
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Affiliation(s)
- Chang-Nam Son
- Keimyung University School of Medicine, Daegu, South Korea. .,Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Ken Cai
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah Stewart
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - John Ferrier
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Karen Billington
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Yun-Jung Jack Tsai
- Department of Radiology, Auckland District Health Board, Auckland, New Zealand
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Paris, France
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Anthony Doyle
- Department of Radiology with Anatomy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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10
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DURAN E, BİLGİN E, ERTENLİ Aİ, KALYONCU U. The frequency of Achilles and plantar calcaneal spurs in gout patients. Turk J Med Sci 2021; 51:1841-1848. [PMID: 33754652 PMCID: PMC8569762 DOI: 10.3906/sag-2011-201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background/aim Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients. Matherial and methods We performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were analyzed by logistic regression analysis. Results 181 patients who had lateral foot radiograph were included in this study. Eighty-one (44.7%) patients had score ≥ 2 Achilles spur, 81 (44.7%) patients had score ≥ 2 plantar spur, and 22 (12.1%) patients had no spur. Age, disease duration, duration between the gout diagnosis and appearing spur, the presence of metabolic comorbidities and hypertension were higher in both Achilles and plantar spurs than no spur group. Forty (22.1%) patients had score ≥ 2 both Achilles and plantar spur. In this group, the mean age was older and the proportion of metabolic comorbidities was higher than the groups of Achilles and plantar spur with a score 0 or 1. Predictor of the development of large or moderate-severe calcaneal spur was the existence of metabolic comorbidity [OR (95% CI): 3.49 (1.11–11.0) and p = 0.033]. Conclusion The presence of metabolic comorbidities increases the frequency of calcaneal spurs in gout patients. This condition can be explained by the impaired microvascular structure and increased hypoxia resulting in calcification on the tendon and ligament insertion sites.
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Affiliation(s)
- Emine DURAN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Emre BİLGİN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Ali İhsan ERTENLİ
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Umut KALYONCU
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
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11
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Abstract
Urate is the end-product of the purine metabolism in humans. The dominant source of urate is endogenous purines and the remainder comes through diet. Approximately two thirds of urate is eliminated via the kidney with the rest excreted in the feces. While the transporter BCRP, encoded by ABCG2, has been found to play a role in both the gut and kidney, SLC22A12 and SLC2A9 encoding URAT1 and GLUT9, respectively, are the two transporters best characterized. Only 8-12% of the filtered urate is excreted by the kidney. Renal elimination of urate depends substantially on specific transporters, including URAT1, GLUT9 and BCRP. Studies that have assessed the biologic effects of urate have produced highly variable results. Although there is a suggestion that urate may have anti-oxidant properties in some circumstances, the majority of evidence indicates that urate is pro-inflammatory. Hyperuricemia can result in the formation of monosodium urate (MSU) crystals that may be recognized as danger signals by the immune system. This immune response results in the activation of the NLRP3 inflammasome and ultimately in the production and release of interleukin-1β, and IL-18, that mediate both inflammation, pyroptotic cell death, and necroinflammation. It has also been demonstrated that soluble urate mediates effects on the kidney to induce hypertension and can induce long term epigenetic reprogramming in myeloid cells to induce "trained immunity." Together, these sequelae of urate are thought to mediate most of the physiological effects of hyperuricemia and gout, illustrating this biologically active molecule is more than just an "end-product" of purine metabolism.
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Affiliation(s)
- Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham 27710, NC, USA.
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12
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Abstract
Multiple interacting checkpoints are involved in the pathophysiology of gout. Hyperuricemia is the key risk factor for gout and is considered a prerequisite for monosodium urate (MSU) crystal formation. Urate underexcretion through renal and gut mechanisms is the major mechanism for hyperuricemia in most people. Multiple genetic, environmental, and metabolic factors are associated with serum urate and alter urate transport or synthesis. Urate supersaturation is the most important factor for MSU crystal formation, and other factors such as temperature, pH, and connective tissue components also play a role. The nucleotide-binding oligomerization domain leucine-rich repeats and pyrin domain-containing protein 3 inflammasome plays a pivotal role in the inflammatory response to MSU crystals, and interleukin 1β is the key cytokine mediating the inflammatory cascade. Variations in the regulatory mechanisms of this inflammatory response may affect an individual's susceptibility to developing gout. Tophus formation is the cardinal feature of advanced gout, and both MSU crystals and the inflammatory tissue component of the tophus contribute to the development of structural joint damage owing to gout. In this article, we review the pathophysiologic mechanisms of hyperuricemia, MSU crystal formation and the associated inflammatory response, tophus formation, and structural joint damage in gout.
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13
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Pecherstorfer C, Simon D, Unbehend S, Ellmann H, Englbrecht M, Hartmann F, Figueiredo C, Hueber A, Haschka J, Kocijan R, Kleyer A, Schett G, Rech J, Bayat S. A Detailed Analysis of the Association between Urate Deposition and Erosions and Osteophytes in Gout. ACR Open Rheumatol 2020; 2:565-572. [PMID: 32955167 PMCID: PMC7571395 DOI: 10.1002/acr2.11172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize in detail the structural bone changes associated with the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout. METHODS Twenty patients with tophaceous gout and involvement of the MTP1 joint received both dual-energy computed tomography (DECT) of the feet for the detection of tophi and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet for the detection of bone erosions and osteophytes. Demographic and clinical data were collected. Tophi in DECT and erosions and osteophytes in HR-pQCT were overlayed to define their anatomical relation. In addition, the feet of 20 sex- and age-matched healthy controls were scanned to define the normal architecture of the MTP1 joint. RESULTS Patients with gout had an increased number and extent of bone erosions and osteophytes compared with their healthy counterparts (erosions: 5 [0-17] vs 1 [1-2], 45.32 mm3 [7.26-550.32] vs 0.82 mm3 [0.15-21.8]; osteophytes: 10.5 [0-26] vs 1 [0-10], 4.93 mm [0.77-7.19 mm] vs 0.93 mm [0.05-7.61 mm]; all P < 0.001). The median tophi volume detected by DECT (0.12 mm3 [0.01-2.53]) was highly associated with the total volume of erosions (r = 0.597, P = 0.005). CONCLUSION Gout patients show increased changes in their bone microarchitecture. The extent of uric acid deposition is positively correlated with the extent of bone loss at the MTP1 joint, highlighting the strong cohesion of inflammation and erosive changes.
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Affiliation(s)
- Caroline Pecherstorfer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Unbehend
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hanna Ellmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Hartmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Camille Figueiredo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel Hueber
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Vienna, Austria and Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Bayat
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
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14
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Felten R, Duret PM, Gottenberg JE, Spielmann L, Messer L. At the crossroads of gout and psoriatic arthritis: "psout". Clin Rheumatol 2020; 39:1405-1413. [PMID: 32062768 DOI: 10.1007/s10067-020-04981-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
Psoriatic arthritis and gout are frequently encountered conditions sharing a number of common risk factors, which render their independent study difficult. Epidemiological studies have demonstrated a strong link between these diseases, suggesting the presence of underlying, intertwined pathophysiological mechanisms that currently remain unknown. Indeed, sodium urate crystals could play a pathogenic role in psoriasis and psoriatic arthritis. In daily practice, the distinction between psoriatic arthritis associated with hyperuricemia and a gouty arthropathy with psoriasis is complex. Several common pathogenic features suggest a more intricate relationship than their mere coexistence in the same patient. Thus, the concurrence of these two diseases should be seen as a novel overlap syndrome, at the boundary between inflammatory and metabolic rheumatism. The present update aims to clarify the determinants of the link and to define this new nosological entity. Its recognition could have therapeutic implications that appear essential for treatment optimization in a personalized setting.Key Points• What is already known about this subject? Psoriatic arthritis (PsA) and gout have strong interconnections, including comorbidities and pathophysiology. One must note that confounding clinical symptoms and radiological signs of PsA and gout are similar and difficult to differentiate in patients whose radiological lesions become too advanced to be differentiated or with less clearly defined phenotypes.• What does this study add? The pathogenic role of chronic hyperuricemia in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These two pathological processes can influence each other.• How might this impact on clinical practice? This new line of thinking regarding the convergence of gout and PsA, involving the role of urate crystals, could prompt a potential new approach to treatment (urate-lowering therapy) among patients with active/refractory PsA.
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Affiliation(s)
- Renaud Felten
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France. .,Laboratoire d'Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France.
| | - Pierre-Marie Duret
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France.,Laboratoire d'Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France
| | - Lionel Spielmann
- Service de Rhumatologie, Hospices Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
| | - Laurent Messer
- Service de Rhumatologie, Hospices Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
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15
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Li L, Wang D, Wang X, Bai R, Wang C, Gao Y, Anastassiades T. N-Butyrylated hyaluronic acid ameliorates gout and hyperuricemia in animal models. PHARMACEUTICAL BIOLOGY 2019; 57:717-728. [PMID: 31622116 PMCID: PMC8871623 DOI: 10.1080/13880209.2019.1672755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Context: Hyaluronic acid (HA) plays critical roles in the structural skeleton, joint lubrication, renal function and cell signaling. We previously showed that partially N-butyrylated, low molecular weight, hyaluronic acid (BHA) exhibited an anti-inflammatory effect in cultured human macrophage, where inflammation was induced either by a TL-4 agonist or the low molecular weight HA itself, in dose-dependent fashion. Objectives: To investigate the anti-inflammatory, antioxidative, and antihyperuricemic effects of BHA using animal models of acute gouty arthritis and hyperuricemia. Materials and methods: The anti-inflammatory effect of articular BHA (10 and 50 μg) injections was evaluated by measuring joint swelling and the serum levels of inflammatory cytokines in a model of acute gouty arthritis induced by intra-articular injection of monosodium urate crystals in Wistar rats (n = 10/group), in comparison to the control group with saline injection. Antioxidative and antihyperuricemic activities were investigated using intraperitoneal injections of oteracil potassium and yeast extract hyperuricemic Balb/C mice, which were treated with intraperitoneal injection of BHA at day 6-8 in the model. Results: In the gouty arthritis rat model, BHA at a higher dosage (50 μg) demonstrated a strong anti-inflammatory effect by reducing the degree of articular swelling and the serum levels of IL-1β, IL-8, IFN-γ, and MCP-1 by 5.56%, 6.55%, 15.58% and 33.18%. In the hyperuricemic mouse model, lower dosage BHA (10 μg) was sufficient to provide antioxidative activities by significantly decreasing the ROS levels in both serum and liver by 14.87% and 8.04%, while improving liver SOD by 12.77%. Intraperitoneal injection of BHA suppressed uric acid production through reducing liver XO activity by 19.78% and decreased the serum uric acid level in hyperuricemic mice by 30.41%. Conclusions: This study demonstrated for the first time that BHA exhibits anti-inflammatory, antioxidative and antihyperuricemic effects in vivo, suggesting a potential therapeutic application of BHA in gouty arthritis and hyperuricemia.
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Affiliation(s)
- Lanzhou Li
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Di Wang
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Xueju Wang
- Pathology Department of China–Japan Union Hospital, Jilin University, Changchun, China
| | - Ruifeng Bai
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Chunyu Wang
- State Key Laboratory of Supramolecular Structure and Materials, Jilin University, Changchun, China
| | - Yin Gao
- Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
- CONTACT Yin Gao School of Life Sciences, Jilin University, Changchun130012, China
| | - Tassos Anastassiades
- Division of Rheumatology, Department of Medicine, Queen’s University, Kingston, Canada
- Tassos Anastassiades Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario K7L 3N6, Canada
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16
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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17
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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18
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Chhana A, Pool B, Callon KE, Tay ML, Musson D, Naot D, McCarthy G, McGlashan S, Cornish J, Dalbeth N. Monosodium urate crystals reduce osteocyte viability and indirectly promote a shift in osteocyte function towards a proinflammatory and proresorptive state. Arthritis Res Ther 2018; 20:208. [PMID: 30201038 PMCID: PMC6131786 DOI: 10.1186/s13075-018-1704-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background Bone erosion is a frequent complication of gout and is strongly associated with tophi, which are lesions comprising inflammatory cells surrounding collections of monosodium urate (MSU) crystals. Osteocytes are important cellular mediators of bone remodeling. The aim of this study was to investigate the direct effects of MSU crystals and indirect effects of MSU crystal-induced inflammation on osteocytes. Methods For direct assays, MSU crystals were added to MLO-Y4 osteocyte cell line cultures or primary mouse osteocyte cultures. For indirect assays, the RAW264.7 macrophage cell line was cultured with or without MSU crystals, and conditioned medium from these cultures was added to MLO-Y4 cells. MLO-Y4 cell viability was assessed using alamarBlue® and LIVE/DEAD® assays, and MLO-Y4 cell gene expression and protein expression were assessed by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. Histological analysis was used to examine the relationship between MSU crystals, inflammatory cells, and osteocytes in human joints affected by tophaceous gout. Results In direct assays, MSU crystals reduced MLO-Y4 cell and primary mouse osteocyte viability but did not alter MLO-Y4 cell gene expression. In contrast, conditioned medium from MSU crystal-stimulated RAW264.7 macrophages did not affect MLO-Y4 cell viability but significantly increased MLO-Y4 cell expression of osteocyte-related factors including E11, connexin 43, and RANKL, and inflammatory mediators such as interleukin (IL)-6, IL-11, tumor necrosis factor (TNF)-α and cyclooxygenase-2 (COX-2). Inhibition of COX-2 in MLO-Y4 cells significantly reduced the indirect effects of MSU crystals. In histological analysis, CD68+ macrophages and MSU crystals were identified in close proximity to osteocytes within bone. COX-2 expression was also observed in tophaceous joint samples. Conclusions MSU crystals directly inhibit osteocyte viability and, through interactions with macrophages, indirectly promote a shift in osteocyte function that favors bone resorption and inflammation. These interactions may contribute to disordered bone remodeling in gout. Electronic supplementary material The online version of this article (10.1186/s13075-018-1704-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashika Chhana
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Bregina Pool
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Karen E Callon
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Mei Lin Tay
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - David Musson
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Dorit Naot
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susan McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Bone & Joint Research Group, University of Auckland, Auckland, New Zealand. .,Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.
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19
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Czegley C, Gillmann C, Schauer C, Seyler L, Reinwald C, Hahn M, Uder M, Jochmann K, Naschberger E, Stock M, Schett G, Bäuerle T, Hoffmann MH. A model of chronic enthesitis and new bone formation characterized by multimodal imaging. Dis Model Mech 2018; 11:dmm.034041. [PMID: 30045841 PMCID: PMC6176995 DOI: 10.1242/dmm.034041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/07/2018] [Indexed: 01/15/2023] Open
Abstract
Enthesitis is a key feature of several different rheumatic diseases. Its pathophysiology is only partially known due to the lack of access to human tissue and the shortage of reliable animal models for enthesitis. Here, we aimed to develop a model that mimics the effector phase of enthesitis and reliably leads to inflammation and new bone formation. Enthesitis was induced by local injection of monosodium urate (MSU) crystals into the metatarsal entheses of wild-type (WT) or oxidative-burst-deficient (Ncf1**) mice. Quantitative variables of inflammation (edema, swelling) and vascularization (tissue perfusion) were assessed by magnetic resonance imaging (MRI), bone-forming activity by [18F]-fluoride positron emission tomography (PET), and destruction of cortical bone and new bone formation by computed tomography (CT). Non-invasive imaging was validated by histochemical and histomorphometric analysis. While injection of MSU crystals into WT mice triggered transient mild enthesitis with no new bone formation, Ncf1** mice developed chronic enthesitis accompanied by massive enthesiophytes. In MRI, inflammation and blood flow in the entheses were chronically increased, while PET/CT showed osteoproliferation with enthesiophyte formation. Histochemical analyses showed chronic inflammation, increased vascularization, osteoclast differentiation and bone deposition in the affected entheseal sites. Herein we describe a fast and reliable effector model of chronic enthesitis, which is characterized by a combination of inflammation, vascularization and new bone formation. This model will help to disentangle the molecular pathways involved in the effector phase of enthesitis.
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Affiliation(s)
- Christine Czegley
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Clarissa Gillmann
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Christine Schauer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Lisa Seyler
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Christiane Reinwald
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Madelaine Hahn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Katja Jochmann
- Department of Developmental Biology, Centre of Medical Biotechnology, Faculty of Biology, University of Duisburg-Essen, 45117, Essen, Germany
| | - Elisabeth Naschberger
- Division of Molecular and Experimental Surgery, Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Michael Stock
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Markus H Hoffmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
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Nam JS, Jagga S, Sharma AR, Lee JH, Park JB, Jung JS, Lee SS. Anti-inflammatory effects of traditional mixed extract of medicinal herbs (MEMH) on monosodium urate crystal-induced gouty arthritis. Chin J Nat Med 2018; 15:561-575. [PMID: 28939019 DOI: 10.1016/s1875-5364(17)30084-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 02/07/2023]
Abstract
Korean oriental medicine prescription is widely used for the treatment of gouty diseases. In the present study, we investigated anti-inflammatory effects of modified Korean herbal formulation, mixed extract of medicinal herbs (MEMH), and its modulatory effects on inflammatory mediators associated with gouty arthritis. Both in vitro and in vivo studies were carried out to assess the anti-inflammatory efficacy of MEMH on monosodium urate (MSU) crystals-induced gouty inflammation. MSU crystals stimulated human chondrosarcoma cell line, SW1353, and human primary chondrocytes were treated with MEMH in vitro. The expression levels of pro-inflammatory mediators and metalloproteases were analyzed. The effect of MEMH on NFκB signaling pathway in SW1353 cells was examined. Effect of MEMH on the mRNA expression level of pro-inflammatory mediators and chemotactic factor from human monocytic cell line, THP-1, was also analyzed. The probable role of MEMH in the differentiation process of osteoblast like cells, SaOS-2, after MSU treatment was also observed. To investigate the effects of MEMH in vivo, MSU crystals-induced ankle arthritic model was established. Histopathological changes in affected joints and plasma levels of pro-inflammatory mediators (IL-1β and TNFα) were recorded. MEMH inhibited NFκB signaling pathway and COX-2 protein expression in chondrocytes. MSU-induced mRNA expressions of pro-inflammatory mediators and chemotactic cytokines were suppressed by MEMH. In MSU crystals-induced ankle arthritic mouse model, administration of MEMH relieved inflammatory symptoms and decreased the plasma levels of IL-1β and TNFα. The results indicated that MEMH can effectively inhibit the expression of inflammatory mediators in gouty arthritis, demonstrating its potential for treating gouty arthritis.
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Affiliation(s)
- Ju-Suk Nam
- Institute For Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24252, Republic of Korea
| | - Supriya Jagga
- Institute For Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24252, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute For Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24252, Republic of Korea
| | - Joon-Hee Lee
- Hana Oriental Clinic, Chucnheon, Gangwon-do 24433, Republic of Korea
| | - Jong Bong Park
- Institute For Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24252, Republic of Korea
| | - Jun-Sub Jung
- Institute of Natural Medicine, College of Medicine, Hallym University, Chucheon, Gangwon-do 24252, Republic of Korea
| | - Sang-Soo Lee
- Institute For Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do 24252, Republic of Korea.
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Dalbeth N, Doyle AJ. Imaging tools to measure treatment response in gout. Rheumatology (Oxford) 2018; 57:i27-i34. [PMID: 29272513 DOI: 10.1093/rheumatology/kex445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/13/2022] Open
Abstract
Imaging tests are in clinical use for diagnosis, assessment of disease severity and as a marker of treatment response in people with gout. Various imaging tests have differing properties for assessing the three key disease domains in gout: urate deposition (including tophus burden), joint inflammation and structural joint damage. Dual-energy CT allows measurement of urate deposition and bone damage, and ultrasonography allows assessment of all three domains. Scoring systems have been described that allow radiological quantification of disease severity and these scoring systems may play a role in assessing the response to treatment in gout. This article reviews the properties of imaging tests, describes the available scoring systems for quantification of disease severity and discusses the challenges and controversies regarding the use of imaging tools to measure treatment response in gout.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
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Durcan L, Grainger R, Keen HI, Taylor WJ, Dalbeth N. Imaging as a potential outcome measure in gout studies: A systematic literature review. Semin Arthritis Rheum 2016; 45:570-9. [PMID: 26522139 DOI: 10.1016/j.semarthrit.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/28/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite major progress in the imaging of gout, it is unclear which domains these techniques can evaluate and whether imaging modalities have the potential to provide valid outcome measures. The aim of this study was to assess the use of imaging instruments in gout according to the Outcomes in Rheumatology Clinical Trials (OMERACT) filter to inform the development of imaging as an outcome measure. METHODS A systematic literature search of imaging modalities for gout was undertaken. Articles were assessed by two reviewers to identify imaging domains and summarize information according to the OMERACT filter. RESULTS The search identified 78 articles (one abstract). Modalities included were conventional radiography (CR) (16 articles), ultrasound (US) (29), conventional computed tomography (CT) (11), dual energy computed tomography (DECT) (20), and magnetic resonance imaging (MRI) (16). Three domains were identified as follows: urate deposition, joint damage, and inflammation. Although sufficient data were available to assess feasibility, validity, and reliability, comprehensive assessment of discrimination was not possible due to the paucity of prospective imaging studies. CR is widely accessible, inexpensive with a validated damage scoring system. US and MRI offer radiation-free methods of evaluating urate deposition, damage and inflammation, but may be limited by accessibility. DECT provides excellent definition of urate deposition and bone damage, but has restricted availability and requires radiation. CONCLUSIONS Imaging methods can detect urate deposition, damage, and inflammation in gout. More than one modality may be required depending on the domains and therapeutic agent of interest. No single imaging method currently fulfils all aspects of the OMERACT filter for any domain.
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Affiliation(s)
- Laura Durcan
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument St, Baltimore, MD 21287.
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Helen I Keen
- University of Western Australia, Perth, Australia
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nicola Dalbeth
- Division of Medicine, University of Auckland, Auckland, New Zealand
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23
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Dalbeth N, Gamble GD, Horne A, Reid IR. Relationship Between Changes in Serum Urate and Bone Mineral Density During Treatment with Thiazide Diuretics: Secondary Analysis from a Randomized Controlled Trial. Calcif Tissue Int 2016; 98:474-8. [PMID: 26713333 DOI: 10.1007/s00223-015-0101-7] [Citation(s) in RCA: 6] [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] [Received: 09/29/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
In observational studies, serum urate concentrations associate with bone mineral density (BMD) and reduced risk of fractures. Thiazide diuretics slow the bone loss in healthy older adults, are associated with reduced incidence of fracture and also increase serum urate. We hypothesized that changes in serum urate are associated with changes in BMD during treatment with thiazide diuretics. We analysed data from a double-blind randomized controlled trial of hydrochlorothiazide (50 mg per day) and placebo in normal post-menopausal women. The relationship between change in serum urate and change in BMD after 2 years of treatment was examined using Spearman correlation and multiple linear regression models. Total body BMD increased in the hydrochlorothiazide group by 0.52 % and reduced in the placebo group by 0.29 % over 2 years (between group difference P = 0.0034). Serum urate increased in the hydrochlorothiazide group by 0.038 mmol/L and reduced in the placebo group by 0.004 mmol/L (between group difference P < 0.0001). At Year 2, there was a positive relationship between the change in serum urate and change in total body BMD for entire study population (r = 0.32, P = 0.0002) and for the hydrochlorothiazide group (r = 0.29, P = 0.023). The association between change in serum urate and change in total body BMD persisted after adjusting for treatment allocation, and change in weight, serum calcium, urinary calcium and serum creatinine (P change in serum urate = 0.043). These data raise the possibility that the effects of hydrochlorothiazide on BMD may be mediated, in part, by changes in serum urate concentrations.
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Affiliation(s)
- Nicola Dalbeth
- Auckland Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
| | - Gregory D Gamble
- Auckland Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Anne Horne
- Auckland Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Ian R Reid
- Auckland Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
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24
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Son CN, Kim TE, Park K, Hwang JH, Kim SK. Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis. J Korean Med Sci 2016; 31:435-42. [PMID: 26955246 PMCID: PMC4779870 DOI: 10.3346/jkms.2016.31.3.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman's rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.
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Affiliation(s)
- Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Tae Eun Kim
- Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Kyungmin Park
- Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Jun Hyun Hwang
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Arthritis & Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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25
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Chhana A, Aati O, Gamble GD, Callon KE, Doyle AJ, Roger M, McQueen FM, Horne A, Reid IR, Cornish J, Dalbeth N. Path Analysis Identifies Receptor Activator of Nuclear Factor-κB Ligand, Osteoprotegerin, and Sclerostin as Potential Mediators of the Tophus-bone Erosion Relationship in Gout. J Rheumatol 2016; 43:445-9. [PMID: 26773114 DOI: 10.3899/jrheum.150738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the relationship between tophus, erosion and bone remodeling factors in gout. METHODS Computed tomography bone erosion and circulating bone factors were measured in adults with tophaceous gout. Multiple regression modeling and path analysis were used to determine predictors of erosion. RESULTS Tophus number, Māori or Pacific ethnicity, creatinine, receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), and sclerostin were independently associated with erosion. Path analysis showed a direct effect of tophus number on erosion, partially mediated through OPG, RANKL, and sclerostin. CONCLUSION Tophus number is strongly associated with bone erosion in gout. Circulating RANKL, OPG, and sclerostin are potential mediators of tophus-related erosion.
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Affiliation(s)
- Ashika Chhana
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Opetaia Aati
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Gregory D Gamble
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Karen E Callon
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Anthony J Doyle
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Mark Roger
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Fiona M McQueen
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Anne Horne
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Ian R Reid
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Jillian Cornish
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland
| | - Nicola Dalbeth
- From the Bone and Joint Research Group, the Department of Medicine, the Department of Anatomy with Radiology, and the Department of Molecular Medicine and Pathology, University of Auckland; and the Department of Radiology, Auckland District Health Board, Auckland, New Zealand.A. Chhana, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; O. Aati, MHSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; G.D. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; K.E. Callon, BSc, Bone and Joint Research Group, Department of Medicine, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, University of Auckland; I.R. Reid, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; J. Cornish, PhD, Bone and Joint Research Group, Department of Medicine, University of Auckland; N. Dalbeth, MBChB, MD, FRACP, Bone and Joint Research Group, Department of Medicine, University of Auckland; A.J. Doyle, MBChB, Department of Anatomy with Radiology, University of Auckland, and Department of Radiology, Auckland District Health Board; M. Roger, MBChB, Department of Radiology, Auckland District Health Board; F.M. McQueen, MD, FRACP, Department of Molecular Medicine and Pathology, University of Auckland.
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26
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The associations of serum uric acid level and hyperuricemia with knee osteoarthritis. Rheumatol Int 2016; 36:567-73. [PMID: 26743214 DOI: 10.1007/s00296-015-3418-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/23/2015] [Indexed: 12/31/2022]
Abstract
To examine the cross-sectional associations of the serum uric acid level and hyperuricemia (HU) with the radiographic features of osteoarthritis (OA), including osteophytes (OST) and joint space narrowing (JSN), a total of 4685 subjects were included in this study. Blood samples were drawn from all subjects. Serum uric acid and some other indexes were detected. OST and JSN were assessed for each subject according to the Osteoarthritis Research Society International (OARSI) atlas. A multivariable logistic analysis model was applied to test the target associations after adjusting a number of potential confounding factors. The prevalence of OST was increased in the highest tertile of uric acid compared to the lowest in female subjects (OR 1.46, 95 % CI 1.07-1.99, P for trend = 0.02). Meanwhile, a positive association between OST and HU was observed in female subjects (OR 1.43, 95 % CI 1.01-2.03, P = 0.05). However, serum uric acid and HU were not significantly associated with JSN in male subjects. The findings of this study indicated that the serum uric acid concentration and prevalence of HU are positively associated with OST of the knee in the female population. Level of evidence Cross-sectional study, Level III.
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Abstract
The tophus is the cardinal feature of advanced gout. This review summarises recent research into the biology, impact and treatment of tophaceous gout. Microscopically, tophi are chronic foreign body granuloma-like structures containing collections of monosodium urate (MSU) crystals surrounded by inflammatory cells and connective tissue. Extracellular trap formation mediated by neutrophil interactions with MSU crystals may be a central checkpoint in tophus formation. Gouty tophi impact on many aspects of health-related quality of life. Tophi are also implicated in the development of structural joint damage and increased mortality risk in people with gout. Effective treatment of tophaceous gout requires long-term urate-lowering therapy, ideally to achieve a serum urate concentration of <5 mg/dL (300 μmol/L). Recent advances in gout therapeutics have expanded urate-lowering therapy options for patients with severe tophaceous disease to allow faster regression of tophi, improved health-related quality of life and, potentially, improved structural outcomes.
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Affiliation(s)
- Ashika Chhana
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd. Grafton, Auckland, New Zealand,
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Vukelić-Nikolić M, Kolarević A, Tomović K, Yancheva D, Cherneva E, Najman S, Šmelcerović A. Effects on MC3T3-E1 Cells and In Silico Toxicological Study of Two 6-(Propan-2-yl)-4-methyl-morpholine-2,5-diones. Nat Prod Commun 2015. [DOI: 10.1177/1934578x1501000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recently, we found that two cyclodidepsipeptides, 3,6-di-(propan-2-yl)-4-methyl-morpholine-2,5-dione (1) and 3-(2-methylpropyl)-6-(propan-2-yl)-4-methyl-morpholine-2,5-dione (2), are excellent inhibitors of xanthine oxidase. In order to obtain more information about the toxicological potential of compounds 1 and 2 on bone cells, the current study was designed to evaluate the effect of these compounds on viability and proliferation of MC3T3-E1 cells. Compound 1 showed neither cytotoxic nor stimulatory effect on cell viability, while compound 2 showed a slight stimulatory effect on cell viability. Both studied compounds showed slight stimulatory effects on proliferation of MC3T3-E1 cells, in a dose dependent manner. Additionally, an in silico toxicological study of compounds 1 and 2 was performed, and the results indicate that they have a good probability of safe biological intake.
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Affiliation(s)
- Marija Vukelić-Nikolić
- Institute of Biology and Human Genetics, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
| | - Ana Kolarević
- Department of Pharmacy, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
| | - Katarina Tomović
- Department of Pharmacy, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
| | - Denitsa Yancheva
- Laboratory of Structural Organic Analysis, Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., build. 9, 1113 Sofia, Bulgaria
| | - Emiliya Cherneva
- Department of Chemistry, Faculty of Pharmacy, Medical University of Sofia, 2 Dunav Str., 1000 Sofia, Bulgaria
| | - Stevo Najman
- Institute of Biology and Human Genetics, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
| | - Andrija Šmelcerović
- Department of Pharmacy, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
- Department of Chemistry, Faculty of Medicine, University of Nis, Bulevar Dr Zorana Djindjica 81, 18000 Nis, Serbia
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Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints. Clin Rheumatol 2015; 34:1939-47. [PMID: 25681072 DOI: 10.1007/s10067-015-2895-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/02/2015] [Accepted: 02/03/2015] [Indexed: 12/27/2022]
Abstract
The aims of the current study are to describe gadolinium-enhanced MRI features of an acute flare of established gouty arthritis in different joints and to examine a possible association between serum uric acid and MRI signs indicative of ongoing inflammation and/or structural joint damage as well as association with disease characteristics and laboratory findings. Twenty-seven male patients with established chronic gout agreed to participate, mean age 47.6 years, and mean disease duration in months 43.2 (±31.8). For all patients, detailed demographic, disease characteristics, and laboratory findings were obtained and correlated with MRI findings. In 27 patients with established gout, a total of 50 MRI studies were performed of the following joints: feet joints (n = 23), ankles (n = 18), knees (n = 5), and hand and wrist joints (n = 4). MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases. In 17 cases, tophaceous lesions were found. Post contrast MRI showed synovial thickening in seven cases. Positive correlations were observed between serum uric acid levels and the following MRI findings: capsular thickening (r = 0.552, p = 0.003), BME (r = 0.668, p ≤ 0.0001), STE (r = 0.559, p = 0.002), and tenosynovitis (r = 0.513, p = 0.006). Using MRI in chronic gout, important features can be detected like BME, minute cartilaginous erosions, and hypertrophic synovial inflammation in post contrast MR images. Serum uric acid (SUA) was positively correlated with capsular thickening, BME, STE, and tenosynovitis.
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Abstract
There has been increased interest in gout in both academic and clinical practice settings. Several reasons may explain this. The prevalence of both hyperuricemia and gout has risen in the last decades in developed countries and therefore the burden of gout has increased. The association of hyperuricemia and gout with cardiovascular outcomes and the opportunity of further benefits of intervention on hyperuricemia have been recently highlighted in the literature. Imaging techniques have proven to be useful for detection of urate deposition, even prior to the first clinical symptoms, enabling the evaluation of the extent of deposition and providing objective measurement of crystal depletion during urate-lowering treatment. Treating to target is increasingly used as the approach to treatment of diverse diseases. Therefore, different targets have been recommended for different stages of the burden of disease and for different stages of treatment. The final strategic target, to which any effort should be taken into consideration, is to completely dissolve urate crystals in tissues and therefore avoid further symptoms and structural damage of involved musculoskeletal structures. In summary, evidence suggest that an early approach to the treatment of gout and associated comorbidities is advisable, that new imaging techniques may help to evaluate both the burden of deposition and response to urate-lowering treatment in selected patients, and finally that the final strategic objective of healthcare for patients with gout is to completely resolve urate crystal deposits.
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Affiliation(s)
- Fernando Perez-Ruiz
- Servicio de Reumatologia, Hospital Universitario Cruces, and BioCruces Health Research Institute, 48903, Baracaldo, Vizcaya, Spain,
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Chowalloor PV, Siew TK, Keen HI. Imaging in gout: A review of the recent developments. Ther Adv Musculoskelet Dis 2014; 6:131-43. [PMID: 25342993 DOI: 10.1177/1759720x14542960] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Gout is a common inflammatory arthritis and is caused by accumulation of monosodium urate crystals in joints and soft tissues. Apart from joint damage, untreated gout is associated with cardiovascular and renal morbidity. Gout, whilst in principle considered to be well understood and simple to treat, often presents diagnostic and management challenges, with evidence to suggest that it is often inadequately treated and poor compliance is a major issue. Imaging tools can aid clinicians in establishing the correct diagnosis, when histological crystal diagnosis is unable to be established, and also assess the burden of inflammatory and structural disease. Imaging can also be used to monitor treatment response. The imaging techniques that currently have a role in the imaging of gout include conventional radiography, ultrasound, computed tomography, dual energy computed tomography, magnetic resonance imaging and nuclear medicine. Despite the lack of major technological advances in imaging of gout in recent years, scientific studies of existing imaging modalities have improved our understanding of the disease, and how to best utilize imaging techniques in the clinical setting.
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Affiliation(s)
- Priya Varghese Chowalloor
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Teck K Siew
- Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Helen Isobel Keen
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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Liu J, Zou GJ, Wu YF, Shen QF. An unusual case of multiple subcutaneous large tophi. QJM 2014; 107:325-6. [PMID: 23904522 DOI: 10.1093/qjmed/hct166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dalbeth N, Doyle AJ, McQueen FM, Sundy J, Baraf HSB. Exploratory study of radiographic change in patients with tophaceous gout treated with intensive urate-lowering therapy. Arthritis Care Res (Hoboken) 2014; 66:82-5. [PMID: 23836458 DOI: 10.1002/acr.22059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/03/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Tophi are strongly associated with structural damage in gout, and urate-lowering therapy reduces tophus size. Pegloticase leads to dramatic reductions in serum urate and subcutaneous tophi in treatment responders. The aim of this analysis was to examine whether profound urate lowering can alter radiographic findings in gout. METHODS Serial plain radiographs of the hands and feet were obtained from 8 patients with tophaceous gout treated with pegloticase. Radiographs were scored for erosion and joint space narrowing (JSN) according to the gout-modified Sharp/van der Heijde method. Scorers were blinded to each other's scores and to the clinical characteristics of the patients (including the clinical response to pegloticase). A detailed qualitative site-by-site analysis was undertaken to define additional changes observed from baseline. RESULTS All patients experienced a profound urate-lowering response (serum urate level <1 mg/dl) during pegloticase treatment. For the entire group, the median total radiographic scores reduced from 69.25 (range 1.5-138) at baseline to 57.25 (range 1.5-110) at 12 months (P = 0.02). Median erosion scores reduced over 1 year (P = 0.008), but JSN scores did not change (P = 0.50). Further reductions were observed in total scores and erosion scores in 5 patients with 24-month followup films (one-way analysis of variance P = 0.009 for total score, 0.02 for erosion, and 0.95 for JSN). Qualitative site-by-site analysis identified regression of soft tissue masses, increased sclerosis, and filling in of erosions in the followup films. CONCLUSION This exploratory study suggests that profound urate lowering can lead to improvement in structural damage, particularly bone erosion, in patients with tophaceous gout.
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Dalbeth N, Aati O, Kalluru R, Gamble GD, Horne A, Doyle AJ, McQueen FM. Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study. Ann Rheum Dis 2014; 74:1030-6. [DOI: 10.1136/annrheumdis-2013-204273] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 01/24/2014] [Indexed: 11/04/2022]
Abstract
ObjectivesThe aim of this work was to examine the relationship between joint damage and monosodium urate (MSU) crystal deposition in gout.MethodsPlain radiographs and dual-energy CT (DECT) scans of the feet were prospectively obtained from 92 people with tophaceous gout. Subcutaneous tophus count was recorded. The ten metatarsophalangeal joints were scored on plain radiography for Sharp–van der Heijde erosion and joint space narrowing (JSN) scores, and presence of spur, osteophyte, periosteal new bone and sclerosis (920 total joints). DECT scans were analysed for the presence of MSU crystal deposition at the same joints.ResultsDECT MSU crystal deposition was more frequently observed in joints with erosion (OR (95% CI) 8.5 (5.5 to 13.1)), JSN (4.2 (2.7 to 6.7%)), spur (7.9 (4.9 to 12.8)), osteophyte (3.9 (2.5 to 6.0)), periosteal new bone (7.0 (4.0 to 12.2)) and sclerosis (6.9 (4.6 to 10.2)), p<0.0001 for all. A strong linear relationship was observed in the frequency of joints affected by MSU crystals with radiographic erosion score (p<0.0001). The number of joints at each site with MSU crystal deposition correlated with all features of radiographic joint damage (r>0.88, p<0.05 for all). In linear regression models, the relationship between MSU crystal deposition and all radiographic changes except JSN and osteophytes persisted after adjusting for subcutaneous tophus count, serum urate concentration and disease duration.ConclusionsMSU crystals are frequently present in joints affected by radiographic damage in gout. These findings support the concept that MSU crystals interact with articular tissues to influence the development of structural joint damage in this disease.
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Dalbeth N, Doyle AJ. Imaging of gout: an overview. Best Pract Res Clin Rheumatol 2013; 26:823-38. [PMID: 23273794 DOI: 10.1016/j.berh.2012.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/13/2012] [Indexed: 01/30/2023]
Abstract
The diverse clinical states and sites of pathology in gout provide challenges when considering the features apparent on imaging. Ideally, an imaging modality should capture all aspects of disease including monosodium urate crystal deposition, acute inflammation, tophus, tissue remodelling and complications of disease. The modalities used in gout include conventional radiography, ultrasonography, magnetic resonance imaging, computed tomography and dual-energy computed tomography. This review discusses the role of each of these imaging modalities in gout, focussing on the imaging characteristics, role in gout diagnosis and role for disease monitoring. Ultrasonography and dual-energy computed tomography are particularly promising methods for both non-invasive diagnosis and monitoring of disease. The observation that ultrasonographic appearances of monosodium urate crystal deposition can be observed in patients with hyperuricaemia but no other clinical features of gout raises important questions about disease definitions.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand.
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Abstract
If left untreated, gout may result in radiographic abnormalities, that is, cartilage loss and periarticular osteopenia plus more-or-less gout-specific radiographic abnormalities: spurs, sclerosis, and periostal new bone formation. In the current issue, Dalbeth and colleagues describe findings from about 800 joints in 20 mostly tophaceous patients, which can help clinicians to identify osteopathologic gout: spurs, osteosclerosis, ankylosis and periostal new bone formation, all symptoms of advanced, untreated gout. These are hallmarks of chronic untreated gout and are to be prevented.
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Dalbeth N, Choi HK. Dual-Energy Computed Tomography for Gout Diagnosis and Management. Curr Rheumatol Rep 2012; 15:301. [DOI: 10.1007/s11926-012-0301-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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