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Johnson RJ, Mandell BF, Schlessinger N, Mount DB, Botson JK, Abdellatif AA, Rhoades R, Singh JA. Controversies and practical management of patients with gout and chronic kidney disease. Kidney Int 2024:S0085-2538(24)00473-3. [PMID: 39033815 DOI: 10.1016/j.kint.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/05/2024] [Accepted: 05/28/2024] [Indexed: 07/23/2024]
Abstract
Uric acid is a toxin retained with advancing kidney disease. Clinical manifestations of hyperuricemia include gout and systemic inflammation that are associated with increased risk for cardiovascular mortality. As many as one third of all patients with chronic kidney disease (CKD) have a history of gout, yet <25% of these patients are effectively treated to target serum urate levels of ≤6 mg/dL. A major reason for ineffective management of gout and hyperuricemia is the complexity in managing these patients, with some medications contraindicated, others requiring special dosing, potential drug interactions, and other factors. Consequently, many nephrologists do not primarily manage gout despite it being a common complication of CKD, leaving management to the primary physician or rheumatologist. We believe that kidney specialists should consider gout as a major complication of CKD and actively manage it in their patients. Here, we present insights from nephrologists and rheumatologists on a team approach to gout management that includes the nephrologist.
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Affiliation(s)
- Richard J Johnson
- Division of Renal Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Brian F Mandell
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic Lerner College of Medicine of Case Western University
| | - Naomi Schlessinger
- Division of Rheumatology, Spencer Fox Eccles School of Medicine, University of Utah
| | - David B Mount
- Renal Divisions, Brigham and Women's Hospital and VA Boston Healthcare System, Harvard Medical School, Boston
| | | | | | | | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
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2
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Imenez Silva PH, Pepin M, Figurek A, Gutiérrez-Jiménez E, Bobot M, Iervolino A, Mattace-Raso F, Hoorn EJ, Bailey MA, Hénaut L, Nielsen R, Frische S, Trepiccione F, Hafez G, Altunkaynak HO, Endlich N, Unwin R, Capasso G, Pesic V, Massy Z, Wagner CA. Animal models to study cognitive impairment of chronic kidney disease. Am J Physiol Renal Physiol 2024; 326:F894-F916. [PMID: 38634137 DOI: 10.1152/ajprenal.00338.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Mild cognitive impairment (MCI) is common in people with chronic kidney disease (CKD), and its prevalence increases with progressive loss of kidney function. MCI is characterized by a decline in cognitive performance greater than expected for an individual age and education level but with minimal impairment of instrumental activities of daily living. Deterioration can affect one or several cognitive domains (attention, memory, executive functions, language, and perceptual motor or social cognition). Given the increasing prevalence of kidney disease, more and more people with CKD will also develop MCI causing an enormous disease burden for these individuals, their relatives, and society. However, the underlying pathomechanisms are poorly understood, and current therapies mostly aim at supporting patients in their daily lives. This illustrates the urgent need to elucidate the pathogenesis and potential therapeutic targets and test novel therapies in appropriate preclinical models. Here, we will outline the necessary criteria for experimental modeling of cognitive disorders in CKD. We discuss the use of mice, rats, and zebrafish as model systems and present valuable techniques through which kidney function and cognitive impairment can be assessed in this setting. Our objective is to enable researchers to overcome hurdles and accelerate preclinical research aimed at improving the therapy of people with CKD and MCI.
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Affiliation(s)
- Pedro H Imenez Silva
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Marion Pepin
- Institut National de la Santé et de la Recherche Médicale U-1018 Centre de Recherche en Épidémiologie et Santé des Population, Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Department of Geriatrics, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris Université Paris-Saclay, Paris, France
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Eugenio Gutiérrez-Jiménez
- Center for Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hopitaux de Marseille, and INSERM 1263, Institut National de la Recherche Agronomique 1260, C2VN, Aix-Marseille Universitaire, Marseille, France
| | - Anna Iervolino
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Matthew A Bailey
- Edinburgh Kidney, Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Lucie Hénaut
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Rikke Nielsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Hande O Altunkaynak
- Department of Pharmacology, Gulhane Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
| | - Robert Unwin
- Department of Renal Medicine, Royal Free Hospital, University College London, London, United Kingdom
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli,' Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Vesna Pesic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ziad Massy
- Centre for Research in Epidemiology and Population Health, INSERM UMRS 1018, Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Villejuif, France
- Department of Nephrology, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris Université Paris-Saclay, Paris, France
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Li S, Hou L, Zhu S, Sun W, Cao J, Yi Q, Zhao D, Song P. Associations of serum uric acid with hypertension status, stages, phenotypes and progressions among Chinese middle-aged and elderly. Nutr Metab Cardiovasc Dis 2024; 34:988-997. [PMID: 38176957 DOI: 10.1016/j.numecd.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/15/2023] [Accepted: 10/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND AIMS No consensus has been reached on the association between serum uric acid (SUA) and hypertension. This study aimed to investigate the associations between SUA and hypertension, including its status, stages, phenotypes and progressions, among middle-aged and older Chinese. METHODS AND RESULTS Data were obtained from the China Health and Retirement Longitudinal Study 2011-2015. Binary logistic regression was used to evaluate the association between SUA and hypertension status. Multinomial logistic regression was used to explore the associations of SUA with hypertension stages, phenotypes and hypertension status progressions. Models were adjusted for potential confounders and stratified by sex. A total of 7931 individuals aged ≥45 years were included, with 39.16 % of hypertension. Significant associations were found of SUA with stage2 and above hypertension (quartile 4 [Q4] vs quartile 1 [Q1]: odds ratio 1.78, 95 % confidence interval 1.31-2.42, P < 0.001), and systolic diastolic hypertension (SDH) (Q4 vs Q1: 1.53, 1.14-2.06, P = 0.005). In sex stratification, significant associations were found between SUA and stage2 and above hypertension and SDH only for men. Moreover, higher quartiles of baseline SUA showed increased risks of maintained hypertension from 2011 to 2015 (Q3 vs Q1: 1.23, 1.03-1.48, P = 0.024; Q4 vs Q1: 1.73, 1.43-2.10, P < 0.001). CONCLUSION Higher SUA was associated with hypertension and maintained hypertension among Chinese middle-aged and elderly. Sex-specific associations of SUA with hypertension stages and phenotypes were observed. Regular measurement of SUA in clinical practice may indicate hypertension and its progression, particularly among men.
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Affiliation(s)
- Shuting Li
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Leying Hou
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siyu Zhu
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weidi Sun
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin Cao
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Yi
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Zhao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Cotten A, Henry S, Scarciolla L, Abou Diwan R, Demondion X, Badr S. Crystal Diseases of the Spine. Semin Musculoskelet Radiol 2023; 27:545-552. [PMID: 37816362 DOI: 10.1055/s-0043-1770763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Gout, calcium pyrophosphate deposition disease, and apatite calcifications, the three main crystal disorders, may involve the spine. These disorders can be completely asymptomatic or associated with various clinical symptoms, such as acute flares and more chronic manifestations. This article presents the typical and more unusual imaging features encountered in these disorders.
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Affiliation(s)
- Anne Cotten
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
| | - Simon Henry
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Laura Scarciolla
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Ralph Abou Diwan
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Xavier Demondion
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, CHU Lille, Unité de Taphonomie Médicolégale & d'Anatomie, Lille, France
| | - Sammy Badr
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
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Baxter B, Sanders S, Patel SA, Martin A, West M. Pegloticase in Uncontrolled Gout: The Infusion Nurse Perspective. JOURNAL OF INFUSION NURSING 2023; 46:223-231. [PMID: 37406337 PMCID: PMC10306337 DOI: 10.1097/nan.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Infused biologics, such as pegloticase, are a core component of managing uncontrolled gout, which is increasing in prevalence. Pegloticase is often the last line of therapy for patients with uncontrolled gout; therefore, achieving a successful course of treatment is critical. The infusion nurse's role in patient education, serum uric acid monitoring, and patient medication compliance is essential for ensuring patient safety and maximizing the number of patients who benefit from a full treatment course of pegloticase. Infusion nurses are on the front lines with patients and need to be educated on potential negative effects associated with the medications they infuse, such as infusion reactions, as well as risk management methods like patient screening and monitoring. Further, patient education provided by the infusion nurse plays a large role in empowering the patient to become their own advocate during pegloticase treatment. This educational overview includes a model patient case for pegloticase monotherapy, as well as one for pegloticase with immunomodulation and a step-by-step checklist for infusion nurses to refer to throughout the pegloticase infusion process. A video abstract is available for this article at http://links.lww.com/JIN/A105.
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Affiliation(s)
- Britni Baxter
- Altus Infusion/Houk Rheumatology, Little Rock, Arkansas (Ms Baxter); Premier Specialty Network, Columbia, Missouri (Ms Sanders); and Horizon Therapeutics PLC, Deerfield, Illinois (Ms Patel, Ms Martin, and Mr West)
| | - Shayla Sanders
- Altus Infusion/Houk Rheumatology, Little Rock, Arkansas (Ms Baxter); Premier Specialty Network, Columbia, Missouri (Ms Sanders); and Horizon Therapeutics PLC, Deerfield, Illinois (Ms Patel, Ms Martin, and Mr West)
| | - Shilpa A. Patel
- Altus Infusion/Houk Rheumatology, Little Rock, Arkansas (Ms Baxter); Premier Specialty Network, Columbia, Missouri (Ms Sanders); and Horizon Therapeutics PLC, Deerfield, Illinois (Ms Patel, Ms Martin, and Mr West)
| | - Andrea Martin
- Altus Infusion/Houk Rheumatology, Little Rock, Arkansas (Ms Baxter); Premier Specialty Network, Columbia, Missouri (Ms Sanders); and Horizon Therapeutics PLC, Deerfield, Illinois (Ms Patel, Ms Martin, and Mr West)
| | - Michael West
- Altus Infusion/Houk Rheumatology, Little Rock, Arkansas (Ms Baxter); Premier Specialty Network, Columbia, Missouri (Ms Sanders); and Horizon Therapeutics PLC, Deerfield, Illinois (Ms Patel, Ms Martin, and Mr West)
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6
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Klauser AS, Strobl S, Schwabl C, Kremser C, Klotz W, Vasilevska Nikodinovska V, Stofferin H, Scharll Y, Halpern E. Impact of Dual-Energy Computed Tomography (DECT) Postprocessing Protocols on Detection of Monosodium Urate (MSU) Deposits in Foot Tendons of Cadavers. Diagnostics (Basel) 2023; 13:2208. [PMID: 37443602 DOI: 10.3390/diagnostics13132208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. MATERIAL AND METHODS A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52-99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. Six fresh cadavers (4 male; 2 female; median age, 78; mean, 78.5; range 61-95) were examined by DECT. Tendon dissection of 2/6 fresh cadavers with positive DECT 120 and negative DECT 150 studies were used to verify MSU deposits by polarizing light microscopy. RESULTS The tibialis anterior tendon was found positive in 57.5%/100% (DECT 150/120), the peroneus tendon in 35%/100%, the achilles tendon in 25%/90%, the flexor halluces longus tendon in 10%/100%, and the tibialis posterior tendon in 12.5%/97.5%. DECT 120 resulted in increased tendon MSU deposit detection, when DECT 150 was negative, with an overall agreement between DECT 150 and DECT 120 of 80% (p = 0.013). Polarizing light microscope confirmed MSU deposits detected only by DECT 120 in the tibialis anterior, the achilles, the flexor halluces longus, and the peroneal tendons. CONCLUSION The DECT 120 protocol showed a higher sensitivity when compared to DECT 150.
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Affiliation(s)
| | - Sylvia Strobl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Schwabl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Kremser
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Violeta Vasilevska Nikodinovska
- University Surgical Clinic "St. Naum Ohridski", Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Yannick Scharll
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ethan Halpern
- Jefferson Prostate Diagnostic and Kimmel Cancer Center, Department of Radiology and Urology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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7
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Zhang WZ. Uric acid en route to gout. Adv Clin Chem 2023; 116:209-275. [PMID: 37852720 DOI: 10.1016/bs.acc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Gout and hyperuricemia (HU) have generated immense attention due to increased prevalence. Gout is a multifactorial metabolic and inflammatory disease that occurs when increased uric acid (UA) induce HU resulting in monosodium urate (MSU) crystal deposition in joints. However, gout pathogenesis does not always involve these events and HU does not always cause a gout flare. Treatment with UA-lowering therapeutics may not prevent or reduce the incidence of gout flare or gout-associated comorbidities. UA exhibits both pro- and anti-inflammation functions in gout pathogenesis. HU and gout share mechanistic and metabolic connections at a systematic level, as shown by studies on associated comorbidities. Recent studies on the interplay between UA, HU, MSU and gout as well as the development of HU and gout in association with metabolic syndromes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular, renal and cerebrovascular diseases are discussed. This review examines current and potential therapeutic regimens and illuminates the journey from disrupted UA to gout.
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Affiliation(s)
- Wei-Zheng Zhang
- VIDRL, The Peter Doherty Institute, Melbourne, VIC, Australia.
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8
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Wu M, Hu X, Lu T, Liu C, Lu H. Uric acid is independently associated with interleukin‐1β levels in tear fluid of hyperuricemia and gout patients. Immun Inflamm Dis 2023; 11:e805. [PMID: 36988248 PMCID: PMC10022423 DOI: 10.1002/iid3.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
Objectives To explore pro‐inflammatory cytokines status in the tear fluid of patients with hyperuricemia and gout and its association with uric acid level. Methods A total of 58 control subjects, 58 hyperuricemia patients including 40 asymptomatic hyperuricemia and 18 gout participants were recruited in this study. For tear analysis, each patient's tears were collected using capillary action microcaps after stimulation. Tear uric acid levels were measured using chemiluminescence. Tear and serum interleukin‐1beta (IL‐1β) and tumor necrosis factor‐alpha (TNF‐α) levels were measured using enzyme‐linked immunosorbent assay. The correlation of serum and tear uric acid levels with IL‐1β and TNF‐α were determined. Results Tear uric acid levels were significantly higher in hyperuricemia group (98.2 ± 51.5 vs. 42.7 ± 24.0 µmol/L, p < .001) than in controls group. IL‐1β concentrations were significantly higher in hyperuricemia eyes compared to control eyes (210.2 ± 113.9 vs. 142.6 ± 29.8 pg/mL, p < .001). Multiple linear regression analysis showed that tear uric acid levels were independently positively associated with tear IL‐1β concentrations (B = 0.192, p < .001). However, no significant correlations were found between serum or tear uric acid and TNF‐α level. Moreover, there were no statistically differences of tear IL‐1β and TNF‐α levels between the asymptomatic hyperuricemia and gout groups. Conclusions Tear uric acid levels were higher in patients with hyperuricemia and gout than in controls. There was a significant positive correlation between tear uric acid value and tear IL‐1β level, implying an interaction between hyperuricemia and ocular inflammation responses.
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Affiliation(s)
- Mian Wu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalSuzhouChina
| | - Xingna Hu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalSuzhouChina
| | - Ting Lu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalSuzhouChina
| | - Chenxiao Liu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalSuzhouChina
| | - Honghong Lu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalSuzhouChina
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Ohashi Y, Kuriyama S, Nakano T, Sekine M, Toyoda Y, Nakayama A, Takada T, Kawamura Y, Nakamura T, Matsuo H, Yokoo T, Ichida K. Urate Transporter ABCG2 Function and Asymptomatic Hyperuricemia: A Retrospective Cohort Study of CKD Progression. Am J Kidney Dis 2023; 81:134-144.e1. [PMID: 35810827 DOI: 10.1053/j.ajkd.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Treatment of asymptomatic hyperuricemia is not commonly implemented. However, it is unclear whether urate deposition that begins during asymptomatic hyperuricemia can induce nephropathy. Dysfunction of ATP-binding cassette subfamily G member 2 (ABCG2), a urate efflux transporter, leads to elevated serum uric acid concentration (SUA). We investigated the association between asymptomatic hyperuricemia and decreased estimated glomerular filtration rate (eGFR), and the impact of ABCG2 on this relationship. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 1,885 Japanese adults undergoing routine health care follow-up between 2007 and 2017 who had eGFR ≥60 mL/min/1.73 m2, of which 311 had asymptomatic hyperuricemia (SUA >7.0 mg/dL). Study participants were classified into 3 categories of estimated ABCG2 function (full, 75%, and ≤50% function). PREDICTORS Baseline SUA and estimated ABCG2 function. OUTCOME Change in eGFR over time. ANALYTICAL APPROACH Linear mixed-effect models were used to analyze the relationship between asymptomatic hyperuricemia, ABCG2 function, and eGFR decline. RESULTS Asymptomatic hyperuricemia was negligibly associated with eGFR decline overall. However, among those with eGFR 60-89 mL/min/1.73 m2 and ≤50% ABCG2 function, eGFR decline was associated with asymptomatic hyperuricemia (P = 0.03). ABCG2 was not associated with eGFR reductions when the SUA was <6.0 mg/dL. Among participants with SUA ≥6.0 mg/dL and eGFR 60-89 mL/min/1.73 m2, ≤50% ABCG2 function was associated with approximately 1.2-fold faster eGFR decline compared with fully functional ABCG2 (P = 0.02). Among the participants with SUA ≥6.0 mg/dL and eGFR 60-89 mL/min/1.73 m2, the adjusted eGFR slopes (given as mean ± standard error of the mean, in mL/min/1.73 m2 per year) were -0.946 ± 0.049, -1.040 ± 0.046, and -1.148 ± 0.069 for full, 75%, and ≤50% ABCG2 function, respectively. LIMITATIONS Lack of measurement of urinary urate and uremic toxins that are known to be transported by ABCG2, and no independent validation cohort. CONCLUSIONS Asymptomatic hyperuricemia was not associated with eGFR decline, except when in the presence of ≤50% ABCG2 function. PLAIN-LANGUAGE SUMMARY The urate transporter ABCG2 is a protein that regulates serum urate concentrations; when dysfunctional, it can lead to elevated serum concentrations of this compound (ie, hyperuricemia). Although persistent hyperuricemia induces gout and kidney injury, the effects on organs during the asymptomatic phase have yet to be established. Therefore, to clarify the relationship between ABCG2, asymptomatic hyperuricemia, and kidney function, we conducted a retrospective cohort study of 1,885 healthy participants, including 311 participants with asymptomatic hyperuricemia. We found that the coexistence of asymptomatic hyperuricemia and severe ABCG2 dysfunction was associated with the age-dependent decline in kidney function. We concluded that asymptomatic hyperuricemia represents a risk factor for chronic kidney disease, at least in individuals with highly dysfunctional ABCG2. This new finding highlights the potential importance of ABCG2 in the pathogenesis of hyperuricemia-induced kidney injury.
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Affiliation(s)
- Yuki Ohashi
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
| | | | | | - Mai Sekine
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yu Toyoda
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Akiyoshi Nakayama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan; Third Division, Aeromedical Laboratory, Japan Air Self-Defense Force, Saitama, Japan
| | - Tappei Takada
- Department of Pharmacy, University of Tokyo Hospital, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yusuke Kawamura
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Laboratory for Mathematics, National Defense Medical College, Saitama, Japan
| | - Hirotaka Matsuo
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Takashi Yokoo
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kimiyoshi Ichida
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan; Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
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10
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Xu Q, Lin CS. An interesting tophus in gingiva. Int J Rheum Dis 2023; 26:401-402. [PMID: 36468714 DOI: 10.1111/1756-185x.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Qiang Xu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chang-Song Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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11
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Johnson RJ, Sanchez Lozada LG, Lanaspa MA, Piani F, Borghi C. Uric Acid and Chronic Kidney Disease: Still More to Do. Kidney Int Rep 2022; 8:229-239. [PMID: 36815099 PMCID: PMC9939362 DOI: 10.1016/j.ekir.2022.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Gout and hyperuricemia are present in 25% and 60% of patients with chronic kidney disease (CKD), respectively. Despite the common association, the role of uric acid in the progression of kidney disease and in metabolic complications remains contested. Some authorities argue that the treatment of asymptomatic hyperuricemia in CKD is not indicated, and some have even suggested hyperuricemia may be beneficial. Here, we review the various arguments both for and against treatment. The weight of the evidence suggests asymptomatic hyperuricemia is likely injurious, but it may primarily relate to subgroups, those who have systemic crystal deposits, those with frequent urinary crystalluria or kidney stones, and those with high intracellular uric acid levels. We recommend carefully designed clinical trials to test if lowering uric acid in hyperuricemic subjects with cardiometabolic complications is protective.
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Affiliation(s)
- Richard J. Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Correspondence: Richard J. Johnson, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, RC-2 Research Building, Room 7012, Mail Stop C281, Aurora, Colorado 80045, USA.
| | - Laura G. Sanchez Lozada
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología “Ignacio Chavez,” , Mexico City, Mexico
| | - Miguel A. Lanaspa
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Federica Piani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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12
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Aggarwal P, Gorell ES, Flood KS, Spicknall K, Breneman D. An uncommon presentation of cutaneous dissemination of gout. JAAD Case Rep 2022; 31:89-92. [PMID: 36545484 PMCID: PMC9762070 DOI: 10.1016/j.jdcr.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | - Debra Breneman
- Correspondence to: Debra Breneman, MD, Department of Dermatology University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267.
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13
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Surgical Treatment of Hand and Foot Gout Stone and Influence Factors on Prognosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4877708. [PMID: 36199773 PMCID: PMC9529424 DOI: 10.1155/2022/4877708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
Purpose To explore the technique of surgical treatment of hand and foot gout stone by using 3D CT reconstruction images and influence factors on prognosis. Method 48 cases of hand and foot gout were treated surgically and retrospective analyzed. Before operation, we used 3D CT reconstruction images to check the accurate site and amount of uric acid (white chalk foam) deposition. Different surgical methods were applied depending on the different deposition site of urine acid stone. The frequency of gout attack and blood uric acid was compared before and after surgery. Patients were followed up to observe the recovery and recurrence and then analyzed the reason of unsuccessful healing. Result Sutures were removed 2 weeks after operation in all cases. The frequency of gout attack and blood uric acid of patients 3 months after operation was lower than those before operation, and the differences were statistically significant. Follow-up ranged from 1 to 3 years, with an average of 1.8 years. Three cases were not followed up. The remaining 45 cases were healed in the first stage. 40 cases had improved joint function, increased range of motion, and relieved discomfort after movement. 5 cases had no improvement in joint function after operation, and 3 of them had gout stone recurrence (nonoperative area) and were treated by second hospital operation. Conclusion Surgical treatment of gout stone in hand and foot under the guidance of three-dimensional CT reconstruction image can effectively alleviate the local symptoms of gout stone and improve the function of hand and foot. Deep tissue can be thoroughly washed by the pressure of pulse gun after resection of the lesion, which can reduce the incidence of gout stone. Malnutrition, hypoproteinemia, and residual urine acid in the wound are the main reasons for unsuccessful healing.
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14
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Toprover M, Mechlin M, Fields T, Oh C, Becce F, Pillinger MH. Monosodium urate deposition in the lumbosacral spine of patients with gout compared with non-gout controls: A dual-energy CT study. Semin Arthritis Rheum 2022; 56:152064. [PMID: 35803060 DOI: 10.1016/j.semarthrit.2022.152064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis in adults. Gout predominantly affects the peripheral joints, but an increasing number of published cases report gout affecting the spine. We used dual-energy CT (DECT) to assess the prevalence of monosodium urate (MSU) deposition in the spine of gout patients compared to controls, and to investigate whether gout or spinal MSU deposition is associated with low back pain. METHODS 25 controls and 50 gout subjects (non-tophaceous and tophaceous) were enrolled. Demographics, gout history, Aberdeen back pain score, serum urate (sU), ESR and CRP were ascertained. Subjects underwent DECT of the lumbosacral spine, which was analyzed using manufacturer's default post-processing algorithm for MSU deposition as well as a maximally-specific algorithm to exclude potential artifact. FINDINGS 72 subjects were analyzed (25 control, 47 gout). Gout subjects had greater BMI, serum creatinine, sU, CRP, and ESR versus controls. Using the default algorithm, MSU-coded volumes in the lumbosacral spines were significantly higher among the gout subjects vs controls (p = 0.018). 34% of gout subjects vs 4% of controls had spinal MSU-coded deposition (p = 0.0036). Applying the maximally-specific DECT post-processing algorithm, 18% of gout patients vs 0% of controls continued to demonstrate spinal MSU-coded deposition (p = 0.04). Non-tophaceous and tophaceous subjects did not differ in spinal MSU-coded deposition or sU. Gout patients had more back pain than controls. INTERPRETATION A significant subpopulation of gout patients have spinal MSU-coded lesions. Default and maximally-specific MSU post-processing algorithms yielded different absolute MSU-coded volumes, but similar patterns of results. Gout patients had more back pain than controls. Spinal MSU deposition in gout patients may have implications for clinical picture and treatment.
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Affiliation(s)
- Michael Toprover
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA.
| | - Michael Mechlin
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, USA
| | - Theodore Fields
- Division of Rheumatology, The Hospital for Special Surgery, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, USA
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Michael H Pillinger
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA
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15
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Klauser AS, Strobl S, Schwabl C, Klotz W, Feuchtner G, Moriggl B, Held J, Taljanovic M, Weaver JS, Reijnierse M, Gizewski ER, Stofferin H. Prevalence of Monosodium Urate (MSU) Deposits in Cadavers Detected by Dual-Energy Computed Tomography (DECT). Diagnostics (Basel) 2022; 12:diagnostics12051240. [PMID: 35626395 PMCID: PMC9139977 DOI: 10.3390/diagnostics12051240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Dual-energy computed tomography (DECT) allows direct visualization of monosodium urate (MSU) deposits in joints and soft tissues. Purpose: To describe the distribution of MSU deposits in cadavers using DECT in the head, body trunk, and feet. Materials and Methods: A total of 49 cadavers (41 embalmed and 8 fresh cadavers; 20 male, 29 female; mean age, 79.5 years; SD ± 11.3; range 52–95) of unknown clinical history underwent DECT to assess MSU deposits in the head, body trunk, and feet. Lens, thoracic aorta, and foot tendon dissections of fresh cadavers were used to verify MSU deposits by polarizing light microscopy. Results: 33/41 embalmed cadavers (80.5%) showed MSU deposits within the thoracic aorta. 11/41 cadavers (26.8%) showed MSU deposits within the metatarsophalangeal (MTP) joints and 46.3% of cadavers demonstrated MSU deposits within foot tendons, larger than and equal to 5 mm. No MSU deposits were detected in the cranium/intracerebral vessels, or the coronary arteries. Microscopy used as a gold standard could verify the presence of MSU deposits within the lens, thoracic aorta, or foot tendons in eight fresh cadavers. Conclusions: Microscopy confirmed the presence of MSU deposits in fresh cadavers within the lens, thoracic aorta, and foot tendons, whereas no MSU deposits could be detected in cranium/intracerebral vessels or coronary arteries. DECT may offer great potential as a screening tool to detect MSU deposits and measure the total uric acid burden in the body. The clinical impact of this cadaver study in terms of assessment of MSU burden should be further proven.
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Affiliation(s)
- Andrea S. Klauser
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Sylvia Strobl
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Christoph Schwabl
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
- Correspondence:
| | - Werner Klotz
- Department of Internal Medicine II, Medical University Innsbruck, 6020 Innsbruck, Austria; (W.K.); (J.H.)
| | - Gudrun Feuchtner
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Bernhard Moriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University Innsbruck, 6020 Innsbruck, Austria; (B.M.); (H.S.)
| | - Julia Held
- Department of Internal Medicine II, Medical University Innsbruck, 6020 Innsbruck, Austria; (W.K.); (J.H.)
| | - Mihra Taljanovic
- Department of Medical Imaging, Banner University Medical Center, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA;
| | - Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Monique Reijnierse
- Division of Musculoskeletal Radiology, Department of Radiology, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands;
| | - Elke R. Gizewski
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Hannes Stofferin
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University Innsbruck, 6020 Innsbruck, Austria; (B.M.); (H.S.)
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16
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Punzi L, Negrete AP, Marson P, Cozza A, Gerli R. The forward-looking advertising. Description of a gouty heart in a 1919 advertisement. Joint Bone Spine 2022; 89:105398. [PMID: 35550424 DOI: 10.1016/j.jbspin.2022.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Leonardo Punzi
- Institute for the History of Rheumatology, Venice, Italy; Centre for Gout and Bone & Joint Diseases, Rheumatology, Venice, Italy
| | | | - Piero Marson
- Institute for the History of Rheumatology, Venice, Italy
| | - Andrea Cozza
- Institute for the History of Rheumatology, Venice, Italy
| | - Roberto Gerli
- Institute for the History of Rheumatology, Venice, Italy; President Italian Society of Rheumatology
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17
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Anti-inflammatory and Antioxidant Effect of Poly-gallic Acid (PGAL) in an In Vitro Model of Synovitis Induced by Monosodium Urate Crystals. Inflammation 2022; 45:2066-2077. [PMID: 35505045 DOI: 10.1007/s10753-022-01676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
Gout is a chronic and degenerative disease that affects the joints and soft tissues because of the crystalline deposit of monosodium urate. The interaction between monosodium urate crystals (MSU) and synoviocytes generates oxidative and inflammatory states. These physiological characteristics have promoted the study of poly-gallic acid (PGAL), a poly-oxidized form of gallic acid reported to be effective in in vitro models of inflammation. The effect of PGAL in an in vitro model of oxidation and synovial inflammation induced by MSU was evaluated after 24 h of stimulation through the morphological changes, the determination of oxidative stress (OS), IL-1β, and the phagocytosis of the MSU. A 20% reduction in synovial viability and the generation of vesicles were observed when they were exposed to MSU. When PGAL was used at 100 and 200 µg/ml, cell death was reduced by 30% and 17%, respectively. PGAL both doses reduce the vesicles generated by MSU. OS generation in synoviocytes exposed to 100 µg/ml and 200 µg/ml PGAL decreased by 1.28 and 1.46 arbitrary fluorescence units (AFU), respectively, compared to the OS in synoviocytes exposed to MSU (1.9 AFU). PGAL at 200 µg/ml inhibited IL-1β by 100%, while PGAL at 100 µg/ml inhibited IL-1β by 66%. The intracellular MSU decreased in synoviocytes stimulated with 100 µg/ml PGAL. The PGAL has a cytoprotective effect against damage caused by MSU in synoviocytes and can counteract the oxidative and inflammatory response induced by the crystals probably because it exerts actions at the membrane level that prevent phagocytosis of the crystals.
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18
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Abstract
PURPOSE OF REVIEW In this review, we report on new findings regarding associations of uric acid with kidney health. We discuss kidney stones, effects of uric acid in chronic kidney disease (CKD), and management of gout in CKD. Recent studies on neuroprotective effects of raising uric acid provide interesting data regarding nephrolithiasis. RECENT FINDINGS Elevated urate levels have been implicated in the progression of chronic kidney disease (CKD), but the results from PERL and CKD-FIX studies did not demonstrate that allopurinol slowed CKD progression. The SURE-PD3 sought to determine if increasing uric acid would slow the progression of Parkinson's disease. Results ultimately did not support this hypothesis, but high urinary uric acid levels caused uric acid stones, not calcium stones. Low urinary pH remains the key to the formation of uric acid stones. Thiazolidinediones improve insulin resistance, which is associated with an increase in urine pH. The most recent research has not supported the hypothesis that lowering serum uric acid levels will slow the progression of CKD or provide neuroprotection in Parkinson's disease. It is still unclear as to why uric acid stone formers have a high net acid excretion. The STOP-GOUT trial demonstrates that there was a lack of significant adverse events with higher urate-lowering dosages of allopurinol and febuxostat, despite patients' kidney function. This may push other studies to administer higher dosages per ACR guidelines. Future studies could then demonstrate decreased progression of CKD.
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Affiliation(s)
- Giana Kristy Ramos
- Nephrology Division, NYU Langone Health, New York, NY, USA
- New York Harbor VA Healthcare System, New York, NY, USA
| | - David S Goldfarb
- Nephrology Division, NYU Langone Health, New York, NY, USA.
- New York Harbor VA Healthcare System, New York, NY, USA.
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19
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Schlesinger N, Padnick-Silver L, LaMoreaux B. Enhancing the Response Rate to Recombinant Uricases in Patients with Gout. BioDrugs 2022; 36:95-103. [PMID: 35316517 PMCID: PMC8938732 DOI: 10.1007/s40259-022-00517-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/20/2022]
Abstract
Refractory, or uncontrolled, gout is a chronic, progressive, inflammatory arthropathy resulting from continued urate deposition after failed attempts to lower serum uric acid below the therapeutic threshold with oral urate-lowering therapies such as allopurinol and febuxostat. Recombinant uricase is increasingly being used to treat refractory gout; however, the immunogenicity of uricase-based therapies has limited the use of these biologic therapies. Antidrug antibodies against biologic therapies, including uricase and PEGylated uricase, can lead to loss of urate-lowering response, increased risk of infusion reactions, and subsequent treatment failure. However, co-therapy with an immunomodulator can attenuate antidrug antibody development, potentially increasing the likelihood of sustained urate lowering, therapy course completion, and successful treatment outcomes. This review summarizes evidence surrounding the use of immunomodulation as co-therapy with recombinant uricases.
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Affiliation(s)
- Naomi Schlesinger
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Brian LaMoreaux
- Medical Affairs, Horizon Therapeutics, 1 Horizon Way, Deerfield, IL, 60015, USA.
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20
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Botson JK, Obermeyer K, LaMoreaux B, Zhao L, Weinblatt ME, Peterson J. Improved joint and patient-reported health assessments with pegloticase plus methotrexate co-therapy in patients with uncontrolled gout: 12-month exploratory outcomes of the MIRROR open-label trial. Arthritis Res Ther 2022; 24:281. [PMID: 36575505 PMCID: PMC9793599 DOI: 10.1186/s13075-022-02979-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Uncontrolled/refractory gout patients are recalcitrant/intolerant to oral urate-lowering therapies (ULTs), experiencing frequent gout flares, functionally limiting tophi, and low quality of life. Pegloticase lowers urate, but anti-pegloticase antibodies limit urate-lowering efficacy and increase infusion reaction (IR) risk. Immunomodulator + pegloticase co-administration may improve treatment response rates, with 79% of MIRROR open-label trial (MIRROR-OL, pegloticase + oral methotrexate) participants meeting 6-month response criteria. Exploratory outcomes from MIRROR-OL are described here. METHODS Adults with uncontrolled gout (serum urate [SU] ≥ 6 mg/dL and ULT-intolerance/recalcitrance or functionally limiting tophi) were included. Oral methotrexate (15 mg/week) was administered 4 weeks before and during pegloticase treatment (biweekly 8 mg infusion, ≤ 52 weeks). Exploratory outcomes included change from baseline (CFB) in number of affected joints, Health Assessment Questionnaires (HAQs), and Gout Global Assessments. RESULTS Fourteen patients received ≥ 1 pegloticase infusion, with 13 included in 52-week analyses (1 enrolled before treatment-extension amendment, exited at 24 weeks). Three patients prematurely exited due to SU rise; 10 completed 52-week evaluations (8 completed 52 weeks of co-therapy, 2 completed 24 weeks [met treatment goals]). At 52 weeks, SU averaged 1.1 ± 2.5 mg/dL, with improvements in HAQ pain and health (CFB: - 33.6 and - 0.7, respectively), Patient and Physician Global Assessments (CFB: - 4.6 and - 5.7, respectively), and joint involvement (CFB: - 5.6, - 8.4, - 6.0 tender, swollen, tophi-affected joints, respectively). Two patients underwent dual-energy computed tomography, showing concomitant monosodium urate volume reductions. All patients had ≥ 1 AE, with 92.9% experiencing acute flare. One mild IR ("cough") occurred and no new safety signals were identified. CONCLUSION Pegloticase + methotrexate co-therapy resulted in sustained SU-lowering with meaningful improvements in clinical measures, urate burden, and patient-reported outcomes. TRIAL REGISTRATION ClinicalTrials.gov (NCT03635957).
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Affiliation(s)
- John K. Botson
- Orthopedic Physicians Alaska, 3801 Lake Otis Parkway, Anchorage, AK 99508 USA
| | - Katie Obermeyer
- grid.476366.60000 0004 4903 3495Horizon Therapeutics plc, Deerfield, IL USA
| | - Brian LaMoreaux
- grid.476366.60000 0004 4903 3495Horizon Therapeutics plc, Deerfield, IL USA
| | - Lin Zhao
- grid.476366.60000 0004 4903 3495Horizon Therapeutics plc, Deerfield, IL USA
| | - Michael E. Weinblatt
- grid.62560.370000 0004 0378 8294Division of Rheumatology, Immunology and Immunity, Brigham and Women’s Hospital, Boston, MA USA
| | - Jeff Peterson
- Western Washington Arthritis Clinic, Bothell, WA USA
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21
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Belviranli S, Turk HB, Oltulu P, Turk N, Mirza E, Küçük A, Aydemir H, Oltulu R. Tear Function Alterations and Conjunctival Impression Cytology Findings in Patients With Gout. Eye Contact Lens 2021; 47:647-650. [PMID: 34417788 DOI: 10.1097/icl.0000000000000832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the tear functions and conjunctival impression cytology (CIC) findings of patients with gout and compare them with healthy controls. METHODS Thirty-four patients with gout (group 1) and 32 age-matched and gender-matched healthy individuals (group 2) were included in this cross-sectional study. Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and CIC grade were evaluated and compared between the groups. RESULTS There was no significant difference between the groups in gender and age (P=0.923 and P=0.078, respectively). The mean of Schirmer 1 test result was significantly lower in group 1 (9.74±6.03 mm) than that in group 2 (17.16±9.33 mm) (P<0.001). The TBUT was also significantly lower in group 1 (7.00±2.09 seconds) than that in group 2 (12.75±5.25 seconds) (P<0.001). The OSDI score (20.04±12.92) was significantly higher in group 1 than that in group 2 (6.19±10.07) (P<0.001). Although 10 patients (29.4%) in group 1 had the CIC grade of 2 to 3, none of the controls had CIC grade 2 to 3. The mean CIC grade in group 1 (1.15±0.89) was significantly higher than that in group 2 (0.47±0.51) (P<0.001). CONCLUSIONS The results of this study suggest that ocular surface alterations assessed by CIC and tear function abnormalities are more common in patients with gout.
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Affiliation(s)
- Selman Belviranli
- Department of Ophthalmology (S.B., E.M., R.O.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey ; Department of Ophthalmology (H.B.T.), Dr. Ersin Arslan Research and Training Hospital, Gaziantep, Turkey ; Department of Pathology (P.O.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey ; Department of Pathology (N.T.), 25 Aralik State Hospital, Gaziantep, Turkey; and Department of Rheumatology (A.K., H.A.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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22
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Goldberg A, Garcia-Arroyo F, Sasai F, Rodriguez-Iturbe B, Sanchez-Lozada LG, Lanaspa MA, Johnson RJ. Mini Review: Reappraisal of Uric Acid in Chronic Kidney Disease. Am J Nephrol 2021; 52:837-844. [PMID: 34673651 DOI: 10.1159/000519491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/06/2021] [Indexed: 12/16/2022]
Abstract
Hyperuricemia predicts the development of chronic kidney disease (CKD) and metabolic complications, but whether it has a causal role has been controversial. This is especially true given the 2 recently conducted randomized controlled trials that failed to show a benefit of lowering uric acid in type 1 diabetes-associated CKD and subjects with stage 3-4 CKD. While these studies suggest that use of urate-lowering drugs in unselected patients is unlikely to slow the progression of CKD, there are subsets of subjects with CKD where reducing uric acid synthesis may be beneficial. This may be the case in patients with gout, hyperuricemia (especially associated with increased production), and urate crystalluria. Here, we discuss the evidence and propose that future clinical trials targeting these specific subgroups should be performed.
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Affiliation(s)
- Avi Goldberg
- Clalit Health Services, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain VA Medical Center, Aurora, Colorado, USA
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23
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Stamp LK, Farquhar H, Pisaniello HL, Vargas-Santos AB, Fisher M, Mount DB, Choi HK, Terkeltaub R, Hill CL, Gaffo AL. Management of gout in chronic kidney disease: a G-CAN Consensus Statement on the research priorities. Nat Rev Rheumatol 2021; 17:633-641. [PMID: 34331037 PMCID: PMC8458096 DOI: 10.1038/s41584-021-00657-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
Gout and chronic kidney disease (CKD) frequently coexist, but quality evidence to guide gout management in people with CKD is lacking. Use of urate-lowering therapy (ULT) in the context of advanced CKD varies greatly, and professional bodies have issued conflicting recommendations regarding the treatment of gout in people with concomitant CKD. As a result, confusion exists among medical professionals about the appropriate management of people with gout and CKD. This Consensus Statement from the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) discusses the evidence and/or lack thereof for the management of gout in people with CKD and identifies key areas for research to address the challenges faced in the management of gout and CKD. These discussions, which address areas for research both in general as well as related to specific medications used to treat gout flares or as ULT, are supported by separately published G-CAN systematic literature reviews. This Consensus Statement is not intended as a guideline for the management of gout in CKD; rather, it analyses the available literature on the safety and efficacy of drugs used in gout management to identify important gaps in knowledge and associated areas for research.
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Affiliation(s)
| | | | - Huai Leng Pisaniello
- Discipline of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ana B Vargas-Santos
- Department of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Mark Fisher
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Prima CARE, Fall River, MA, USA
| | - David B Mount
- Renal Divisions, Brigham and Women's Hospital, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Terkeltaub
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Catherine L Hill
- Discipline of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Angelo L Gaffo
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham VA Medical Center, Birmingham, AL, USA
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Simple metabolic markers associated with tophaceous gout. Clin Rheumatol 2021; 40:5047-5053. [PMID: 34264406 DOI: 10.1007/s10067-021-05861-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The relationship between tophaceous gout and metabolic markers is not well understood. The aim of this study was to compare the correlations between different metabolic markers and tophi and evaluate their potential predictive values for tophus. METHOD We analysed the data of gout patients in Beijing Jishuitan Hospital from 2013 to 2020. Ten laboratory indicators (UA, eGFR, underexcretion, GLU, TRIG, HDL-C, ALT, TBIL, γ-GT and UPH) were included to evaluate the relationship between tophaceous gout and metabolic markers. RESULTS Tophi was present in 14.7% (119/808) of gout patients. UA, eGFR, ALT and γ-GT were independently related to the development of tophi; UA and γ-GT were positively correlated. The γ-GT/ALT ratio and UA/eGFR ratio showed a positive correlation with tophi, with (rho, P) of (0.305, < 0.001) and (0.195, < 0.001), respectively. The γ-GT/ALT ratio showed the best classificatory performance (AUC = 0.749, P < 0.001) for tophi among the four positive correlation indicators. With increasing integer γ-GT/ALT ratio, the incidence of tophi (4.9%, 9.7%, 22.3% and 38.4%, P < 0.001), chronic kidney disease (2.5%, 5.2%, 12.3% and 19.2%, P < 0.001) and hyperuricemia over 10 years (6.6%, 10.7%, 18.5% and 26.4%, P < 0.001) showed a progressive increase. The γ-GT/ALT ratio was positively correlated with the number of tophi and duration of hyperuricemia, negatively correlated with eGFR. CONCLUSIONS UA, eGFR, γ-GT and ALT were independently associated with tophi. The γ-GT/ALT ratio may be used as a predictor or monitor of tophi.
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Pascart T, Carpentier P, Choi HK, Norberciak L, Ducoulombier V, Luraschi H, Houvenagel E, Legrand J, Verclytte S, Becce F, Budzik JF. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: The VASCURATE study. Semin Arthritis Rheum 2021; 51:895-902. [PMID: 34198148 DOI: 10.1016/j.semarthrit.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden. METHODS Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi. RESULTS We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p<0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p<0.001). CONCLUSION Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
| | - Paul Carpentier
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA
| | - Laurène Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Julie Legrand
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Sébastien Verclytte
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
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Ahmad MI, Masood S, Furlanetto DM, Nicolaou S. Urate Crystals; Beyond Joints. Front Med (Lausanne) 2021; 8:649505. [PMID: 34150794 PMCID: PMC8212931 DOI: 10.3389/fmed.2021.649505] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
Gout is the most common inflammatory arthropathy caused by the deposition of monosodium urate (MSU) crystals. The burden of gout is substantial with increasing prevalence of gout globally. The prevalence of Gout in the United States has increased by over 7% in the last two decades. Initially, it was believed that MSU crystal deposits occur only in the joints with the involvement of the periarticular soft tissues, but recent studies have shown the presence of MSU crystal deposition in extra-articular sites as well. Human plasma becomes supersaturated with uric acid at 6.8 mg/dl, a state called hyperuricemia. Beyond this level, uric acid crystals precipitate out of the plasma and deposit in soft tissues, joints, kidneys, etc. If left untreated, hyperuricemia leads to chronic gout characterized by the deposition of tophi in soft tissues such as the joints, tendons, and bursae. With the advent of newer imaging techniques such as DECT, MSU crystals can be visualized in various extra-articular sites. Extra-articular deposition of MSU crystals is believed to be the causative factor for the development of multiple comorbidities in gout patients. Here, we review the literature on extra-articular deposition of urate crystals and the role of dual-energy computed tomography (DECT) in elucidating multi-organ involvement. DECT has emerged as an invaluable alternative for accurate and efficient MSU crystal deposition detection. Future studies using DECT can help determine the clinical consequences of extra-articular deposition of MSU in gout patients.
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Affiliation(s)
- Muhammad Israr Ahmad
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Salman Masood
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Daniel Moreira Furlanetto
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Uric Acid and Hypertension: Prognostic Role and Guide for Treatment. J Clin Med 2021; 10:jcm10030448. [PMID: 33498870 PMCID: PMC7865830 DOI: 10.3390/jcm10030448] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
The relationship between serum uric acid (SUA) and hypertension has been a subject of increasing interest since the 1870 discovery by Frederick Akbar Mahomed. Several epidemiological studies have shown a strong association between high SUA levels and the presence or the development of hypertension. Genetic analyses have found that xanthine oxidoreductase (XOR) genetic polymorphisms are associated with hypertension. However, genetic studies on urate transporters and Mendelian randomization studies failed to demonstrate a causal relationship between SUA and hypertension. Results from clinical trials on the role of urate-lowering therapy in the management of patients with hypertension are not uniform. Our study sought to analyze the prognostic and therapeutic role of SUA in the hypertensive disease, from uric acid (UA) biology to clinical trials on urate-lowering therapies.
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