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Ahn JK. Epidemiology and treatment-related concerns of gout and hyperuricemia in Korean. JOURNAL OF RHEUMATIC DISEASES 2023; 30:88-98. [PMID: 37483480 PMCID: PMC10324937 DOI: 10.4078/jrd.2022.0001] [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: 12/15/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 07/25/2023]
Abstract
Gout is the most common form of inflammatory arthritis that affects mainly middle-aged men, and there is clear evidence of an association between hyperuricemia and the risk for gout. Increasing prevalence of gout and hyperuricemia has been reported in many countries. The prevalence of gout and hyperuricemia are constantly increasing in Korea with the patients at risk for developing a variety of comorbidities. Although there have been studies on the association between gout or serum uric acid level and several neurodegenerative diseases, cancer, and cardiovascular mortality, the causal relationship between gout and these comorbidities are still unclear. The associations of substantial economic burden with hyperuricemia, gout attack, and suboptimal treatment are well known. Gout is a disease that requires lifelong management including lifestyle modification. However, gout is poorly managed worldwide although effective urate-lowering drugs exist. In this review, we addressed epidemiological studies and treatment-related problems in the Korean population with gout or hyperuricemia to obtain the best clinical outcomes and reduce their medical burden.
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Affiliation(s)
- Joong Kyong Ahn
- Divison of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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He L, Zhao H, Wang F, Guo X. Inflammatory rheumatic diseases and the risk of Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13:999820. [PMID: 36438950 PMCID: PMC9684169 DOI: 10.3389/fneur.2022.999820] [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: 07/21/2022] [Accepted: 10/24/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Several studies showed inconsistencies in the relationships between inflammatory rheumatic diseases (IRDs) and the risk of Parkinson's disease (PD). Therefore, we carried out a meta-analysis to investigate the associations between different IRDs and PD risk. METHODS A comprehensive search was undertaken on PubMed, Embase, Cochrane Library, and Web of Science databases up to June 2022. Studies reporting the relationships between IRDs and PD risk were included. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by using random-effects models. RESULTS Twenty-two publications covering seven IRDs containing data from 833,004 patients were identified for quantitative analysis. The pooled results indicated that ankylosing spondylitis (RR = 1.55, 95% CI: 1.31-1.83, I2 = 32.1%, P < 0.001), Sjögren's syndrome (RR = 1.34, 95% CI: 1.22-1.47, I2 = 58.5%, P < 0.001), and Behcet's disease (RR = 1.93, 95% CI: 1.07-3.49, I2 = 57.6%, P = 0.030) were associated with an increased PD risk. However, no significant associations were observed between gout, rheumatoid arthritis, systemic lupus erythematosus, as well as polymyalgia rheumatica and the subsequent development of PD. CONCLUSION Ankylosing spondylitis, Sjögren's syndrome, and Behcet's disease may increase PD risk.
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Affiliation(s)
| | | | | | - Xiaoyan Guo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Pou MA, Orfila F, Pagonabarraga J, Ferrer-Moret S, Corominas H, Diaz-Torne C. Risk of Parkinson's disease in a gout Mediterranean population: A case-control study. Joint Bone Spine 2022; 89:105402. [PMID: 35504516 DOI: 10.1016/j.jbspin.2022.105402] [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: 01/01/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION High levels of serum urate has been associated to a neuroprotective effect in Parkinson's disease (PD) as an antioxidant agent. However, the relation between gout and PD remains contradictory. OBJECTIVE To study if the neuroprotective effect of serum urate is maintained in patients with gout in a large urban Mediterranean population. METHODS Primary care based matched case-control study, carried out using an electronic health record database from the public primary care health system of Barcelona. The database contains anonymous data from 1,520,934 patients. All patients, over 40 years old, with a new diagnostic record of PD, or a new prescription of dopaminergic drugs were included (incident cases). We randomly selected four controls for each case, matched by gender and age, with the frequency matching approach. Retrospective data of PD risk factors were also collected for each individual. A multivariate logistic regression model was used to evaluate the association of gout and PD, adjusted by the presence of other risk factors. RESULTS A new PD diagnosis was found in 17,629 individuals (incident diagnosis rate of 2.2 per 1000 individuals). Multivariate logistic regression model showed for gout: aOR=0.83 (0.76-0.91). When stratified by age, aOR for those under 75years was 0.99 (0.85-1.16) and 75 or over OR=0.77 (0.70-0.86). Dyslipidemia, hypertension and diabetes mellitus were associated with an increased risk of PD. Tobacco consumption was protective. CONCLUSION Our study, the first one made in a Mediterranean population, shows a PD protective effect of gout in both men and women over 75years old.
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Affiliation(s)
- Maria A Pou
- EAP Encants, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Orfila
- Unitat de Suport a la Recerca, Ambit Barcelona Ciutat, Barcelona, Spain
| | | | | | - Hector Corominas
- Servei de Reumatologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cesar Diaz-Torne
- Servei de Reumatologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Koponen M, Paakinaho A, Lin J, Hartikainen S, Tolppanen AM. Identification of Drugs Associated with Lower Risk of Parkinson's Disease Using a Systematic Screening Approach in a Nationwide Nested Case-Control Study. Clin Epidemiol 2022; 14:1217-1227. [PMID: 36325200 PMCID: PMC9620835 DOI: 10.2147/clep.s381289] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Drugs for other indications may be repurposable as disease-modifying drugs for Parkinson's disease (PD). A systematic hypothesis-free approach can enable identification of candidates for repurposing. We applied a hypothesis-free systematic approach to identify drugs associated with lower risk of PD to discover candidates with potential for repurposing as disease-modifying drugs for PD and to illustrate challenges in observational studies that simultaneously investigate multiple repurposing candidates. Methods The Finnish Parkinson's disease study (FINPARK), a nationwide nested case-control study, was randomized to screening (10,183 cases, 67,849 controls) and replication (10,184 cases, 67,754 controls) samples, including cases diagnosed in 1998-2015. After screening all univariable associations of register-derived exposure to individual-drug, group- and subgroup level since 1995 (exposure ≥3 years before outcome, threshold P = 0.1), different exposure periods were used in confounder-adjusted replication analyses. Results In screening stage, the group-level (antipsoriatics and antigout preparations) and subgroup-level (cicatrizants, topical antipsoriatics, antigout preparations and mydriatics and cycloplegics) associations were mainly due to individual drugs. Seven other drugs (eg methotrexate, drugs for chronic obstructive pulmonary disease, COPD and/or asthma) were associated with lower risk. Associations of antigout preparations and antipsoriatics were replicated. COPD/asthma drugs, methotrexate and diabetes drugs were studied in separate, indication-restricted designs. Discussion The results reflect the known risk factors and the implied role of the immune system in PD pathogenesis and spurious associations. They underline the importance of controlling for confounding by indication, which is challenging to apply to systematic screening.
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Affiliation(s)
- Marjaana Koponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Anne Paakinaho
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Julian Lin
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
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Fazlollahi A, Zahmatyar M, Alizadeh H, Noori M, Jafari N, Nejadghaderi SA, Sullman MJM, Gharagozli K, Kolahi AA, Safiri S. Association between gout and the development of Parkinson's disease: a systematic review and meta-analysis. BMC Neurol 2022; 22:383. [PMID: 36221048 PMCID: PMC9552480 DOI: 10.1186/s12883-022-02874-0] [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: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND As a natural antioxidant, uric acid plays a protective role against neurodegenerative disorders, including Parkinson's disease (PD). Therefore, the risk of PD has been found to be lower in people with hyperuricemia. In this article, we conducted a systematic review and meta-analysis to investigate whether gout affects the future risk of developing PD. METHODS We searched PubMed, Scopus, the Web of Science, and Google Scholar to find relevant studies, up to March 16, 2022. Studies investigating the risk of PD, following a gout diagnosis, were included if they were cross-sectional, case-control or cohort studies. The Newcastle Ottawa Scale (NOS) checklist was used to assess the quality of all included studies. The meta-analysis was performed using STATA 17.0. RESULTS Ten studies were included, which were comprised of three case-controls, six cohort studies and one nested case-control study. We found no significant association between gout and the risk of PD among both sexes (RR = 0.94, 95% CI: 0.86-1.04), although the association was significant for females (RR = 1.09; 95% CI: 1.02-1.17). Subgroup analysis also showed no significant findings by age group, whether they were receiving treatment for gout, study design, quality assessment score, and method of gout ascertainment. In contrast, the studies that defined PD according to the use of drugs showed significant results (RR = 0.82; 95% CI: 0.76-0.89). There was a significant publication bias on the association between gout and PD. CONCLUSIONS The presence of gout had no significant effect on the risk of subsequently developing PD. Further analyses are recommended to investigate the effects of demographic and behavioral risk factors.
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Affiliation(s)
- Asra Fazlollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Zahmatyar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Alizadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Jafari
- Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Koroush Gharagozli
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Serum Uric Acid Levels in Parkinson’s Disease: A Cross-Sectional Electronic Medical Record Database Study from a Tertiary Referral Centre in Romania. Medicina (B Aires) 2022; 58:medicina58020245. [PMID: 35208569 PMCID: PMC8877142 DOI: 10.3390/medicina58020245] [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: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Parkinson’s disease (PD) is a prevalent neurodegenerative condition responsible for progressive motor and non-motor symptoms. Currently, no prophylactic or disease-modifying interventions are available. Uric acid (UA) is a potent endogenous antioxidant, resulting from purine metabolism. It is responsible for about half of the antioxidant capacity of the plasma. Increasing evidence suggests that lower serum UA levels are associated with an increased risk of developing PD and with faster disease progression. Materials and Methods: We conducted an electronic medical record database study to investigate the associations between UA levels and different characteristics of PD. Results: Out of 274 datasets from distinct patients with PD, 49 complied with the predefined inclusion and exclusion criteria. Lower UA levels were significantly associated with the severity of parkinsonism according to the Hoehn and Yahr stage (rs = 0.488, p = 0.002), with the motor complications of long-term dopaminergic treatment (r = 0.333, p = 0.027), and with the presence of neurocognitive impairment (r = 0.346, p = 0.021). Conclusions: Oxidative stress is considered a key player in the etiopathogenesis of PD, therefore the involvement of lower UA levels in the development and progression of PD is plausible. Data on the potential therapeutic roles of elevating serum UA (e.g., by precursor administration or diet manipulation) are scarce, but considering the accumulating epidemiological evidence, the topic warrants further research.
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