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Disveld IJM, Fransen J, Rongen GA, Kienhorst LBE, Zoakman S, Janssens HJEM, Janssen M. Crystal-proven Gout and Characteristic Gout Severity Factors Are Associated with Cardiovascular Disease. J Rheumatol 2018; 45:858-863. [PMID: 29657151 DOI: 10.3899/jrheum.170555] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our aim was to examine the prevalence of cardiovascular disease (CVD) in patients with crystal-proven gout compared to arthritis controls. Further, we analyzed the association between characteristic gout severity factors and CVD to provide further support for a pathogenetic relationship between gout and CVD. METHODS Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers cohort. Joint fluid analysis was performed in all referred patients; controls were negative for crystals. Patients' characteristics and different manifestations of CVD and gout severity factors (disease duration, attack frequency, tophi, affected joints, high serum urate acid level, joint damage) were collected. Gout patients were compared with controls for the prevalence of CVD. In addition, the association between characteristic gout severity factors and presence of CVD was analyzed. RESULTS Data from 700 gout patients and 276 controls were collected. CVD was present in 47% (95% CI 44%-51%) and 24% (95% CI 19%-29%) of gout patients and controls, respectively. Corrected for confounders, gout was still strongly associated with an increased prevalence of CVD compared to controls (OR 3.39, 95% CI 2.37-4.84). In patients with gout, disease duration ≥ 2 years, oligo- or polyarthritis, serum urate acid > 0.55 mmol/l at presentation, and joint damage were independently (p < 0.05) associated with prevalent CVD. CONCLUSION Crystal-proven gout was strongly associated with an increased prevalence of CVD. In patients with gout, characteristic gout severity factors were associated with CVD.
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Affiliation(s)
- Iris J M Disveld
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Jaap Fransen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Gerard A Rongen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Laura B E Kienhorst
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Sahel Zoakman
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Hein J E M Janssens
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital
| | - Matthijs Janssen
- From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands. .,I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital.
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Vazirpanah N, Kienhorst LBE, Van Lochem E, Wichers C, Rossato M, Shiels PG, Dalbeth N, Stamp LK, Merriman TR, Janssen M, Radstake TRDJ, Broen JC. Patients with gout have short telomeres compared with healthy participants: association of telomere length with flare frequency and cardiovascular disease in gout. Ann Rheum Dis 2017; 76:1313-1319. [PMID: 28347991 DOI: 10.1136/annrheumdis-2016-210538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/31/2017] [Accepted: 03/02/2017] [Indexed: 01/12/2023]
Abstract
AIM AND BACKGROUND Chronic inflammation associates with increased senescence, which is a strong predictor for cardiovascular disease. We hypothesised that inflammation accelerates senescence and thereby enhances the risk of cardiovascular disease in gout. METHODS We assessed replicative senescence by quantifying telomere length (TL) in a discovery cohort of 145 Dutch patients with gout and 273 healthy individuals and validated our results in 474 patients with gout and 293 healthy participants from New Zealand. Subsequently, we investigated the effect of cardiovascular disease on TL of all participants. Also, we measured TL of CD4+ and CD8+ T lymphocytes, B lymphocytes, monocytes, natural killer cells and plasmacytoid dendritic cells. Additionally, we assessed the potential temporal difference in TL and telomerase activity. RESULTS TL in PBMCs of healthy donors decreased over time, reflecting normal ageing. Patients with gout demonstrated shorter telomeres (p=0.001, R2=0.01873). In fact, the extent of telomere erosion in patients with gout was higher at any age compared with healthy counterparts at any age (p<0.0001, R2=0.02847). Patients with gout with cardiovascular disease had the shortest telomeres and TL was an independent risk factor for cardiovascular disease in patients with gout (p=0.001). TL was inversely associated with the number of gouty flares (p=0.005). CONCLUSIONS Patients with gout have shorter telomeres than healthy participants, reflecting increased cellular senescence. Telomere shortening was associated with the number of flares and with cardiovascular disease in people with gout.
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Affiliation(s)
- N Vazirpanah
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L B E Kienhorst
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Van Lochem
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - C Wichers
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Rossato
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P G Shiels
- University of Glasgow, Institute of Cancer Sciences, Wolfson-Wohl Translational Cancer Research Centre, Glasgow, UK
| | - N Dalbeth
- University of Auckland, Auckland, New Zealand
| | - L K Stamp
- University of Otago, Christchurch, New Zealand
| | | | - M Janssen
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - T R D J Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Ca Broen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Kienhorst LBE, van Lochem E, Kievit W, Dalbeth N, Merriman ME, Phipps-Green A, Loof A, van Heerde W, Vermeulen S, Stamp LK, van Koolwijk E, de Graaf J, Holzinger D, Roth J, Janssens HJEM, Merriman TR, Broen JCA, Janssen M, Radstake TRDJ. Gout Is a Chronic Inflammatory Disease in Which High Levels of Interleukin-8 (CXCL8), Myeloid-Related Protein 8/Myeloid-Related Protein 14 Complex, and an Altered Proteome Are Associated With Diabetes Mellitus and Cardiovascular Disease. Arthritis Rheumatol 2016; 67:3303-13. [PMID: 26248007 DOI: 10.1002/art.39318] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 07/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The frequent association of gout with metabolic syndrome and cardiovascular disease (CVD) suggests that it has a systemic component. Our objective was to study whether circulating proinflammatory cytokines are associated with comorbidities in gout patients. METHODS We studied 330 gout patients from 3 independent cohorts and compared them with 144 healthy individuals and 276 disease controls. We measured circulating levels of interleukin-8 (IL-8)/CXCL8, IL-1β, IL-6, IL-10, IL-12, and tumor necrosis factor, after which we performed proteome-wide analysis in a selection of samples to identify proteins that were possibly prognostic for the development of comorbidities. Replication analysis was performed specifically for myeloid-related protein 8 (MRP-8)/MRP-14 complex. RESULTS Compared to healthy controls and disease control patients, patients with gouty arthritis (n = 48) had significantly higher mean levels of CXCL8 (P < 0.001), while other cytokines were almost undetectable. Similarly, patients with intercritical gout showed high levels of CXCL8. CXCL8 was independently associated with diabetes mellitus in patients with intercritical gout (P < 0.0001). Proteome-wide analysis in gouty arthritis (n = 18) and intercritical gout (n = 39) revealed MRP-8 and MRP-14 as the proteins with the greatest differential expression between low and high levels of CXCL8 and also showed a positive correlation of MRP8/MRP14 complex with CXCL8 levels (R(2) = 0.49, P < 0.001). These findings were replicated in an independent cohort. The proteome of gout patients with high levels of CXCL8 was associated with diabetes mellitus (odds ratio 16.5 [95% confidence interval 2.8-96.6]) and CVD (odds ratio 3.9 [95% confidence interval 1.0-15.3]). CONCLUSION Circulating levels of CXCL8 are increased during both the acute and intercritical phases of gout, and they coincide with a specific circulating proteome that is associated with risk of diabetes mellitus and CVD. Further research focused on the roles of CXCL8 and MRP8/MRP14 complex in patients with gout is warranted.
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Affiliation(s)
| | | | - Wietske Kievit
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Arnoud Loof
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sita Vermeulen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | - Hein J E M Janssens
- Radboud University Medical Center, Nijmegen, The Netherlands, and Rijnstate Hospital, Arnhem, The Netherlands
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Kienhorst LBE, Janssens HJEM, Fransen J, van de Lisdonk EH, Janssen M. Arthritis of the first metatarsophalangeal joint is not always gout: a prospective cohort study in primary care patients. Joint Bone Spine 2014; 81:342-6. [PMID: 24468668 DOI: 10.1016/j.jbspin.2013.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/02/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Arthritis of the first metatarsophalangeal joint has been considered pathognomonic for gout, but it is unknown how frequently other forms of arthritis occur in this joint. The aims were to determine the validity of the general practitioner's clinical diagnosis using joint fluid analysis as the reference test, the prevalence of other diagnoses than gout, and the signs and symptoms that discriminate between gout and non-gout patients. METHODS This prospective cohort study comprised primary care patients with monoarthritis of the first metatarsophalangeal joint. After patient recruitment by general practitioners, patients' characteristics were collected by a rheumatologist. Joint fluid was analyzed for the presence of monosodium urate-crystals. If crystals were absent, patients entered a follow-up period of 6 years, or until a definite diagnosis. If during follow-up crystals were identified, the patient was classified as already having gout at baseline assessment. RESULTS One hundred and fifty-nine primary care patients were included. At baseline the clinical diagnosis was gout in 98%. The positive and negative predictive values of the diagnosis of gout were 0.79 and 0.75, respectively. After follow-up 77% had gout, 8% had another rheumatic disease, and 15% had a transient unspecified monoarthritis. Gout patients had discriminating signs and symptoms from non-gout patients. CONCLUSIONS Gout is an important but certainly not an exclusive cause of arthritis of the first metatarsophalangeal joint.
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Affiliation(s)
- Laura B E Kienhorst
- Department of Rheumatology, Rijnstate Hospital, Arnhem, PO Box 8, 6880 AA, Velp, The Netherlands.
| | - Hein J E M Janssens
- Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands; Department of Clinical Research, Rijnstate Hospital, Arnhem, PO Box 8, 6880 AA, Velp, The Netherlands
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Eloy H van de Lisdonk
- Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, Rijnstate Hospital, Arnhem, PO Box 8, 6880 AA, Velp, The Netherlands
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