Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout

Cipolletta, Edoardo; Tata, Laila J.; Nakafero, Georgina; Avery, Anthony; Mamas, Mamas A.; Abhishek, Abhishek

doi:10.1001/jama.2022.11390

Cited by 117 publications

(92 citation statements)

References 42 publications

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“…As the incidence and prevalence of gout are increasing, more therapeutic strategies are needed to treat recalcitrant and refractory gout flares for patients whose quality of life is otherwise severely impaired. What is more, a recent study suggests that, in gouty patients, there is an increased risk of a cardiovascular event after an attack ( 49 ). This would also argue in favors of treating attacks in a more intense way.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

et al. 2023

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BackgroundGout is the most common type of inflammatory arthritis. Nonsteroidal anti-inflammatory drugs, corticosteroids, and colchicine are the first-line agents, although they are contraindicated in many patients. Blockade of IL-1 with anakinra can be an alternative.ObjectiveTo present a case series of 10 difficult-to-treat gout patients treated with anakinra and perform a scoping review of the effectiveness and safety of anakinra in gout patients.MethodsA total of 1,519 citations were screened. The reviewers ran a two-stage screening process by title/abstract and full-text reading. Thirty-eight articles finally met the selection criteria and were included for data extraction and synthesis. Experience in difficult-to treat and complex clinical scenarios, such as active infection, hemodialysis, and transplantation, were specifically described.ResultsThe study sample comprised 551 patients, from whom 648 flares were finally analyzed. The mean age was 57.9 years, and 82.9% were men. The clinical presentation was polyarticular in 47.5% and tophaceous in 66.9%. Sixty-five patients with an active infection, 41 transplanted patients and 14 in haemodyalisis treated with anakinra are described. More than half of the patients had >1 associated comorbidity. Anakinra was effective both for flares (94%) and for long-term treatment (91%) and well tolerated. In the case of flares, 34 (6.7%) adverse effects were registered. Adverse events were more prevalent in long-term treatment.ConclusionAnakinra was effective and safe for management of gout flares in difficult-to-treat patients. It has been used in multiple complex scenarios, such as active infections, dialysis, transplantation, chronic kidney disease, and polyarticular gout. Anakinra has also proven effective as long-term treatment, although there are more concerns about its safety.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

et al. 2023

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“…Several epidemiological studies have indicated that the change of uric acid (UA) is associated with the risk of cardiovascular and all-cause death [7][8][9] . For every 1 mg/dl increase in UA, cardiovascular and overall mortality increase by 12% and 20%, respectively 10) .…”

Section: Tdt-mediated Dutp Nick-end Labeling Assaymentioning

confidence: 99%

“…Moreover, we confirmed by flow mortality did not show gender differences 8) . Several articles have been published showing that the occurrence of MACE is associated with increased vulnerability of plaques 7,[26][27][28] . On this basis, we further observed the microstructure of the plaques.…”

Section: Activation Of Autophagy Can Partially Reverse the Foam Cell ...mentioning

confidence: 99%

“…Several clinical and epidemiological studies have established a link between HUA and atherosclerosis 7,8,10,11) . There have also been some basic studies studying the possible mechanisms behind HUA and atherosclerosis and involving a variety of cells, vascular endothelial cells, immune cells (e.g., macrophages, T cells), and vascular smooth muscle cells [19][20][21][22] .…”

Section: Activation Of Autophagy Can Partially Reverse the Foam Cell ...mentioning

confidence: 99%

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High Uric Acid Promotes Atherosclerotic Plaque Instability by Apoptosis Targeted Autophagy

Liu

Xie

et al. 2023

JAT

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Aims: Acute rupture or erosion of unstable atherosclerotic plaques is a major cause of adverse consequences of atherosclerotic cardiovascular disease, often leading to myocardial infarction or stroke. High uric acid (HUA) is associated with the increasing risk of cardiovascular events and death. However, the mechanism by which HUA promotes atherosclerosis and whether HUA affects plaque stability are still unclear. Methods: We constructed an atherosclerotic Apoe−/− mouse model with HUA. The progression of atherosclerosis and plaques was determined by Oil Red O staining, hematoxylin and eosin (H&E) staining, and Masson staining. TdT-mediated dUTP nick-end labeling assay and immunohistochemistry were used to observe the changes of apoptosis and autophagy in plaques, respectively. Then, we validated the in vivo results with RAW 264.7 cell line. Results: HUA promoted atherosclerosis and exacerbated plaque vulnerability, including significantly increased macrophage infiltration, lipid accumulation, enlarged necrotic cores, and decreased collagen fibers. HUA increased cell apoptosis and inhibited autophagy in plaques. In vitro results showed that HUA decreased cell viability and increased cell apoptosis in foam cells macrophages treated with oxidized low-density lipoprotein. An activator of autophagy, rapamycin, can partially reverse the increasing apoptosis. Conclusion: HUA promoted atherosclerosis and exacerbated plaque vulnerability, and HUA facilitates foam cell apoptosis by inhibiting autophagy.

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“…De acuerdo con el estudio de epidemiologia global de Dehlin et al (2) , Latinoamérica no posee datos fiables sobre la prevalencia y desenlaces de esta condición. Sin embargo, la obesidad y otras comorbilidades cardiometabólicas se asocian fuertemente con la gota, por lo que se presume, entonces (3) , que la prevalencia es alta. Ahora bien, este es un círculo vicioso negativo sobre el riesgo y enfermedad cardiovascular, puesto que la hiperuricemia y crisis gotosa generan hipertensión vasoactiva inducida por ácido úrico, a expensas de lesión microvascular e intersticial del parénquima renal y arterial (3,4) .…”

Section: Señor Editorunclassified

Cardiovascular risk in patients with acute gout: is there any association and need for treatment?

Picón-Jaimes

Merchán-Cepeda

Castro-Córdoba

et al. 2022

Arch Peru Cardiol Cir Cardiovasc

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Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout

Cited by 117 publications

References 42 publications

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature

High Uric Acid Promotes Atherosclerotic Plaque Instability by Apoptosis Targeted Autophagy

Cardiovascular risk in patients with acute gout: is there any association and need for treatment?

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