Coexistent Hyperuricemia and Gout in Rheumatoid Arthritis: Associations With Comorbidities, Disease Activity, and Mortality

Abstract

ObjectiveAlthough hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes in RA is unclear. We undertook this study to examine associations of coexistent hyperuricemia and gout with RA disease measures, RA treatments, and survival.MethodsParticipants from a longitudinal RA study were categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline serum UA levels with all‐cause and cardiovascular disease (CVD)–related mortality were examined in multivariable survival analyses.ResultsOf 1,999 participants with RA, 341 (17%) had serum UA concentrations of >6.8 mg/dl, and 121 (6.1%) were diagnosed with gout. There were no significant associations of serum UA concentration or gout with RA disease activity or treatment at enrollment, with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs. After adjustments for age and sex, moderate hyperuricemia (serum UA >6.8 to ≤8 mg/dl) was associated with an increased risk of CVD‐related mortality (hazard ratio 1.56 [95% confidence interval 1.11–2.21]). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompany hyperuricemia. Results corresponding with serum UA concentrations of >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline serum UA concentration with all‐cause mortality.ConclusionOur study reports the frequency of hyperuricemia and gout in patients with RA. These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity.

Genetic Correlation Analysis and Transcriptome-wide Association Study Suggest the Overlapped Genetic Mechanism between Gout and Attention-deficit Hyperactivity Disorder

“…Few studies suggested that a significant proportion of RA patient’s exhibit monosodium urate deposition consistent with gout, challenging the previous perceptions that gout and RA are mutually exclusive conditions. 45…”

Associations Between the NLRP3 and IL-1β Gene Polymorphisms and Gout Susceptibility

“…Gout is a self-limited in ammatory joint disease which pathogenesis is complex and it attack is the outcome of combined action of multiple factors.Such as excessive intake sea food or alcohol is considered the predominant risk factor of gout,and the result from Horvathova V et al revealed that [15] as the increase of the age,the risk of gout is also increasely and the gout patients compare to healthy individuals have higher BMIs.Studies have shown that [16][17][18] there are close correlations between gout and kidney disease,obesity,hypertension,diabetes mellitus,cardiovascular and cerebrovascular diseases and so on.Our analysis showing that BMI,DBP,SUA,GLU,BUN,CREA,TG,HDL-C and LDL-C are the risk factors of gout which in line with most of the research conclusion [19][20] .However,in particular,gout is a polygenic hereditary disease and genetic factors are still play crucial role in gout.…”

Phytochemicals as Anti-Inflammatory Agents in Animal Models of Prevalent Inflammatory Diseases

“…Chlorogenic acid, the main bioactive phytochemicals in coffee, belongs to the polyphenol family and has been reported to have anti-gout activity, elicited via its anti-inflammatory effects [ 46 ]. Gout is a form of inflammatory arthritis that is highly associated with RA patients [ 47 ]. Triptolide shows inhibitory effects by decreasing IL-18 and IL-18 receptors in rheumatoid arthritis synovial fibroblasts stimulated by phorbol 12-myristate 13-acetate (PMA) [ 48 ].…”