Development of Acute Gouty Attack in the Morbidly Obese Population after Bariatric Surgery

Antozzi, Priscila; Soto, Flavia; Arias, Fernando; Carrodeguas, Lester; Ropos, Trumane; Zundel, Natán; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1381/0960892053576802

Cited by 31 publications

(24 citation statements)

References 7 publications

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“…Our data suggest that this increase may occur due to renal dysfunction associated with major surgery, although other metabolic effects due to fasting or rapid weight loss may also have contributed 23. Other groups have reported gout flares in the postoperative period in people undergoing bariatric surgery 24 25. This was also observed in one of our participants with established gout who developed a postoperative flare in the context of severe hyperuricaemia.…”

Section: Discussionsupporting

confidence: 83%

Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study

et al. 2013

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Objectives Weight loss leads to reduced serum urate (SU) in people with obesity. However, the clinical relevance of such reductions in SU is unknown. This study examined the impact of non-surgical weight loss and bariatric surgery on SU targets in people with morbid obesity and diabetes. Methods The study was a single-centre, prospective study of 60 people with type 2 diabetes and body mass index ≥35 kg/m 2 . Following 6 months of non-surgical weight loss, all participants had laparoscopic sleeve gastrectomy, with a further 1 year of follow-up. Serial SUs were measured throughout the study. Results Participants experienced mean (SD) weight loss of 5.5 (4.1) kg prior to surgery and 34.3 (11.1) kg following surgery. SU did not change following nonsurgical weight loss (0.38 (0.09) mmol/L at baseline and 0.38 (0.10) mmol/L at follow-up), but increased to 0.44 (0.15) mmol/L in the immediate postoperative period and reduced to 0.30 (0.08) mmol/L 1 year after surgery ( p<0.05 for both compared with baseline). Baseline SU, cessation of diuretics, female sex and change in creatinine independently predicted change in SU at the final visit. In participants without gout, SU above saturation levels (≥0.41 mmol/L) were present in 19/48 (40%) at baseline and 1/48 (2%) 1 year after surgery ( p<0.0001). In participants with gout, SU above therapeutic target levels (≥0.36 mmol/L) were present in 10/12 (83%) at baseline and 4/12 (33%) 1 year after surgery ( p=0.031). Conclusions Clinically relevant reductions in SU occur following bariatric surgery in people with diabetes and WHO class II or higher obesity.

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Section: Discussionsupporting

confidence: 83%

Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study

et al. 2013

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“…No difference in the number of gouty attacks was observed in the control group . Antozzi et al reported a pre‐operative diagnosis of gout in 0.4% (5/1240) of a cohort of bariatric patients. Post‐operatively, two of the five patients experienced acute gouty.…”

Section: Discussionmentioning

confidence: 95%

Hyperuricemia and acute gout after laparoscopic sleeve gastrectomy

et al. 2019

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The aim of this study was to evaluate the prevalence of hyperuricemia and acute gout after laparoscopic sleeve gastrectomy (LSG). Risk factors for developing gout were also examined.Eighty-five patients underwent LSG were enrolled in this prospective study. Serum uric acid levels, gout attacks and total water levels % derived by bioimpedance were examined pre-operatively and 1 month post-operatively. Hyperuricemia was identified in 30.6% preoperatively and in 18.82% of patients post-operatively. From the patients' group with pre-operative hyperuricemia, 53.9% were normalized, 46.2% had increased uric acid postoperatively while gout was observed in 11.5%. From the patients group without pre-operative hyperuricemia, hyperuricemia and gout were observed in 6.8% and 5.1% post-operatively, respectively. The relative risk for developing hyperuricemia was 6.2 (95% confidence interval[CI] 2.2-17.8) and for developing gout was 2.3 (95% CI 2.2-17.8). Statistical significant differences for gout among the groups with and without gout were indicated concerning preoperative use of medications (P < 0.001), age (P = 0.025), post-operative uric acid levels (P < 0.001) and post-operative total water levels % (P = 0.048). The prevalence of hyperuricemia was 18.8% and gout attack of 7.1% 1 month after LSG. From the cohort of patients with pre-operative hyperuricemia, a significant proportion normalized uric acid, while 11.5% developed gout. Patients without hyperuricemia pre-operatively developed hyperuricemia and gout in 6.8% and 5.1% post-operatively, respectively. The patients who had gout were younger and had 37% water levels post-operatively. K E Y W O R D Sbariatric surgery, gout, hyperuricemia, laparoscopic sleeve gastrectomy

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“…As many turn to surgical means of weight loss, it is encouraging that a recent prospective study of 60 patients with type 2 diabetes and BMI ≥35 kg/m 2 found clinically significant reductions in serum uric acid levels one year after bariatric surgery (115). Interestingly, uric acid levels and gout attacks initially increase peri-operatively secondary in part to the catabolic effect of surgery, rapid weight loss, and renal impairment(115, 116). However, patients with weight loss post bariatric surgery ultimately benefit from reduced inflammation and show decreased production of interleukins including IL-1β, IL-6 and IL-8 in response to MSU crystals (117).…”

Section: Other Lifestyle Factorsmentioning

confidence: 99%

“…A study by Hanna et al actually reported lower serum uric acid levels in chronic smokers, though data was not adjusted for potential confounders such as BMI (116, 118). This confirmed findings from a prior cross-over study reporting decreased uric acid levels after smoking a cigarette (119).…”

Section: Other Lifestyle Factorsmentioning

confidence: 99%

Gout

MacFarlane¹,

Kim²

2014

Rheumatic Disease Clinics of North America

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Gout is a common inflammatory arthritis triggered by the crystallization of uric acid within the joints. Gout affects millions worldwide and has an increasing prevalence. Recent research has been carried out to better qualify and quantify the risk factors predisposing individuals to gout. These can largely be broken into non-modifiable risk factors such as sex, age, race, and genetics, and modifiable risk factors such as diet and lifestyle. Increasing knowledge of factors predisposing certain individuals to gout could potentially lead to improved preventive practices. This review summarizes the non-modifiable and modifiable risk factors associated with development of gout.

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Development of Acute Gouty Attack in the Morbidly Obese Population after Bariatric Surgery

Abstract: Although rare, gout must be considered a co-morbid illness in obese and morbidly obese patients. Surgeons should be familiar with the signs and symptoms of attacks in the postoperative period, and be knowledgeable in the management.

Cited by 31 publications

References 7 publications

Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study

Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study

Hyperuricemia and acute gout after laparoscopic sleeve gastrectomy

Gout

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