Hyperuricemia is associated with intermittent hand joint pain in a cross sectional study of elderly females: The AGES-Reykjavik Study

Abstract

Background The debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain. Methods and findings Participants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07–1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32–2.31), p<0.001) remained significant. The best model for describing the relationship between serum uric acid levels (SUA) and intermittent hand joint pain in ≥10 joints was non-linear with a cut-off at 372 μmol/L. The attributable surplus number of symptomatic females with SUA ≥372 μmol/L was approximately 2.0% of the study population for those reporting pain in ≥10 hand joints. Next after having severe hand osteoarthritis, SUA ≥372 was an independent predictive factor of intermittent pain in ≥10 hand joints. Intermittent hand joint pain was also an independent risk factor for worse general health description. Conclusion Results from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.

Why Does Hyperuricemia Not Necessarily Induce Gout?

“…Given the recent safety concerns, gradually up-titrated allopurinol remains the first-line ULT [ 96 ] together with concomitant colchicine or nonsteroidal anti-inflammatory drugs for enhancement of efficacy [ 97 ]. Adversely, treatment of hyperuricemia has raised attention besides gout, and current debates on whether asymptomatic hyperuricemia should be treated are still ongoing [ 2 , 98 , 99 ]. This may partially be due to both low and high SUA levels being associated with increased all-cause and cause-specific mortality with a U-shaped association [ 100 , 101 ].…”

Osteoarthritis and Hyperuricemia: Is There a Relationship?

“…В регрессионном анализе, с учетом возраста, ИМТ и ОА суставов кистей, значения МК более 372 мкмоль/л у женщин независимо увеличивали риск интермиттирующих болей в кистях в целом (OШ = 1,30; 95%-ный ДИ: 1,07-1,58; p = 0,008) и таких же болей более чем в 10 суставах кистей (OШ = 1,75; 95%-ный ДИ: 1,32-2,31; p < 0,001). Исследователи делают заключение, что ГУ у пожилых женщин может быть довольно частой причиной периодических болей в определенных суставах, и это поднимает вопрос о целесообраз ности лечения бессимптомной ГУ [15].…”

Why Hyperuricemia Does Not Necessarily Induce Gout?

“…Given the recent safety concerns, gradually up-titrated allopurinol remains the first-line ULT [96] together with concomitant colchicine or nonsteroidal anti-inflammatory drugs for enhancement of efficacy [97]. Adversely, treatment of hyperuricemia has been raised attention besides gout, and current debates on whether asymptomatic hyperuricemia should be treated are still ongoing [2,98,99]. This may partially be due to both low and high SUA levels are associated with increased all-cause and cause-specific mortality with a U-shaped association [100,101].…”