Prediction of renal and cardiometabolic outcomes in gout during urate‐lowering therapy by sonography

Abstract

ObjectivesTo assess whether the extent of monosodium urate (MSU) crystal deposition estimated by ultrasound could predict renal and cardiometabolic events during urate‐lowering therapy (ULT).MethodsA prospective study on gout patients from two referral centers initiating ULT who underwent baseline ultrasound and were followed for 1 year. Ultrasound scans assessed six joints for double‐contour (DC) signs and tophi. A five‐point change (mL/min/1.73 m2) in the glomerular filtration rate at month 12 (M12) was considered significant. Outcomes of interest were renal function degraded versus improved and a composite cardiometabolic outcome (new hypertension, diabetes, atherosclerotic disease, and cardiovascular death). Homogeneity analyses and Cox regression models were performed.ResultsOne hundred sixty patients were recruited. At baseline, 81.1% of patients (n = 129) showed sonographic tophi with a mean number of 1.4 joints (±1.3) with a DC sign. At M12, 18 patients (11.3%) were lost to follow‐up. The serum urate (SU) target (<6.0 mg/dL) was reached in 86 patients (69.9%). Regarding renal function, 15.9% of patients showed improvement, while in 31.0% it degraded. Fourteen new cardiometabolic events occurred in 12 patients. Neither the DC sign nor tophi showed any significant impact on the outcomes of interest. Baseline SU level was higher in those with renal improvement but not with renal decline, while achieving the SU target protected against new cardiometabolic events (HR = 0.2; 95% CI: 0.05–0.81).ConclusionsSonographic MSU crystal burden was unhelpful in predicting renal and cardiometabolic events during the first year of ULT. Reaching the SU target prevented cardiometabolic events, while its benefit in preserving/improving renal function is unclear.

Association between serum uric acid levels and lung function in the NHANES cohort (2007–2012): A cross‐sectional analysis of a diverse American population

“…UA is commonly measured for evaluating renal function, diagnosing gout, and monitoring drug response 4,5 . UA has been proposed to be associated with metabolic syndrome, hypertension, cardiovascular diseases, dyslipidemia, and thyroid dysfunction 6–8 . Additionally, there has been an increasing focus on the link between UA levels and the severity of pulmonary disease 9,10 …”

“…4,5 UA has been proposed to be associated with metabolic syndrome, hypertension, cardiovascular diseases, dyslipidemia, and thyroid dysfunction. [6][7][8] Additionally, there has been an increasing focus on the link between UA levels and the severity of pulmonary disease. 9,10 Lung function testing is a valuable tool that offers objective measures to aid in diagnosing, clinical management, or surgical preparation of individuals with respiratory symptoms or those at risk of respiratory disease.…”