Serum Uric Acid - a Potential Marker of Inflammation in Rheumatoid Arthritis

Introduction: Serum uric acid (SUA) has been associated with inflammation in metabolic disorders as well as infections. Its role in autoimmune diseases like Rheumatoid Arthritis (RA) is not well established. Our study aims to evaluate the association of serum uric acid and inflammation in patients of RA. Aims and Objectives: To estimate the prevalence of hyperuricemia in RA patients, and correlation of serum uric acid levels with disease activity scores and already established inflammatory markers Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). Material and methods: 150 RA patients as per sample size calculation fulfilling the inclusion and exclusion criteria were taken into the study and evaluated with respect to disease activity, current treatment, inflammatory markers ESR and CRP, and their SUA levels measured. Data was recorded in MS Excel sheet and statistical analysis done by JASP software. Results: Patients with hyperuricaemia had higher disease activity scores and higher levels of CRP. SUA levels correlated positively and significantly with CRP levels and clinical disease activity index (CDAI) and positively but not significantly with ESR. SUA levels didn’t differ between genders, serological status of RA, or between different treatment groups. Conclusion: SUA by itself has the potential to be an independent marker of inflammation in patients of RA

Artritis Gotosa. 10 años de Seguimiento / Artritis Gotosa. 10 años de Seguimiento

Introduction: gouty arthritis is a persistent metabolic disease that produces an increase of the circulating uric acid, with the resulting deposit of monosodic urate crystals in the tissues. Objective: to characterize patients with gouty arthritis clinically and epidemiologically. Methods: a descriptive investigation of 72 patients with a diagnosis of gouty arthritis, assisted at Arnaldo Milián Castro Clinical Surgical University Hospital was carried out from January 2008 to December 2017. Results: patients between 40 and 49 years of age were the most representative group with a highest incidence in not white patients and the male sex. Obesity and hypertension prevailed as previous personal antecedents. Alcohol intake was the most represented toxic habit. A crisis of inflammation of the big toe was the more frequent starting manifestation. Swelling of soft tissues was the main radiologic alteration. Conclusion: gouty arthritis is present with a highest frequency in the male sex with a peak of incidence in the fourth decade of life. It is associated to bad diet habits and alcohol intake that could cause joint damage(AU)

Introducción: la artritis gotosa es una enfermedad metabólica persistente, que produce un aumento del ácido úrico circulante, con el consiguiente depósito de cristales de uratos monosódicos en los tejidos. Objetivo: caracterizar clínica y epidemiológicamente a los pacientes con artritis gotosa. Método: se realizó una investigación descriptiva de 72 pacientes con diagnóstico de artritis gotosa, atendidos en el Hospital Universitario Clínico Quirúrgico Arnaldo Milián Castro, entre enero del 2008 y diciembre del 2017. Resultados: los pacientes entre 40 y 49 años de edad fueron los más representativos, con mayor incidencia en no blancos y del sexo masculino. Predominó la obesidad y la hipertensión arterial como antecedentes patológicos personales. El alcohol fue el hábito tóxico mayoritariamente representado. La crisis de podagra resulto ser la manifestación inicial más usual. El aumento de partes blandas fue la principal alteración radiológica. Conclusiones: La gota se presenta con mayor frecuencia en el sexo masculino con un pico de incidencia en la cuarta década de la vida. Está asociada a malos hábitos dietéticos y al consumo de bebidas alcohólicas pudiendo ocasionar daño articular(AU)

Serum Uric Acid in Acute Coronary Syndromes

Introduction: Uric acid (urate), an organic compound ofcarbon, nitrogen, oxygen and hydrogen has been thought to beprotective against ageing, oxidative stress and oxidative cellinjury owing to its oxidant property. Recent epidemiologicaland clinical evidences suggest that hyperuricaemia might be arisk factor for cardiovascular disease where enhanced oxidativestress plays an important pathophysiological role. The studyis taken up to determine serum uric acid levels in AcuteCoronary Syndromes (ACS) and to compare the incidence ofcomplications in hyperuricaemic and normouricaemic acutecoronary syndrome patients.Material and Methods: A prospective cohort study wasconducted in the Department of Medicine in collaborationwith Department of Biochemistry, RIMS, Imphal fromOctober 2014 to September 2016, among 73 normouricaemicACS patients and 73 hyperuricaemic ACS patients. Clinicaland anthropometric data were taken from each subject.Laboratory evaluation involves serum uric acid by enzymaticcolorimetric method.Results: The mean serum uric acid level in the studypopulation was 5.96 ± 1.88 mg/dl. Arrhythmias occurred in27.4% of hyperuricemic patients and 5.5% of normouricemicpatients. It is observed that 27 patients developed congestivecardiac failure (CCF), out of which 17 patients (22.3%)were hyperuricaemic and 10 patients (13.7%) werenormouricaemic. Pulmonary edema (PE) was observed in 35hyperuricaemic and 28 normouricaemic patients (47.9% and38.4% respectively).Conclusions: Complications of ACS such as arrhythmias,CCF and PE occurred more frequently in hyperuricaemicindividuals. Thus, it can be concluded that serum uric acidlevel can be considered a suitable marker for predicting ACSrelated future adverse events.

Gout and pregnancy: A report of a new case and systematic review / Gota y embarazo: revisión sistemática, incluyendo el reporte de un nuevo caso

Abstract Article history: Received 4 January 2017 Accepted 17 October 2017 Available online 24 May 2018 Introduction: Unlike other rheumatic diseases, gout is rare in women of childbearing age. Due to the low number of cases available for the study, current information is based mainly on case reports. Objective: To describe the characteristics and the outcome of the pregnancy of women with gout. Methods: A systematic literature search was undertaken by the investigators in the PubMed and Embase databases, from the inclusion date to August 2016. Patients were included if they met the definition of gout according to the American Rheumatism Association criteria, and that they had the description of its follow-up during the pregnancy. Data collection and analysis: each pregnancy was treated as a separate observation for analysis. The maternal and fetal-neonatal outcomes data were extracted from the articles finally selected. Results: The search identified 125 potentially relevant articles, but after a full-text review only 12 articles met the inclusion criteria. Of the 23 pregnancies described, there were 16 (69.5%) live births, 5 (21.7%) were aborted, in one (4.3%), the pregnancy was terminated, and in one case report (4.3%) there was no description on the term of pregnancy. No maternal deaths were reported. Two babies died a few hours after birth. Congenital malformations were not described in any case report. The most frequent maternal complications were renal damage, anemia, preeclampsia, and postpartum uremia. Conclusions: Gout during pregnancy is not common, but it is known to occur. While the majority of women with gout delivered healthy infants, they were at increased risk of having maternal complications.

Resumen Introducción: A diferencia de otras enfermedades reumáticas, la gota es una enfermedad rara en mujeres en edad fértil. Debido al escaso número de casos disponibles para el estudio, la información actual se basa, principalmente, en reportes de casos. Objetivo: Describir las características y el desarrollo del embarazo en mujeres con gota. Métodos: Una búsqueda sistemática de literatura fue realizada en las bases de datos PubMed, Lilacs, Ebsco y Embase, desde la fecha de inclusión hasta agosto del 2016. Se incluyó a pacientes que cumplieron con la definición de gota según los criterios de la American Rheumatism Association y que tenían la descripción de su seguimiento durante el embarazo. Cada embarazo se trató como una observación independiente para el análisis. A partir de los artículos finalmente seleccionados, se extrajeron los desenlaces materno-fetales. Resultados: La búsqueda identificó 125 artículos potencialmente relevantes, después de la revisión de texto completo, 12 artículos cumplieron los criterios de inclusión. Se describen 23 embarazos que resultaron en 16 (69,5%) nacimientos vivos, 5 (21,7%) abortos, una (4,3%) interrupción del embarazo y en un caso (4,3%) no se describió el desenlace. No se reportaron muertes maternas. Dos recién nacidos fallecieron después del parto. No se documentaron malformaciones congénitas. Las complicaciones maternas más frecuentes fueron la insuficiencia renal, la anemia, la preeclampsia y la uremia posparto. Conclusiones: La gota durante el embarazo no es común, pero se sabe que ocurre. Mientras que la mayoría de las mujeres con gota tuvieron bebés sanos, presentaban un mayor riesgo de tener complicaciones maternas.

Critical revision of the medical treatment of gout in Brazil / Revisão crítica do tratamento medicamentoso da gota no Brasil

ABSTRACT Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

RESUMO A gota é considerada a forma mais comum de artrite inflamatória em homens acima de 40 anos. Os autores apresentam uma breve revisão sobre o tratamento atual da gota e discutem as limitações farmacológicas existentes no Brasil para o tratamento dessa enfermidade. Apesar de o alopurinol ainda ser a principal medicação para a redução dos níveis de uricemia de pacientes com gota no país, os autores também apresentam dados que apontam para uma grande oportunidade para o mercado farmacológico brasileiro em relação ao tratamento da hiperuricemia e da artrite gotosa e especialmente para pacientes usuários de sistemas privados de saúde e do SUS (Sistema Único de Saúde).

Hiperuricemia y componentes del síndrome metabólico en niños y adolescentes obesos / Hyperuricaemia and metabolic syndrome in obese children and adolescents

Introducción: La hiperuricemia se ha observado como una alteración metabólica adicional en pacientes adultos obesos, pero es poco conocida su magnitud en pacientes pediátricos. Objetivos: Analizar la asociación entre ácido úrico sérico (AUS) con magnitud de la obesidad general y visceral y con otras mediciones bioquímicas en niños y adolescentes obesos de Santiago, Chile. Sujetos y método: En un estudio transversal se evaluaron 770 niños (edades: 6-15 años) de un colegio público de Santiago, Chile, encontrando 227 obesos (29%) (IMC > 2 DE, estándares OMS). Se seleccionaron aleatoriamente 90 niños y aceptaron participar 77, sin otras enfermedades crónicas. Se evaluó: peso, talla, perímetro abdominal, adiposidad visceral con ultrasonografía abdominal y mediciones metabólicas: insulinemia, glucemia (HOMA), lípidos séricos, aspartato aminotransferasa, alanina aminotransferasa (ALT) y AUS. Resultados: Las concentraciones de AUS fueron 0,200 ± 0,065 mmol/l. El AUS fue mayor en niños con valores de hiperinsulinismo (ajustado según edad): 0,221 ± 0,075 vs 0,183 ± 0,054 mmol/l (p < 0,01), sin diferencias según HOMA; las diferencias también se observaron según ALT (> vs < 26 U/ml): 0,238 ± 0,070 vs 0,178 ± 0,054 mmol/l, p < 0,001; la regresión logística controlando por sexo, edad e intensidad de la obesidad mostró solo las ALT asociadas a aumento de AUS. No hubo asociación de mayor AUS con magnitud de IMC, adiposidad visceral o hígado graso. Conclusiones: Los niños y adolescentes obesos de Santiago, Chile, tienen una uricemia mayor en asociación a un aumento de la actividad de la enzima ALT e hiperinsulinismo. Se justifica analizar uricemia en el estudio de niños obesos y en su seguimiento.

Introduction: Hyperuricaemia has been suggested as an additional metabolic factor in adult obese patients, but it has not been sufficiently studied in paediatric. Objectives: To assess the relationship between serum uric acid levels (SUAL) with the level of general and visceral obesity, and other biochemical parameters in children and adolescents of Santiago, Chile. Subjects and method: A cross sectional study was conducted on 770 children and adolescents (ages: 6-15 y.) from a public school in Santiago, Chile, of whom 227 (29%) were obese (BMI > 2 SD, WHO growth standards). Ninety subjects were randomly selected and 77 with no other chronic disease (41 males) accepted to participate. Data was collected on weight, stature, abdominal circumference (AC), visceral adiposity using ultrasound, and other biochemical measurements including fasting glucose, insulin, serum lipids, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and SUAL. Results: The mean SUAL was 0.200 ± 0.065 mmol/L, and was increased in children with hyperinsulinism (adjusted by age: 0.221 ± 0.075 vs 0.183 ± 0.054 mmol/L; P < .01), with no significant differences according to HOMA. Differences were also found between children with ALT > or < 26 U/mL: 0.238 ± 0.070 vs 0.178 ± 0.054 mmol/L, P < .001. The logistic regression showed the increased SUAL was only associated with increased ALT. No significant differences were found in general or visceral adiposity measurements or fatty liver. Conclusions: Children and adolescents from Santiago, Chile have higher uric acid serum uric acid levels as well as an association with increased ALT and insulin. It is demonstrated in this study that uric acid should be measured in obese children and adolescents, and in their follow up.

Poorly controlled gout: who is doing poorly?

Gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals, is commonly seen in primary care and specialist clinics. In recent years, there has been a resurgence of interest in gout due to advances in therapies and the understanding of pathophysiology, with new guidelines being published by international bodies. However, there is still a gap between the goals of treatment and actual day-to-day practice. Barriers that result in poorly controlled gout include patient factors such as lack of understanding of the disease, stigma and nonadherence to treatment, as well as physician factors such as knowledge gaps, inadequate use of allopurinol and lack of ownership of the disease. The medical profession needs to do more to bridge the gap through physician and patient education, identification of treatment targets with appropriate use of drugs, and dissemination of guidelines.

Phenytoin Induced Changes in Glucose and Lipid Metabolism is Related to Increased Urate Synthesis.

Aim: The study was to investigate the relationship of phenytoin-associated hyperuricaemia with the hyperglycaemia and dyslipidaemia caused by phenytoin administration. Methods: Forty-two albino Wistar rats were randomly divided into six (6) groups of 7 rats each. Group 1 animals served as the control (receiving normal saline 0.50 ml). Groups 2,3,4,5 and 6 received phenytoin, phenytoin + vitamin C, phenytoin + vitamin E, phenytoin +vitamin E +vitamin C and phenytoin + allopurinol respectively. The drugs were administered once daily for four weeks by oral intubation as follows: Phenytoin: 5 mg/kg body weight of rat, vitamin C: 1.4 mg/kg body weight of rat, Vitamin E: 10 IU/kg body weight of rat and allopurinol 5mg/kg body weight of rats. Appropriate immunoassay or spectrophotometric methods were used for analysis of fasting plasma glucose, insulin, cholesterol, triglyceride and catalase activities. Results: Showed a significant elevation of serum uric acid following phenytoin administration (p= 0.000) that were not reversed by co-administration of antioxidant vitamins but were reduced by allopurinol administration. Serum catalase activities which were significantly depressed by phenytoin treatment were reversed by antioxidant Vitamins C, E or allopurinol. The concentration of fasting plasma glucose, insulin resistance index, total cholesterol and triglyceride were significantly increase [(59.5%: p=0.001), (87.9%: p=0.005), (35.7%: p=0.000), (34.5% p=0.027)] respectively by phenytoin administration compared to control. However, the values of these parameters were not significantly lowered by antioxidant Vitamins, but significant reduction (p=0.017) to values similar to those of normal control group were observed in the group receiving both phenytoin and allopurinol. Fasting plasma insulin levels were not significantly (16.8%: p=0.137) affected by these drug treatments. Pearson bivariate correlation analysis of data of the experimental groups and control showed significant positive correlation between uric acid and fasting plasma glucose (r=0.598, P=0.000), fasting plasma insulin (r=0.394, P=0.010), insulin resistance index (HOMAIR: r=0.551, P=0.000), total cholesterol (r=0.677, P=0.000) and triglyceride (r=0.490, P.0.001). Conclusion: We conclude that the metabolic toxicities of phenytoin associated with impaired glucose metabolism, insulin resistance and dyslipidaemia, are related to phenytoin induced hyperuricaemia.

Hyperuricaemia and its Relations with Serum Lipid Abnormalities in Untreated, Newly Diagnosed Adult Nigerian Hypertensive Patients.

Aims: To determine the prevalence of hyperuricaemia in adult Nigerians with untreated newly diagnosed hypertension and to evaluate its relations with serum lipid abnormalities. Study Design: Cross-sectional study. Place and Duration of Study: General Out-patient Department, Medical Out-patient Department and Emergency Room of the University of Ilorin Teaching Hospital, Ilorin, Nigeria between May 2007 and October 2007. Methodology: One hundred and fifty (150) untreated newly diagnosed hypertensive patients 18 years and above and one hundred and fifteen (115) age and sex-matched normotensive individuals were recruited into the study. Thorough clinical evaluation and laboratory investigations were done for both patients and controls including serum uric acid and serum lipid profile. Atherogenic ratio (Total cholesterol/Low density lipoprotein-cholesterol) was calculated for both patients and controls. Results: Of the one hundred and fifty newly diagnosed hypertensive patients, 52 (34.7%) were males and 98 (65.3%) females, with a range of 19-85 years and a mean age (±SD) of 50.412.3 years. Among the normotensive controls, 49 (42.6%) were males and 66 (57.4%) females with range of 23-80 years and a mean (±SD) of 50.712.7 yrs. Mean serum UA in hypertensive patients and normotensive controls was 0.40.1 mmol/l and 0.30.1 mmol/l respectively. Hyperuricaemia was found in 36.7% of hypertensive patients and 17.4% of normotensive controls (P<0.001). Serum UA was significantly higher in hypertensive patients than in normotensive controls (P<0.0001). Among hypertensive patients high TC and high LDL-c were the most prevalent types of serum lipid abnormalities. There was a significant positive correlation between serum UA and TG (r=0.21, P = 0.01). Conclusion: The study shows that hyperuricaemia and serum lipid abnormalities are prevalent among adult Nigerians with hypertension. There was a significant correlation between serum uric acid and serum triglyceride. This study recommends routine measurement of serum uric acid in both newly diagnosed hypertensive patients as well as those on antihypertensive drugs.

Effect of the fractions of Erythrina stricta leaf extract on serum urate levels and Xo/Xdh activities in oxonate-induced hyperuricaemic mice.

The present study was aimed at investigating the in vivo hypouricaemic activity of the various fractions of the hydromethanolic extract of the leaves of Erythrina stricta roxb (papilionacea) using oxonate-induced hyperuricaemic mice. The leaves of this species was used in traditional medicinal system for the treatment of gout, rheumatism, jaundice, bronchitis, fever, skin eruptions, wounds, etc. The pet-ether, chloroform, ethyl acetate and residual fractions at a dose of 200 mg/kg b.w. orally, were tested for their ability to reduce the serum urate level and inhibitory actions on the XO/XDH enzyme activities in the mouse liver and intestine. Potassium oxonate (280 mg/kg, i.p.), an uricase inhibitor was used to induce hyperuricaemia. Allopurinol (10 mg/kg, p.o.) was used as the positive control. The pet-ether, chloroform and ethyl acetate fractions when administered to hyperuricaemic mice produced a significant reduction in serum urate levels. In addition, these fractions elicited significant inhibitory actions on the XO/XDH enzyme activities in the mouse liver. The hypouricaemic activity may be due to the inhibition of XO/XDH enzymes. The effect of the fractions was less potent than allopurinol. The activity produced by the residual fraction was insignificant (P>0.05). Phytochemical screening of the leaves of Erythrina stricta revealed the presence of tannins, flavonoids, alkaloids and terpenoids. The presence of phytochemical constituents may be partly responsible for the beneficial effect of the fractions on hyperuricaemia and gout. These results suggest that the leaves of Erythrina stricta could be used as a potential source to treat gout and other inflammatory disorders.

Relationship between hvperuricemia and chronic kidney disease in Pudong New Area of Shanghai / 中华流行病学杂志

Objective To investigate the relationships between hyperuricaenia,serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of Pudong New Area,Shanghai.Methods 3326 residents aged 20-80 years were randomly selected from Pudong New Area,Shanghai through multistage sampling and interviewed between April and July of 2008.Fasting blood sample and morning ovid urine sample were collected for each participant for testing of SUA,serum creatinine,urinary albumin and creatinine.Both urine albumin to creatinine ratio (ACR)and glomerular filtration rate (GFR) were calculated to estimate the renal function.Results The overall prevalence of CKD was 16.0％ (age standardized 13.2％ ).The mean values of estimated GFR in participants with CKD and without CKD were (89.19 ± 27.25) and ( 105.88 ± 98.37) ml· min-1 ·(1.73 m2) -1,respectively.The prevalence rates of CKD in serum uric acid quartiles:first quartile,less than 4.2 mg/dl; second quartile,4.2-5.0 mg/dl; third quartile,5.0-6.0 mg/dl; and fourth quartile,6.0 mg/dl or more were 13.9％,15.0％,15.8％and 19.4％ (P＜0.05) respectively,increasing along with the increase of SUA among both sexes.Compared to the serum uric acid first quartile,the multivariate-adjusted odds for CKD of the second,third and fourth quartiles were 1.19 [95％ confidence interval (CI):0.90-1.58],1.27 (95％ CI:1.02-1.70),1.28 (95％ CI:1.10-1.68),respectively. Conclusion Hyperuricaemia was independently associated with the increased prevalence of CKD among population living in the Pudong New Area,Shanghai.

Molecular analysis of a SNP in SCL2A9 and uric acid levels in Chinese male gout patients / 中华风湿病学杂志

ObjectiveSLC2A9 is a novel identified urate transporter that affects serum uric acid levels. The present study is aimed to investigate rs7442295 polymorphism in intron 6 of SLC2A9 in a population of Chinese male gout or hypemricaemia subjects. MethodsA total of 268 gout patients and 288 healthy male volunteers were included. Blood pressure, body mass index(BMI), serum uric acid, glucose, lipid,urea and creatine were detected. DNA was purified from peripheral blood and the rs7442295 polymorphism was evaluated using high resolution melting ( HRM ) analysis and direct sequencing. Data were analyzed with t test or chi-square test. Results A/A and A/G genotypes were unambiguously distinguished with HRM technology. The occurrence of the homozygous type (G/G) was completely absent among the study population.The prevalence of the A/A and A/G genotype was 96.2％ and 3.8％ respectively. However, no significant differences of genotype frequencies were found in gout patients and normal subjects(x2=0.003, P=0.82; x2=0.003, P=1.00). But the serum uric acid levels in individuals with the A/G genotype[(293±100) μmol/L]were significantly lower than those with the A/A genotype[(392±133) μmol/L](t=2.426, P＜0.01 ). The A/G genotype frequency was significantly higher in the low-uric acid group than in the high uric-acid group (x2=6.279, P=0.01 ). Genotyping based on HRM was fully concordant with sequencing. Conclusion The polymorphism rs7442295 in SLC2A9 may be a genetic marker to assess risk of hyperuricemia among Chinese male Hart population. HRM is a simple, fast, reliable and close-tube technology for genotyping.

Hyperuricaemia and antioxidant enzymes in red cells of patients with malignacy of haematological origin.

Serum uric acid, red cell SOD and catalase activities were determined in 117 patients acute lymphoblastic leukaemia, chronic myelocytic leukaemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, polycythemia vera and multiple myeloma in comparison to 40 healthy normal subjects. About 6-40 percent of these patients had serum uric acid level over 7 mg/dl. Altogether, 14 patients had hyperuricaemia, therefore they were grouped together. There was a reverse relationship between serum uric acid level and SOD activity in these patients. The hyperuricaemia is a result of increased proliferation and destruction of tumour cells which stimulates the generation of superoxide radicals. Therefore, red cell SOD will be decreased in patients with hyperuricaemia. In order to compensate for an elevated oxidant stress, SOD will therefore increase. These findings could explain the variable results of red cell SOD reported earlier in patients with malignancy of haematological origin. There was no relationship between serum uric acid and red cell catalase activity in these patients.