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

OBJECTIVES: To assess whether the extent of monosodium urate (MSU) crystal deposition estimated by ultrasound could predict renal and cardiometabolic events during urate-lowering therapy (ULT). METHODS: A 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. RESULTS: One 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). CONCLUSIONS: Sonographic 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.

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout.

Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis. Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0-3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression. Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2-3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03-1.50) and a positive PD signal (OR 1.67; 95% CI 1.09-2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association. Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.

Lupus eritematoso sistémico / Systemic lupus erythematosus

El lupus eritematoso sistémico es una enfermedad autoinmune, crónica,que afecta al tejido conectivo y cuya etiología es desconocida.Se caracteriza por la presencia de manifestaciones clínicas asociadasa la presencia de autoanticuerpos. Su prevalencia en España es de91 casos/100.000 habitantes. Es más frecuente en mujeres que enhombres en una relación 10:1.El propósito de este artículo, séptimo de una serie dirigida a los cuidadosenfermeros en reumatología, es presentar el lupus eritematososistémico, recorriendo generalidades de esta patología, sus manifestacionesclínicas, además del régimen terapéutico y la Educaciónpara la Salud dirigida a estos pacientes. Los cuidados enfermerosde las personas con esta patología tienen el objetivo de facilitar elautocuidado y el afrontamiento eficaz de la enfermedad, por lo quedeben incluir: recomendaciones higiénicas generales, recomendacionespara la reducción del riesgo cardiovascular y otras comorbilidades,enfatizar la importancia de la adherencia al tratamiento y elcumplimiento de las citas de revisión (AU)

Systemic lupus erythematosus is a chronic, autoimmune disease thataffects connective tissue and which aetiology is unknown. It is characterizedby clinical manifestations associated with the presence ofantibodies. Its prevalence in Spain is 91 cases/100,000 inhabitants.It is more frequent in women than men in a ratio of 10:1.The objective of this article, the seventh in a series aimed at nursingcare in rheumatology, is to present systemic lupus erythematosus,covering its general aspects, clinical manifestations, therapeuticregime and health education aimed at these patients. Nursing careof patients with this pathology aims to facilitate self-care and aneffective coping with the disease, thus making it necessary to include:general hygienic recommendations, recommendations forthe reduction of cardiovascular risk and other comorbidities, emphasison the importance of adherence to treatment and follow-upvisits (AU)