Assessment of Primary Healthcare Providers' Knowledge and Practices in Addressing Asymptomatic Hyperuricemia and Gout in the Asir Region of Saudi Arabia.

Introduction and aim Gout, the most common form of inflammatory arthritis, arises from hyperuricemia, a condition where elevated levels of uric acid lead to the deposition of monosodium urate (MSU) crystals in the joints. Nevertheless, it's important to note that not all cases of hyperuricemia result in gout. Methodology This cross-sectional study was conducted in the Asir region of Saudi Arabia, targeting primary healthcare physicians (PHPs) specializing in family medicine and general practice. The study utilized a modified electronic questionnaire, inspired by similar studies and aligned with recent guidelines, to assess PHPs' knowledge and practices concerning asymptomatic hyperuricemia (AH) and gout. The questionnaire encompassed the PHPs' demographic data and their knowledge and practices for AH and gout management. Results Out of 201 participating PHPs, the majority were male (68.2%), predominantly aged 25-34 years (73.1%), and practicing as general practitioners (61.2%). A significant proportion of PHPs had less than five years of experience (63.7%). In terms of education, 36.8% attended continuing medical education (CME) on AH or gout, and 66.7% were aware of the related management guidelines. The study revealed that the total knowledge score among PHPs averaged 5.18 out of seven, indicating a moderate level of knowledge. However, their practice level was moderate, with a mean practice score of 6.75 out of 12. The study also found no significant differences in knowledge scores based on gender, age, or years of experience, but significant variations were noted based on medical specialty. Conclusion There is a moderate level of knowledge and practice among PHPs in managing AH and gout in the Asir region. Despite adequate knowledge levels, there appears to be a gap in implementing this knowledge into practice, particularly in long-term management strategies. The findings emphasize the need for ongoing medical education and specialized training programs to bridge these gaps. The study provides a valuable framework for identifying and addressing similar challenges in other regions and medical practices.

Exploring the Effects of Elevated Serum Uric Acid Levels on Hypertension: A Scoping Review of Hyperuricemia.

Hypertension (HTN) is a global health concern due to its increasing prevalence and association with life-threatening complications. An intriguing area of investigation in HTN research is the relationship between HTN and hyperuricemia. In light of this, we conducted a review to summarize the relevant studies exploring the link between elevated serum uric acid (sUA) concentration and new-onset HTN. Through a comprehensive search of PubMed Central, MEDLINE, and PubMed databases, we identified 20 studies that met our inclusion criteria. The research encompassed various study designs, including cohort studies, cross-sectional studies, reviews, and clinical trials. Pathologically, the elevated sUA levels activate the renin-angiotensin system and also cause the formation of urate crystals, triggering inflammation in the kidneys. Additionally, direct effects on the endothelium contribute to inflammation, oxidative stress, nitric oxide depletion, and smooth muscle cell proliferation, ultimately leading to atherosclerosis. These diverse mechanisms collectively play a role in the pathogenesis of HTN. Interestingly, lowering sUA has been shown to reverse early-stage HTN dependent on uric acid. However, this effect is not observed in the uric acid-independent second stage of HTN. Various studies have demonstrated an independent and dose-dependent association between sUA levels and the prevalence of HTN across different populations and genders. The review highlights the potential role of uric acid-lowering drugs, like allopurinol, in the prevention and early-stage management of HTN. However, there is scarce research on the efficacy of other uric acid-lowering agents and combination therapies. We believe our review provides compelling evidence of the association between elevated sUA concentration and new-onset HTN. Identifying and managing hyperuricemia can provide a preventive approach to reducing the burden of HTN and its associated complications.

Association between uric acid levels and incidence of type 2 diabetes: Population-based Panasonic cohort study 11.

AIMS: This cohort study intended to assess the association between serum uric acid levels and incidence of type 2 diabetes in a Japanese population. METHODS: Individuals who participated a medical health checkup program carried out by Panasonic Corporation from 2008 to 2018 were included in this study. A total of 122,123 participants (92,718 men and 29,405 women) were included. During the research period, 6,386 participants developed type 2 diabetes. RESULTS: Multivariate analysis showed that, in men, serum uric acid levels were not significantly associated with incident type 2 diabetes after adjusting for diabetes risk factors. However, in women, the risk of type 2 diabetes incidence was higher in the group with uric acid levels 5.1-6.0 mg/dL (hazard ratio, 2.01 [95 % confidence interval: 1.26-3.42]) or > 6.1 mg/dL (hazard ratio, 1.85 [95 % confidence interval: 1.11-3.22]) than in the group with uric acid levels ≤ 3 mg/dL. Furthermore, in women, the area under the receiver operating characteristic curve and optimized cut-off values of uric acid for the incidence of type 2 diabetes at 10 years were 0.720 and 4.8 mg/dL, respectively. CONCLUSIONS: Serum uric acid levels were associated with incident type 2 diabetes in Japanese women but not in Japanese men.

The Correlation of Serum Uric Acid Levels With the Severity of Coronary Artery Disease in Diabetic Patients: A Cross-Sectional Study.

Background and aim  Coronary artery disease (CAD) is a severe and life-threatening complication in patients with diabetes, resulting in significant morbidity and death burden globally. Although serum uric acid levels have been linked to the aetiology of both CAD and diabetes, the association between uric acid and CAD severity in diabetic patients remains unknown. This study aimed to investigate the relationship between serum uric acid levels and the severity of CAD in patients with diabetes undergoing coronary angiography. This study also compared patient parameters and comorbidities linked with high uric acid levels. Material and methods This cross-sectional study was conducted at the Lady Reading Hospital in Peshawar, Pakistan, from October 20, 2022, to September 20, 2023. A total of 290 patients with diabetes were enrolled. These participants were divided into groups depending on their serum uric acid levels: Group A (n = 145) and Group B (n = 145). On average, patients in Group A had high serum uric acid levels, whereas those in Group B had normal serum uric acid levels. Coronary angiograms were analysed using well-established assessment methods to determine the severity of CAD using the Syntax score as the mean score was greater for Group A with higher serum uric acid levels than Group B.  Results The mean age of patients in Group A was 59.2±7.1 years, whereas in Group B, it was 60.5±6.8 years. The percentage of male patients in Group A was 62% and 58.6% in Group B. The mean BMI for group A was 28.4±2.3 kg/m2, while the mean BMI for group B was 27.9±2.1 kg/m2. In both groups, the prevalence of hypertension, dyslipidemia and family history of CAD did not differ significantly. Group A's mean serum uric acid levels were 8.17 ± 1.64, while in Group B, 5.03 ± 1.09. Similarly, the mean Syntax score, which is a visual estimate of CAD burden and complexity, was higher in Group A (37.59 ± 3.41) compared to Group B (26.44 ± 2.97), and the difference was statistically significant (p = 0.001). The severity of CAD based on syntax score was found to be significantly different in both groups (p=0.04). Conclusion This study illustrates that patients with high uric acid levels are more likely to have CAD as indicated by a higher mean Syntax score in Group A compared to Group B. However, serum uric acid levels alone cannot accurately predict the severity of CAD on coronary angiography in diabetic patients. These findings add to the evidence already available, emphasizing the significance of serum uric acid as a potential biomarker for risk stratification in this vulnerable population.

Changes in the prevalence of hyperuricemia in clients of health examination in Eastern China, 2009 to 2019.

BACKGROUND: With the continuous improvement of people's living standards, the incidence of hyperuricemia (HUA) is increasing globally. The prevalence of HUA ranged in terms of region, race, and age. This study aims to investigate the changes in the prevalence of HUA in clients of health examination in Eastern China between 2009 and 2019. METHODS: Chinese men and women aged 20-79 years (n = 4847 in the 2009 group and n = 12,188 in 2019 group) who had received health examinations were enrolled. Serum uric acid (UA) levels and biochemical parameters, including fasting blood-glucose (FBG), triglyceride (TG), total cholesterol (CHOL), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (Cr) and blood urea nitrogen (BUN) were evaluated. The prevalence of HUA in different age groups were measured, and the correlation of biochemical parameters with HUA were analyzed. RESULTS: The prevalence of HUA was 18.7% in the 2019 group, which was significantly higher than that in 2009 (11.1%). In females, the prevalence of HUA was significantly higher in 2019 than 2009 for age groups of 20-29 and 30-39 years. In male population, 2019 participants had significantly higher age-specific prevalence for all age groups than 2009 participants. Young men aged 20-29 years became the main population of HUA in the 2019 participants, whereas middle-aged men aged 40-49 years had the highest prevalence of HUA in the 2009 participants. The prevalence rates of HUA in all BMI groups in 2019 participants were significantly higher than those in 2009 participants. Spearmen's correlation analysis and Logistic regression analysis indicated that BMI was positively correlated with HUA. The receiver-operating characteristic curve (ROC) analysis showed BMI > 24.48 kg/m2 and BMI > 23.84 kg/m2 displayed good capacities to discriminate the population with HUA from those without HUA in 2009 and 2019 participants, respectively. CONCLUSIONS: In recent 10 years, the prevalence of HUA was increased rapidly in Chinese adults, especially in males. In 2019, the young male group (20-29 years old) replaced the middle-aged male group (40-49 years old) in 2009 as the leading age group for male HUA. BMI was positively correlated with HUA, and might be a potential risk factors to predict HUA.

Relationship between maternal serum uric acid level and preeclampsia with or without severe features.

Hyperuricaemia is common in preeclampsia. Its relationship and the utility in predicting of preeclampsia must be evaluated. The objective was to determine the association between maternal serum uric acid level and preeclampsia with or without severe features, including maternal and neonatal outcomes. A retrospective study was conducted at Rajavithi Hospital between June 2015 and May 2019. Inferential analysis comparison using binary logistic regression analysis and correlation using Chi-Square test/Fisher's exact test were used for analysis. Among the 400 participants, 331 (82.7%) women were preeclampsia with severe features. The mean uric acid level was significantly higher in women with preeclampsia with severe features compared to those without (6.44 ± 1.44 vs 5.87 ± 1.53 mg/dL, p-value = .016). Uric acid greater than 7 mg/dL was associated with renal involvement and preeclampsia with severe features. Uric acid 5-7 and greater than 7 mg/dL correlated with preterm birth (OR 2.67, 95% CI 1.59-4.49 and OR 4.89, 95% CI 2.75-8.68, respectively). Uric acid greater than 7 mg/dL also increased the risk of RDS and NICU admission. In conclusion, a high uric acid level is associated with preeclampsia with severe features and adverse pregnancy outcomes and may be the predictor of the severity of preeclampsia.Impact statementWhat is already known on this subject? Hyperuricaemia is a common finding in preeclamptic pregnancy due to reduction of uric acid clearance secondary to reduced glomerular filtration rate, increased reabsorption, and decreased secretion. The correlation of increase maternal uric acid level and preeclampsia including adverse pregnancy outcomes has been evaluated and supported the use of uric acid as a predictor for preeclampsia development. However, its clinical utility is still debateable.What the results of this study add? The present study demonstrated the association between higher maternal serum uric acid level and severity of preeclampsia. Particularly, serum uric acid greater than 7 mg/dL was associated with preeclampsia with severe features. Additionally, serum uric acid level 5-7 mg/dL and greater than 7 mg/dL had a positive correlation with adverse maternal and neonatal outcomes.What the implications are of these findings for clinical practice and/or further research? Maternal serum uric acid may be used as the predictor of severity of preeclampsia. However, the sensitivity and specificity and the precise clinical utility of uric acid related to preeclampsia need to be further evaluated in larger sample size.

Early hearing loss detection in gout using extended high frequency audiometry.

OBJECTIVE: The study aimed to analyse the hearing levels of patients with gout using extended high frequencies (EHFs) audiometry. Thus, we aimed to reveal the early detectability of potential hearing losses. DESIGN: Comparative cross-sectional study. SETTINGS: A single centre patient was diagnosed with gout disease. PARTICIPANTS: Two groups consisted of 32 patients with gout and 32 healthy volunteers. MAIN OUTCOME MEASURES: The primary outcome was hearing thresholds in pure tone (PT) audiometry and EHFs audiometry. Also, the association between audiometric results and haematological and biochemical parameters were evaluated. RESULTS: There was no significant difference between groups in terms of mean hearing thresholds in PT audiometry. But, at all frequencies above 4000 Hz (4000-18 000 Hz), the hearing thresholds were significantly higher in patients with gout. Also, the hearing thresholds above 8000 Hz were positively correlated with serum uric acid levels. Hearing thresholds at higher frequencies were positively correlated with haemoglobin levels and negatively correlated with high-density lipoprotein levels. CONCLUSION: To our knowledge, this is the first study in the literature demonstrating the high frequency of hearing loss in patients with gout using EHFs audiometry. We consider that using EHFs audiometry should have an important place in the early detection of potential hearing losses in gout patients.

Hyperuricemia prevalence and its association with metabolic disorders: a multicenter retrospective real-world study in China.

BACKGROUND: The prevalence of hyperuricemia (HUA) and gout continues to increase in China. Research suggests that HUA may be related to many diseases other than gout. However, further population research is required to investigate the association between HUA and metabolic syndromes. This study sought to investigate the prevalence of HUA in an average population in China, and the association between serum uric acid (UA) levels and related metabolic disorders. METHODS: This multicenter retrospective real-world study examined the hospital information system data of 4 tertiary hospitals in 3 provinces in China. The data of patients aged between 18 and 80 years, who had attended at least 1 medical appointment at which their UA level was recorded, were analyzed to evaluate associations between UA levels and metabolic disorders. RESULTS: Among the 374,506 enrolled subjects (49.7% male; mean age 51.5 years old), the overall prevalence of HUA and gout were 14.8% and 0.5%, respectively. The prevalence was higher among males than females (17.6% vs. 12.0%, 0.8% vs. 0.1%; both P<0.001). Groups exhibiting higher UA levels had increased adjusted odds ratios for dyslipidemia and chronic kidney disease (CKD) in both sexes. Changes in UA levels from the baseline were negatively correlated with changes in the estimated glomerular filtration rate and hemoglobin A1c among both sexes (all P<0.001), and were positively correlated with changes in total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) (all P<0.05) among males, and changes in TC, TG, LDL-C and glucose (all P<0.001) among females. CONCLUSIONS: HUA is associated with dyslipidemia and CKD both cross-sectionally and longitudinally. Similar phenomena were observed in both sexes.

Effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open arthrolysis combined with hinged external fixation: a retrospective study.

BACKGROUND: Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow arthrolysis. METHODS: The study included 131 patients with post-traumatic elbow stiffness who underwent arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 µmol/L), 34 in Q2 (293-348 µmol/L), 32 in Q3 (348-441 µmol/L), and 32 in Q4 (441-710 µmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS: Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION: This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.

Association Of Non-Alcoholic Fatty Liver Disease With Serum Uric Acid.

BACKGROUND: Non-alcoholic fatty liver disorder is a clinicopathological condition, characterized by macro vesicular steatosis in hepatic cells and metabolic stress related disorders without other causes of chronic hepatic disease. Uric acid is basically a heterocyclic compound of hydrogen, carbon, oxygen and nitrogen. Uric acid is the metabolic end product of purine metabolism. Hyperuricemia is considered to be related with the causes responsible for the production of metabolic syndrome. It may cause gout, impaired renal function, hypertension, hypertriglyceridemia, obesity and diabetes mellitus. The objective of study is to investigate the association of non-alcoholic fatty liver disease (NAFLD) and serum uric acid level. METHODS: This cross-sectional study was conducted at Ayub Teaching institute Abbottabad. According to predesigned questionnaire and informed consent, 100 subjects between ages 40-50 years were selected for the study. Data collected and analysis done by SPSS version 20. RESULTS: It was observed that 20 (40%) subjects developed NAFLD as compared to 30(60%) of the subjects with normal serum uric acid level. Chi-square test was applied and values found to be significant (p=0.013). CONCLUSIONS: Our study shows association of NAFLD with serum uric acid level.

A meta-analysis of the association between gout, serum uric acid level, and obstructive sleep apnea.

Previous epidemiological investigations have evaluated the association between gout, serum uric acid levels, and obstructive sleep apnea syndrome (OSAS), but with inconsistent results. We conducted this meta-analysis aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Relevant studies were identified via electronic databases from inception to December 17, 2018. Study selection was conducted according to predesigned eligibility criteria, and two authors independently extracted data from included studies. The hazard ratio (HR) and weighted mean difference (WMD) and their corresponding 95% confidence interval (CI) were derived using random-effects models. We conducted meta-, heterogeneity, publication bias, sensitivity, and subgroup analyses. Eighteen studies, involving a total of 157,607 individuals (32,395 with OSAS, 125,212 without OSAS) and 12,262 gout cases, were included. Results show that serum uric acid levels are elevated in patients with OSAS (WMD = 52.25, 95% CI 36.16-64.33); OSAS did not reach statistical significance as a predictor of gout (but there was a trend, HR = 1.25, 95% CI 0.91-1.70) and that the association between OSAS and serum uric acid was quite robust. OSAS may be a potential risk factor for hyperuricemia and the development of gout and thus, effective OSAS therapy may present as a valuable preventive measure against gout. Still, it is vital to undertake clinical studies with better designing to corroborate these associations and shed new light on it.

Effect of serum uric acid level on the incidence of acute kidney injury after off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective To investigate the effect of preoperative serum uric acid level on the incidence of acute kidney in-jury after off-pump coronary artery bypass grafting and to discuss whether serum uric acid level is an independent predictor of postoperative acute kidney injury.Methods A total of 631 patients undergoing off-pump coronary artery bypass grafting in Anzhen Hospital from January 2018 to June 2018 were reviewed.Patients were divided into high uric acid group(higher-than-median)and low uric acid group(lower-than-median) , based on the preoperative serum uric acid level of the patients.The de-mographic variables, comorbidities, the chelsea comorbidity index, preoperative medication, serum creatinine level and glo-merular filtration rate were compared between the two groups.Meanwhile, intraoperative operative time, infusion volume, post-operative acute kidney injury staging and the rate of frozen plasma usage , continuous renal replacement therapy and reoperation rate were observed.Results Among the 631 patients, 83(13.2％, 83/631)cases developed postoperative acute kidney inju-ry, 65(78.3％, 65/83) cases had a higher level of preoperative serum uric acid above the median(OR =3.143, 95％CI:1.850-8.798, P=0.001).After adjustment, multivariate analysis showed that elevated level of serum uric acid and BMI >30 kg/m2, the increase of preoperative serum creatinine level, the decrease of glomerular filtration rate( <60 ml/min) and higher CCI score were associated with postoperative acute kidney injury independently .Intraoperative fluid volume , diabetes and preoperative diuretic administration did not relate to the incidence of acute kidney injury after cardiac surgery .Conclusion Elevated serum uric acid level can be a strong predictor for the incidence of acute kidney injury after off-pump coronary artery bypass grafting.

Comparison of Clinical Advantage between Topiroxostat and Febuxostat in Hemodialysis Patients.

To determine the response of hemodialysis (HD) patients to topiroxostat after a switch from febuxostat, we evaluated the efficacy, tolerability, and serum concentration of topiroxostat in HD patients after the switch. In this 16-month prospective observational study, we assessed the serum uric acid (UA) levels, other laboratory data, and serum topiroxostat concentrations of 10 HD patients who had been receiving febuxostat at a dose of 10 mg/d for over 1 year. No statistical difference was observed between the tolerability index at baseline and 16 months after the switch to topiroxostat. Serum UA after the switch in all patients (attained serum UA levels of ≤6 mg/dL) was 5.6±1.7 mg/dL (60%) at baseline, 4.9±0.5 mg/dL (100%) at 6 months and 5.7±0.4 mg/dL (50%) at 16 months (p=0.25), respectively. In patients with baseline serum UA levels >6 mg/dL, serum UA was significantly reduced at 6 and 16 months compared with baseline. Minimum serum concentrations of serum topiroxostat were lower than the limit of quantification (<25 ng/mL). Our results indicate that a switch from febuxostat 10 mg/d to topiroxostat 40 mg/d might reduce serum UA levels, with no change in other clinical laboratory data over the long term. These effects were more frequent in patients with high serum UA levels. Furthermore, topiroxostat therapy was more cost effective than febuxostat therapy. Thus, topiroxostat therapy could be a better treatment option for HD patients who develop high serum UA levels after febuxostat 10 mg/d administration.

Clinical Implication of Plasma Uric Acid Level / 가정의학회지

The debate over the clinical meaning of plasma uric acid level is still a very hot issue. As the interest in health grows larger in the general public, the number of having a regular health check-up is increasing rapidly. Most of the health care centers routinely check the plasma uric acid level but it is not simple to interpret and explain the appropriate meaning of that. Over the past decade, there have been several studies on clinical implication of plasma uric acid level but the question still remains. However the clinical significance of the results might be different according to the severity of cardiovascular risk among subjects studied, and the findings for correlation with the established risks have enough proof to be applied to clinical practice. Additionally, the uric acid-lowering agents should not be used in general population even though it has reason to be prescribed in a specific high risk patient. Thus, this review seeks to be helpful in clinical practice by examining the preexisting related studies in a different perspective.

Disseminated rectal carcinoid tumor with production of immunoreactive motilin.

This report presents a patient with a rectal carcinoid tumor of small size ( 14 mm in diameter), with typical growth pattern, localized in the mucosa. Despite these microscopically good prognostic features the patient died from metastatic disease 30 months later. The tumor had an unusual hormone profile with main secretion of immunoreactive motilin and serotonin. Immunocytochemically these substances were localized in separate tumor cell populations; the majority of tumor cells were motilin-immunoreactive and a minority were serotonin-immunoreactive. The patient was first treated interventionally by hepatic arterial embolizations and later medically with octreotide. The treatment resulted in long periods of good palliation related to reduced levels of tumor markers and weight gain. The plasma concentrations of motilin were analyzed with a N-terminal-specific assay before and during treatment.