Clinical features and recurrent attack in gout patients according to serum urate levels during an acute attack

Abstract

Background/Aims: A substantial portion of gout patients have normal serum urate levels during an acute attack but data on the clinical characteristics and risk of recurrence compared with hyperuricemic patients are limited. Methods: In this retrospective cohort study, clinical features of normouricemic and hyperuricemic patients were compared. Multivariate analysis was performed to determine whether normouricemic patients were less likely to have a recurrent attack. Results: Among a total of 221 gout patients, 88 (39.8%) had normouricemia during an acute attack. Postsurgical gout (22.7% vs. 6.0%, p < 0.001), hemodialysis initiation (9.1% vs. 2.3%, p = 0.029) and inflammatory activity were higher in normouricemic patients than in hyperuricemic patients. The frequency of renal insufficiency was lower in normouricemic patients (25.0% vs. 53.4%, p < 0.001). However, the recurrence rate of gout attack was not different between the two groups (24.7% vs. 33.0%, p = 0.220). In multivariate analysis, female sex, history of urinary stone, presence of tophi, and use of thiazide were associated with increase of recurrent gout attack, but not with serum urate status during an acute attack (hazard ratio, 1.075; 95% confidence interval, 0.972 to 1.190; p = 0.159). Conclusions: Normouricemia during an acute gout attack was more frequently observed in postsurgical episodes, hemodialysis initiation and patients with preserved renal function. While higher inflammatory activity was observed in normouricemic patients, recurrent attack was not associated with serum urate levels during an acute attack. Thus, careful follow-up should be considered in gout patients regardless of serum urate levels during an acute attack.

Does normouricemic status in acute gouty arthritis really reflect a normal status? Consider confounders of serum levels of urate

“…Urano et al [7] showed that a reduction in the urate level in acute gouty arthritis patients correlated with the levels of C-reactive protein (CRP) and interleukin-6, suggesting that an inflammatory response and increased urinary urate excretion explained the sudden decline in urate level. Lee et al [6] reported similar results; normouricemic acute gouty arthritis patients exhibited higher-level inflammation in terms of higher white blood cell counts in blood and joint fluid, a higher CRP level, and more fever [6]. Thus, urate levels measured during an acute flare may be a useful indicator of severe gout.…”

“…Females become prone to gout only after menopause. Hence, whether older age and the female sex exhibit multicolinearity shoulde be considered in results of Lee et al [6].…”

“…In a recent issue of the Korean Journal of Internal Medicine, Lee et al [6] focused on the differences between hyperuricemic and normouricemic acute gouty arthritis patients. Although the study was retrospective in nature and all patients were recruited from a single hospital, the characteristics of normouricemic acute gouty arthritis patients were described, as were factors triggering gout recurrence.…”

“…Lee et al [6] showed that several factors were associated with gout recurrence. Interestingly, the initial urate level was not, and females exhibited a significantly higher hazard ratio.…”

LncRNAs Landscape in the patients of primary gout by Microarray Analysis

“…Previous studies have 56 demonstrated that an attack of gouty arthritis is triggered by the deposition of MSU crystals in the 57 joint and MSU crystals is widely recognized as endogenous danger signal by components of the 58 innate immune system [3,4]. Hyperuricemia is the biochemical basis of gout [5].…”