Hyperuricemia in Psoriatic Arthritis: Epidemiology, Pathophysiology, and Clinical Implications

Tripolino, Cesare; Ciaffi, Jacopo; Ruscitti, Piero; Giacomelli, Roberto; Melicòni, Riccardo; Ursini, Francesco

doi:10.3389/fmed.2021.737573

Cited by 22 publications

(16 citation statements)

References 97 publications

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“…26 The importance of discriminating gouty inflammation ("psout") from reactivation of PsA symptoms is linked to the ability of the intra-articular deposition of MSU and CPP crystals to erode joints via pro-inflammatory processes. 27,28 Underlying the crystal-stimulated inflammatory cascade are many complex cellular mechanisms that may lead to an optimized use of existing drugs and the introduction of novel therapeutic strategies.…”

Section: Discussionmentioning

confidence: 99%

Acute joint swelling in psoriatic arthritis: Flare or “psout”—A 10-year-monocentric study on synovial fluid

Galozzi

Oliviero

Scanu

et al. 2022

Exp Biol Med (Maywood)

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Psoriatic arthritis (PsA) is a multifaceted inflammatory disease associated with psoriasis that can affect peripheral joints, entheses, and the axial skeleton with a variable clinical course. Acute episodes of joint swelling in PsA patients can have different causes and require specific treatments. We aimed to describe the acute joint swelling in PsA patients via synovial fluid (SF) analyses, assessing in particular the presence of pathogenic crystals, to determine whether it is a flare or an acute episode of gout (“psout”) during the course of the disease. This retrospective study was based on the results of SF analysis of samples collected from unselected adult PsA patients referred to our clinic for acute joint swelling. Demographic characteristics, disease involvement, laboratory findings on SF, and treatment options were recorded and reviewed. Among 5,478 SF samples analyzed in a 10-year time span, 213 complete SF records from PsA patients were evaluated. Overall, after adjustment for the degree of synovial inflammation, significant differences were observed in term of sex ( p = 0.0017) and ongoing therapy ( p = 0.0246). Non-inflammatory SFs, indeed, were mainly described for female PsA patients under therapy. Regarding serum uric acid levels, there were 19/213 (8.9%) PsA with hyperuricemia (HU), who were older, mostly male, patients with mild articular involvement and rare pathogenic crystals in their SF. Although it is known that the risk of gout is higher among patients with PsA (“psout”), monosodium urate crystals were reported only in 5/213 SFs (2.4%) of our cohort and in 2/19 SFs (10.5%) of HU PsA patients. Moreover, hyperuricemia seems not to modify the SF features in PsA patients. This study results seem to suggest that the convergence of gout and PsA, involving the role of urate crystals, is a more intricate relationship, which needs further insights to be unraveled.

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Section: Discussionmentioning

confidence: 99%

Acute joint swelling in psoriatic arthritis: Flare or “psout”—A 10-year-monocentric study on synovial fluid

Galozzi

Oliviero

Scanu

et al. 2022

Exp Biol Med (Maywood)

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“…PsA is associated with several metabolic abnormalities. Insulin resistance, hypertension, diabetes, and hyperuricemia are common comorbidities defining the spectrum of the systemic psoriatic disease ( 59 ). Literature about the effects of nutritional interventions in PsA is limited ( 60 , 61 ), with no specific dietary indication for PsA patients.…”

Section: Ketogenic Diet In Psoriatic Arthritismentioning

confidence: 99%

The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review

et al. 2021

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The principle of ketogenic diet (KD) is restriction of carbohydrates to a maximum of 5–10% of the total daily caloric intake, aiming at shifting body metabolism toward ketone bodies. Different studies suggested promising results of KD to help patients to lose weight, to reduce insulin requirements in diabetes, to supplement cancer protocols, to treat neurological conditions and to optimize control of metabolic and cardiovascular diseases. However, literature about the anti-inflammatory properties of KD in rheumatic diseases is still limited. The beneficial effects of weight loss in patients with inflammatory arthritis can be explained by biomechanical and biochemical factors. Obesity is associated with macrophage activation and production of pro-inflammatory cytokines including TNF-α, IL-1b, and IL-6. The clinical effect of KD may be primarily attributed to improvement of insulin sensitivity. Insulin resistance is associated with an increase of TNF-α, IL-1α, IL-1β, IL-6, and leptin. Moreover, reduction of body's adipose tissue and weight loss account for part of the anti-inflammatory effects and for the impact of KD on cardiovascular health. In rheumatoid arthritis, fasting was shown to be effective in reducing disease symptoms, possibly through the production of β-hydroxybutyrate (BHB), the main ketone body. BHB may exert inhibitory effects also on IL-17 and intermittent fasting improved the clinical manifestations of psoriatic arthritis. In ankylosing spondylitis, current literature doesn't allow to draw conclusion about the effects of KD. Future prospective studies will be needed to elucidate the potential beneficial effects of KD on specific domains and clinical outcomes in patients with inflammatory arthritis.

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“…Uric acid crystals are a strong stimulator of congenital immunity. Hyperuricemia can increase the crystallization of uric acid in and around the joints, thereby inducing PSA in psoriatic subjects (26).…”

Section: Introductionmentioning

confidence: 99%

Presence of Crystals in the Synovial Fluid of Patients With Psoriatic Arthritis

Popova-Belova¹,

Geneva-Popova²,

Попова³

et al. 2022

Preprint

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Analyzing synovial fluid from joints affected by the pathological process of psoriatic arthritis is part of the overall patient examination, since it may have differential diagnostic significance. The purpose of this study was to assess the presence of crystals in the synovial fluid of psoriatic arthritis patients as biomarkers for disease activity. Materials and methods: The synovial fluid of 156 patients with proven PSA diagnosis (patients covered CASPAR criteria) was analyzed over 24 months and compared to 50 patients with activated gonarthrosis. The Leica DM4500P polarization microscope (Leica Microsystems, Germany) was used for crystal detection. Pain and disease activity measures were also evaluated (PSA VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI). The statistical analysis was carried out using SPSS version 26 with a significance set at p < 0.05. Results: The macroscopic appearance of synovial fluid from patients with psoriatic arthritis was clear in 84.6% of the patients. Synovial fluid crystals were found in 23.71% of patients with psoriatic arthritis - predominantly monosodium urate (67.58%) but also calcium pyrophosphate (21.62%) and lipid drops (5.4%). The presence of monosodium urate crystals significantly correlates with all pain and disease activity measures – VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI. In 67.56% of patients with established crystals treatment with an anti-TNF blocker was started at the discretion of the treating rheumatologist due to high levels of disease activity. Conclusion: Examining the synovial fluid in PSA patients is a necessary minimally invasive procedure in cases of joint effusion, since the presence of synovial fluid crystals is a significant indicator of disease severity. The current analyses demonstrate that the presence of synovial fluid crystals in PSA patients can be used as a biomarker for disease severity and the necessity to commence biological treatment (most often TNF-a-blocker).

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Hyperuricemia in Psoriatic Arthritis: Epidemiology, Pathophysiology, and Clinical Implications

Cited by 22 publications

References 97 publications

Acute joint swelling in psoriatic arthritis: Flare or “psout”—A 10-year-monocentric study on synovial fluid

Acute joint swelling in psoriatic arthritis: Flare or “psout”—A 10-year-monocentric study on synovial fluid

The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review

Presence of Crystals in the Synovial Fluid of Patients With Psoriatic Arthritis

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