Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options

Abstract

Gout, the most prevalent inflammatory arthritis worldwide, is associated with cardiovascular and renal diseases, and is an independent predictor of premature death. The frequencies of obesity, chronic kidney disease (CKD), hypertension, type 2 diabetes, dyslipidaemias, cardiac diseases (including coronary heart disease, heart failure and atrial fibrillation), stroke and peripheral arterial disease have been repeatedly shown to be increased in gout. Therefore, the screening and care of these comorbidities as well as of cardiovascular risk factors are of outmost importance in patients with gout. Comorbidities, especially CKD, and drugs prescribed for their treatment, also impact gout management. Numerous epidemiological studies have shown the association of asymptomatic hyperuricaemia with the above-mentioned diseases and cardiovascular risk factors. Animal studies have also produced a mechanistic approach to the vascular toxicity of soluble urate. However, causality remains uncertain because confounders, reverse causality or common etiological factors might explain the epidemiological results. Additionally, these uncertainties remain unsolved despite recent studies using Mendelian randomisation or therapeutic approaches. Thus, large randomised placebo-controlled trials are still needed to assess the benefits of treating asymptomatic hyperuricaemia.

Genome‐Wide Association and Functional Studies Reveal Novel Pharmacological Mechanisms for Allopurinol

“…These attacks are typically caused by chronically high concentrations of serum uric acid (SUA), or hyperuricemia, and are characterized by the extreme pain and discomfort they cause for patients . The painful and debilitating attacks associated with this disease as well as the underlying hyperuricemia have been shown to be risk factors for various diseases, including coronary heart disease, stroke, and especially chronic kidney disease, which represents the greatest comorbidity risk for gout patients . Thus, management of gout and hyperuricemia has become increasingly important in the prevention of life‐threatening cardiac and renal diseases.…”

“…have been shown to be risk factors for various diseases, including coronary heart disease, stroke, and especially chronic kidney disease, which represents the greatest comorbidity risk for gout patients. [2][3][4][5][6] Thus, management of gout and hyperuricemia has become increasingly important in the prevention of life-threatening cardiac and renal diseases.…”

Relationship between coffee consumption and serum uric acid level in the general Korean population: A nationwide cross‐sectional study

“…Uric acid has antioxidant properties and is related to type 2 immune responses; however, an imbalance between uric acid production in the liver and its excretion in the kidney and intestinal tract can cause elevated serum uric acid levels, and ultimately gout . Gout is associated not only with arthritis, but also with a variety of diseases, including cardiovascular and renal diseases . Various genetic and environmental factors have been shown to affect serum uric acid levels.…”

“…1 Gout is associated not only with arthritis, but also with a variety of diseases, including cardiovascular and renal diseases. 2 Various genetic and environmental factors have been shown to affect serum uric acid levels. A variety of diets have been associated with uric acid level alterations, and alcohol is not recommended for the treatment and management of gout as it increases serum uric acid levels.…”

Therapy with canakinumab for gout

“…Установлено, что отложение кристаллов МУН может вызывать субклиническое воспаление у пациентов со стойкой гиперурикемией задолго до появления первых симптомов подагрического артрита [3]. Наличие гиперурикемии и подагры ассоциируется с более высоким риском общей и сердечнососудистой смерти, а также развитием артериальной гипертензии, нарушением липидного и углеводного обмена, развитием и прогрессированием хронической болезни почек, метаболическим синдромом [4][5][6]. Хроническое прогрессирующее поражение суставов и периартикулярных тканей при подагре приводит к снижению качества жизни и инвалидизации [7].…”