Global burden of gout in 1990-2019: A systematic analysis of the Global Burden of Disease study 2019

Current Techniques in the Imaging of Gout

Gout is a common inflammatory arthritis with well-described imaging characteristics. Radiography depicts erosive change and in advanced cases, tophus deposition near joints and in association with tendons or bursae. Computed tomography demonstrates the same features but may also use dual-energy or photon-counting techniques that allow for tissue composition analysis and the specific identification of monosodium urate deposition. Magnetic resonance imaging (MRI) is useful in identifying tophi and the damage associated with gout, such as bone erosion and cartilage loss in advanced cases. MRI also helps differentiate gout from other types of inflammatory arthritis, infection, or tumor that may have a similar clinical presentation. Ultrasound is widely used in the diagnosis of gout and also useful in procedural guidance of joint aspiration or soft tissue biopsy.

Moxibustion inhibits inflammation in monosodium urate crystal-induced gouty arthritis model rats through metabolomic regulation

Background

Moxibustion is a form of therapy that to warm the acupoints located skin by using dried mugwort leaves. It is widely used to treat gouty arthritis (GA). However, the mechanism of moxibustion on improving GA has not been fully revealed. In this study, we explore the mechanism of moxibustion on GA via metabolomics combined with traditional Chinese medicine (TCM) theory.

Methods

Three days before model induction, the rats of moxibustion groups were treated with moxibustion in the ST36 and SP6, and then, a GA rat model induced by monosodium urate (MSU) was established. Biological samples, including joint synovial tissue and serum samples, were collected and measured by histopathological staining, molecular biology assays and liquid chromatography-mass spectrometry (LC-MS)-based metabolomics.

Results

We found that moxibustion could reduce the ankle edema induced by MSU crystals, decrease the expression of related proinflammatory genes, decrease the levels of serum IL-18 and IL-1β, and restore the metabolism of glycerol phospholipids, niacin and nicotinamide in GA model rats.

Conclusion

Moxibustion can regulate the metabolism of GA model rats widely to inhibit inflammation. Our research deepens our understanding of the complex mechanisms of moxibustion and promotes the application of moxibustion in the clinical practice.

Elevated Soluble Suppressor of Tumorigenicity 2 Levels in Gout Patients and Its Association with Cardiovascular Disease Risk Indicators

PURPOSE

To investigate the association between soluble suppressor of tumorigenicity 2 (sST2) levels and cardiovascular disease predictors in patients with gout.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of patients with gout who were tested for sST2 but did not receive uric acid-lowering therapy. These patients were classified into elevated and normal sST2 groups using a cut-off of >49.6 ng/mL and >35.4 ng/mL in males and females, respectively. Correlations between clinical and laboratory variables, sST2 levels, and elevated sST2 level predictors were assessed using linear and logistic regression analyses.

RESULTS

Notably, 27 (11.3%) and 211 (88.7%) of the 238 identified patients had elevated and normal sST2 levels, respectively. Linear regression analysis revealed that male sex (β=-0.190, p=0.002), body mass index (BMI) (β=-0.184, p=0.002), white blood cell count (β=0.231, p<0.001), C-reactive protein (β=0.135, p=0.031), and fasting blood glucose (β=0.210, p<0.001) were independently associated with sST2 levels. In multivariate logistic regression analysis, male sex [odds ratio (OR) 0.112, p=0.001], BMI (OR 0.836, p=0.008), creatinine (OR 5.730, p=0.024), and fasting blood glucose (OR 1.042, p=0.002) predicted elevated sST2 levels. Patients with increased sST2 levels had a significantly higher atherosclerotic cardiovascular disease risk score and a greater proportion of high-risk Framingham Risk Score compared to the normal sST2 group (p=0.002 and p<0.001).

CONCLUSION

Patients with gout and elevated sST2 levels have a higher risk of future cardiovascular disorders, which may provide insights into risk stratification and the implementation of intervention strategies.

Association Between Inflammatory Arthritis, Genetic Risk, and the Long-Term Risk of Degenerative Aortic Stenosis: A Prospective Cohort Study

BACKGROUND

Inflammatory arthritis is recognized to increase cardiovascular disease risk, but its association with degenerative aortic stenosis is not well understood.

METHODS

This prospective cohort study used participants from the UK Biobank, focusing on 4 major types of inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout. The primary outcome was the incidence of degenerative aortic stenosis. The primary analysis used Cox proportional hazards models to evaluate the association between inflammatory arthritis and the long-term risk of degenerative aortic stenosis, as well as to explore potential effect modifiers. Genetic risk was evaluated using polygenic risk scores and self-reported family history of cardiovascular diseases.

RESULTS

The study included 497 567 participants, with 271 129 women (54.5%) and 468 015 White individuals (94.1%). The median age was 58 years. Over a median follow-up of 12.58 years, 4571 cases (0.9%) of degenerative aortic stenosis were identified. Compared with the control group, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout were associated with increased risks of degenerative aortic stenosis by 54% (hazard ratio [HR], 1.54 [95% CI, 1.28-1.85]), 72% (HR, 1.72 [95% CI, 1.19-2.50]), 176% (HR, 2.76 [95% CI, 1.43-5.32]), and 36% (HR, 1.36 [95% CI, 1.20-1.54]), respectively. These associations were independent of genetic risk (P for interaction>0.05). Additionally, we identified significant interactions between sex (P for interaction=0.036), age (P for interaction<0.001), and socioeconomic status (P for interaction=0.014) with rheumatoid arthritis, ankylosing spondylitis, and gout on the incidence of degenerative aortic stenosis, respectively.

CONCLUSIONS

Inflammatory arthritis is significantly associated with an increased long-term risk of degenerative aortic stenosis, underscoring the need for enhanced risk assessment for degenerative aortic stenosis in these populations.

The changing burden of gout in adults aged 70 and above based on the global burden of disease 2019

Introduction

Gout is a significant global health issue, particularly among adults aged 70 and above. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management.

Methods

This study analyzed data from the Global Burden of Disease study to assess the prevalence and trends of gout among adults aged 70 and above from 1990 to 2019. We evaluated temporal trends and regional disparities by calculating the estimated annual percentage change (EAPCs).

Results

Globally, the number of older adults individuals affected by gout increased from 5,316,210 cases in 1990 to 15,666,063 cases in 2019. It is noteworthy that the global burden of gout among the older adults continued to rise from 1990 to 2019, with an EAPC of 1.17 (95% CI: 1.02 to 1.32). In 2019, the prevalence rates among individuals aged 70-74, 75-79, 80-84, and 85 and above were 3,121.31 per 100,000, 3,437.17 per 100,000, 3,592.38 per 100,000, and 3,726.91 per 100,000, respectively. The regions with the highest prevalence rates of gout in 2019 were Australasia, High-income North America, and Southern Latin America, with rates of 8,500.73, 8,351.33, and 4,666.87 per 100,000, respectively. At the national level, some developed countries such as New Zealand, the United States of America, and Australia had the highest prevalence rates, reaching 8,893.74, 8,508.06, and 8,427.94 per 100,000, respectively. It is noteworthy that regions with higher levels of Socio-Demographic Index tended to have relatively higher burden of gout among the older adults, and the prevalence rates varied across different regions and age groups.

Conclusion

The study underscores the persistent burden of gout among the older adults, emphasizing the need for targeted interventions to address this issue and improve public health outcomes in this demographic.

A study on the correlation between hyperuricemia and lifestyle and dietary habits

This study aimed to compare whether differences in lifestyle and dietary habits have an impact on hyperuricemia and to provide a reliable basis for the health management of citizens in our city. A total of 10,883 subjects who did not suffer from hyperuricemia, was anticipated in this study in 2018. After 2 years of follow-up, 7727 did not suffer from hyperuricemia and 3156 suffered from hyperuricemia. Dietary habits and lifestyle were collected by questionnaire. Multivariate logistic regression was used to identify the risk factors of hyperuricemia. For the analysis of the amount of change in uric acid (UA) before and after 2 years, t-tests and spearman correlation were used to explore the differences between the groups, and the trend effect of each variable on the amount of change in uric acid was analyzed by linear regression equations. The results showed that the prevalence of hyperuricemia varied by sex, high-fat food, smoked and fried food, milk and soy products, sugary drinks, sleep time, and the degree of smoking and drinking. Among them, infrequent consumption of milk and soy products, and short sleep time were risk factors for hyperuricemia, and men were more likely to have elevated uric acid levels after 2 years. It is recommended that people with hyperuricemia should actively limit their intake of fried foods, alcohol, and purine-rich foods, increase their intake of milk and soy foods, increase their sleep time, and seek to improve kidney and liver function.

Association between serum iron status and gout: results from the NHANES and Mendelian randomization study

Aims. Previous observational studies have provided inconsistent evidence for the association between serum iron status and the risk of gout. Moreover, it remains uncertain whether the observed association is causal or due to confounding or reverse causality. This research aimed to investigate the association of serum iron status indicators with the risk of gout and to further examine the causal relationship by the Mendelian randomization (MR) method. Methods. We first conducted a cross-sectional study from the National Health and Nutrition Examination Survey 2017-2018, including a total of 4635 participants. The association of serum iron status indicators with gout risk was evaluated using a multivariable logistic regression model. Furthermore, a two-sample MR study using genetic data from large-scale genome-wide association studies of serum iron status indicators (246 139 individuals) and gout (discovery: 13 179 cases and 75 0634 controls; replication: 5292 cases and 368 788 controls; 2115 cases and 67 259 controls) was conducted to infer causality. Inverse-variance-weighting (IVW) was applied as the main method of MR analysis. A series of sensitivity analyses were used to evaluate the robustness of their relationship. Results. In the cross-sectional study, there was no significant relationship between serum iron status indicators and gout risk. However, IVW results showed that genetically predicted serum iron and transferrin saturation (TSAT) were significantly associated with the increased risk of gout in the discovery analysis [odds ratio (OR): 1.21; 95% confidence interval (CI): 1.10-1.32; P = 9.80 × 10-5 for serum iron and OR: 1.16; 95% CI: 1.08-1.25; P = 7.14 × 10-5 for TSAT]. The replication analysis provided similar results compared with the discovery analysis. Conclusion. Our study provides support for potential causal associations between serum iron and the altered risk of gout. Further investigations are warranted to elucidate the biological processes through which iron influences susceptibility to gout.

Risk of myocardial infarction and heart failure in gout patients: a systematic review and meta-analysis

BACKGROUND

Gout is a metabolic disease caused by decreased blood uric acid excretion and purine metabolism disorders. Long-term and persistent metabolic dysfunction gradually affects other organ functions and is the main factor inducing Myocardial Infarction (MI) and Heart Failure (HF), seriously affecting the health of patients. This study adopts a meta-analysis to analyze the risk of MI and HF in gout patients.

METHODS

Clinical research literature related to gout complicated with MI or HF was searched in databases such as PubMed, Embase, Web of Science, Cochrane Library, etc. through computer retrieval before March 2023. Literature content was carefully read and retrieved, and screening was conducted based on inclusion and exclusion criteria. Relevant data were extracted from the final screened literature, and a forest map was drawn using RevMan 5.3 software for meta-analysis.

RESULTS

After searching in various databases, 2519 articles were obtained. After screening, 8 articles were finally included for meta-analysis. Among the 22 included literature, 9 analyzed the risk of gout and MI, and heterogeneity tests showed P = 0.20 and I2 = 28%. Fixing effects analysis showed RR = 4.60, 95%CI = 4.39-4.82, and P < 0.001. Nine articles analyzed the risk of gout and HF, and heterogeneity tests showed that P = 0.13 and I2 = 37%. Fixing effects analysis showed RR = 2.71, 95%CI = 2.61-2.82, and P < 0.001. Eight studies compared the incidence of MI or HF between male gout and non-gout patients. Heterogeneity tests showed P = 0.21 and I2 = 28%, while fixing effects analysis showed RR = 1.98 and 95%CI = 1.89-2.01, with P < 0.001. Four articles statistically compared the incidence of MI or HF between female gout and non-gout patients. Heterogeneity tests showed P = 0.15 and I2 = 43%. Fixing effects analysis showed RR = 1.70, 95%CI = 1.57-1.83, and P < 0.001. Thirteen studies compared the incidence of MI or HF in gout patients of different genders. Heterogeneity tests showed P = 0.37 and I2 = 7%. Fixing effects analysis showed RR = 0.03, 95%CI = 0.03-0.03, and P < 0.001.

CONCLUSION

Compared to non-gout patients, gout patients are more prone to MI or HF and are not affected by gender. However, among gout patients, women have a higher risk of MI or HF than men.

Association between Hidradenitis Suppurativa and Gout: A Propensity Score-Matched Cohort Study

INTRODUCTION

While an association between hidradenitis suppurativa (HS) and inflammatory arthritis has been reported in clinical studies, the potential link between HS and gout remains uncertain. As HS and gout share common immunological pathways, we conducted a retrospective cohort study to determine whether HS patients are at an increased risk of developing gout in the future.

METHODS

This retrospective multicenter cohort study obtained information through the US collaborative network, a subset of the TriNetX research network. Patients diagnosed with HS between January 01, 2005, and December 31, 2017, were recruited, and a 1:1 propensity score matching was conducted to identify appropriate controls. The hazard ratio (HR) for the new-onset gout in HS patients was subsequently calculated.

RESULTS

Compared to individuals without HS, those with HS were associated with a 1.39-fold higher risk (95% confidence interval [CI], 1.20, 1.62) of developing new-onset gout within 5 years after the index date. This association remained significant in shorter follow-up times and sensitivity analyses utilizing different matching models. For both male and female HS patients, the risk of developing new-onset gout within 5 years after the index date was statistically significant, with respective HRs of 1.61 (95% CI, 1.28, 2.02) for males and 1.41 (95% CI, 1.11,1.78) for females.

CONCLUSION

HS patients are at a high risk of developing gout within 5 years after an HS diagnosis while comparing with non-HS controls.

Discovery of 4-(isopentyloxy)-3-nitrobenzamide derivatives as xanthine oxidase inhibitors through a non-anthraquinone exploration

In our previous study, we reported a series of N-(9,10-anthraquinone-2-carbonyl) amino acid derivatives as novel inhibitors of xanthine oxidase (XO). Recognizing the suboptimal drug-like properties associated with the anthraquinone moiety, we embarked on a nonanthraquinone medicinal chemistry exploration in the current investigation. Through systematic structure-activity relationship (SAR) studies, we identified a series of 4-(isopentyloxy)-3-nitrobenzamide derivatives exhibiting excellent in vitro potency against XO. The optimized compound, 4-isopentyloxy-N-(1H-pyrazol-3-yl)-3-nitrobenzamide (6k), demonstrated exceptional in vitro potency with an IC50 value of 0.13 μM. Compound 6k showed favorable drug-like characteristics with ligand efficiency (LE) and lipophilic ligand efficiency (LLE) values of 0.41 and 3.73, respectively. In comparison to the initial compound 1d, 6k exhibited a substantial 24-fold improvement in IC50, along with a 1.6-fold enhancement in LE and a 3.7-fold increase in LLE. Molecular modeling studies provided insights into the strong interactions of 6k with critical amino acid residues within the active site. Furthermore, in vivo hypouricemic investigations convincingly demonstrated that 6k significantly reduced serum uric acid levels in rats. The MTT results revealed that compound 6k is nontoxic to healthy cells. The gastric and intestinal stability assay demonstrated that compound 6k exhibits good stability in the gastric and intestinal environments. In conclusion, compound 6k emerges as a promising lead compound, showcasing both exceptional in vitro potency and favorable drug-like characteristics, thereby warranting further exploration.

Associations between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hyperuricemia: a cross-sectional study

BACKGROUND AND OBJECTIVE

The value of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) assessment in the context of metabolic abnormalities is growing in importance. Nevertheless, the relationship between NHHR and hyperuricemia (HUA) is unknown. This study seeks to investigate the relationship between NHHR and HUA.

METHODS

The data derived from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) included 7,876 adult participants. The multivariable logistic regression model, subgroup analysis and smooth fitting curve were utilized in order to investigate the association between NHHR and HUA.

RESULTS

In the fully adjusted model 3, NHHR was significantly associated with HUA. Specifically, participants in the highest quartile of NHHR had 1.95 times higher odds of HUA prevalence compared to those in the lowest quartile [2.95 (2.39, 3.64), P < 0.0001]. Although the overall trend suggested a positive association, further analysis using smooth fitting curves and threshold effect analysis indicated that this association was nonlinear, with an inflection point at 5.8. The positive association persisted across different HUA definitions and after removing outliers. Subgroup analysis showed significant interactions between NHHR and HUA in different races and diabetes statuses. The odds of HUA prevalence were higher among non-diabetic participants [1.40 (1.32, 1.49), P < 0.0001] compared to diabetic participants [1.18 (1.06, 1.32), P = 0.0031]. Mexican Americans had the lowest odds of HUA prevalence [1.09 (0.92, 1.27), P = 0.2413] compared to other races.

CONCLUSIONS

There is a significant positive association between NHHR and HUA, indicating that NHHR may serve as a potential risk assessment maker for HUA, although further prospective studies are needed for validation.

Association between triglyceride glycemic index and gout in US adults

BACKGROUND

Insulin resistance (IR) has been linked to the development of gout. The triglyceride glycemic (TyG) index is a useful biomarker of IR, and the evidences between TyG and gout are limited. Therefore, this study aimed to examine the association between the TyG index and gout in the United States (U.S).

METHODS

The cross-sectional study was conducted among adults with complete TyG index and gout data in the 2007-2017 National Health and Nutrition Examination Survey (NHANES). The TyG index was calculated as fasting triglycerides (mg/dl) * fasting glucose (mg/dl)/2. Gout was assessed by self-report questionnaire (MCQ160n). Weighted chi-squared and weighted Student's t-test were used to assess group differences. Weighted multivariable logistic regression analysis, subgroup analysis, and interaction tests were used to examine the TyG index and gout association.

RESULTS

The final participants were 11,768; 5910 (50.32%) were female, 7784 (73.26%) were 18-60 years old, 5232 (69.63%) were white, and 573 (5.12%) had gout. After adjusting for all covariates, the TyG index was positively associated with gout; each unit increase in TyG index was associated with 40% higher odds of gout (odds ratio (OR), 1.40; 95% CI: 1.82-2.66; p < 0.0001). Participants in the highest TyG index tertile group were at high risk of gout (odds ratio (OR), 1.64; 95% CI: 1.06-2.54, p = 0.03) versus those in the lowest tertile group. Interaction tests showed no significant effect of age, race, marital status, PIR level, education, BMI, smoking status, drinking status, hypertension, and DM on this association between TyG index and gout (p for interaction > 0.05).

CONCLUSIONS

In this large cross-sectional study, our results suggested that a higher TyG index was associated with an increased likelihood of gout in U.S. adults. Our findings highlight that the TyG index is a reliable biomarker of IR; management of IR among adults may prevent or alleviate the development of gout; meanwhile, the TyG index may be a simple and cost-effective method to detect gout.

[Gout, beyond the joint: How should we treat it?]

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment.

Isolation and identification of uric acid-dependent Aciduricibacillus chroicocephali gen. nov., sp. nov. from seagull feces and implications for hyperuricemia treatment

Hyperuricemia has become the second most prevalent metabolic disease after diabetes, but the limitations of urate-lowering treatment (ULT) drugs and patient nonadherence make ULT far less successful. Thus, more ULT approaches urgently need to be explored. Uric acid-degrading bacteria have potential application value in ULT. In this study, we isolated 44XBT, a uric acid-degrading bacterium, from black-headed gull (Chroicocephalus ridibundus) feces. Using a polyphasic taxonomic approach, strain 44XBT was identified as a novel genus within the family Bacillaceae; subsequently, the name Aciduricibacillus chroicocephali was proposed. Strain 44XBT had a unique uric acid-dependent phenotype and utilized uric acid and allantoin as the sole carbon and nitrogen sources, but not common carbon sources or complex media. In the genome, multiple copies of genes involved in uric acid metabolic pathway (pucL, pucM, uraD, and allB) were found. Six copies of pucL (encoding urate oxidase) were detected. Of these, five pucL copies were in a tandem arrangement and shared 70.42%-99.70% amino acid identity. In vivo experiments revealed that 44XBT reduced serum uric acid levels and attenuated kidney damage in hyperuricemic mice through uric acid catalysis in the gut and gut microbiota remodeling. In conclusion, our findings discover a strain for studying bacterial uric acid metabolism and may provide valuable insights into ULT.

IMPORTANCE

The increasing disease burden of hyperuricemia highlights the need for new therapeutic drugs and treatment strategies. Our study describes the developmental and application values of natural uric acid-degrading bacteria found in the gut of birds and broadened the source of bacteria with potential therapeutic value. Furthermore, the special physiology characteristics and genomic features of strain 44XBT are valuable for further study.

Systemic inflammatory cytokine profiles in patients with gout during flare, intercritical and treat-to-target phases: TNFSF14 as new biomarker

INTRODUCTION

Untreated gout is characterised by monosodium urate (MSU) crystal accumulation responsible for recurrent flares that are commonly separated by asymptomatic phases. Both phases are inflammatory conditions of variable intensity. Gout flares are self-limited inflammatory reactions involving multiple mediators. This study aimed to characterise the inflammatory profiles of gout at different phases.

METHODS

Using the Olink targeted proteomics, levels of 92 inflammation-related proteins were measured in plasma samples of a prospective gout population (GOUTROS), collected at gout flare (T1), the intercritical phase (T2) and after reaching the target serum urate level under urate-lowering therapy (T3). Results were validated in an independent cohort (OLT1177-05) with plasmas collected at T1 and T2. Ex vivo and in vitro experiments were performed to assess the inflammatory properties of new biomarkers.

RESULTS

In total, 21 inflammatory new biomarkers were differentially expressed during the three time-points of gout disease. The levels of four of these proteins (interleukin 6 (IL-6), colony-stimulating factor 1, vascular endothelial growth factor A and tumour necrosis factor superfamily 14 (TNFSF14)) were increased during gout flare in an independent cohort. IL-6 and TNFSF14 had the highest fold change in expression during T1 versus T2 or T3. TNFSF14 was produced at the inflamed joint and enhanced the inflammatory response induced by lipopolysaccharide and MSU crystal stimulation. Conversely, TNFSF14 blockade reduced the inflammatory response. Additionally, single nucleotide polymorphisms of TNFSF14 affected the ability of myeloid cells to produce inflammatory cytokines.

CONCLUSION

Gout flare involves multiple inflammatory mediators that may be used as potential therapeutic targets.

Association of C-reactive protein with all-cause and cause-specific mortality in people with gout

AIMS

To test the association of C-reactive protein (CRP) with all-cause and cause-specific mortality in people with gout.

METHODS

This cohort study included 502 participants with gout from the National Health and Nutrition Examination Survey. Multivariate Cox regression analysis, subgroup analysis, and restricted cubic spline (RCS) analyses were utilized to examine the association of CRP levels with all-cause, cardiovascular, and cancer mortality.

RESULTS

After adjusting for multiple variables, Cox regression analysis showed that compared with individuals in the lowest tertile of CRP levels, those in the middle and highest tertiles experienced increases in all-cause mortality risk of 74.2% and 149.7%, respectively. Similarly, the cancer mortality risk for individuals in the highest tertile of CRP levels increased by 283.9%. In addition, for each standard deviation increase in CRP, the risks of all-cause and cancer mortality increased by 25.9% and 35.4%, respectively (P < 0.05). Subgroup analyses demonstrated that the association between CRP levels and all-cause mortality remained significant across subgroups of age (≤ 60 and > 60 years), gender (male), presence or absence of hypertension, non-diabetes, cardiovascular disease, non-cardiovascular disease and non-cancer. Furthermore, the association with cancer mortality was significant in subgroups including males, those without hypertension and cancer, and those with or without diabetes. However, the association with cardiovascular mortality was only significant in the non-hypertension subgroup (P < 0.05). Nonlinear association of CRP with all-cause mortality and linear association with cancer mortality were also confirmed (P for nonlinearity = 0.008 and 0.135, respectively).

CONCLUSIONS

CRP levels were associated with increased all-cause and cancer mortality among individuals with gout.

Diagnostic values of different musculoskeletal ultrasound signs, serum uric acid, and their combined detection for gouty arthritis

Objectives

The study aimed to investigate the diagnostic values of different musculoskeletal ultrasound (MSUS) signs, serum uric acid (SUA), and their combined detection for gouty arthritis (GA).

Patients and methods

In this retrospective study, 70 patients (62 males, 8 females; mean age: 46.1±14.1 years; range, 25 to 86 years) diagnosed with GA (the GA group) between August 2022 and March 2023 and 70 patients (54 females, 16 males; mean age: 49.0±14.1 years; range, 21 to 75 years) diagnosed with rheumatoid arthritis and osteoarthritis during the same period (the non-GA group) were included. The positive rate of MSUS signs and SUA in both groups was recorded to compare the differences. The correlations of MSUS signs and SUA with GA were analyzed using Spearman's rank correlation analysis. The diagnostic values of different MSUS signs, SUA, and their combined detection for GA were analyzed using a receiver operating characteristic, the area under the curve (AUC), sensitivity, specificity, and the Youden index.

Results

The positive rate of the double contour (DC) sign (chi-squared [χ2 ]=102.935, p<0.001), hyperechoic spots (χ2=56.395, p<0.001), bone erosions (χ2 =10.080, p<0.001), and SUA (χ2 =41.117, p <0.001) were higher in the GA group than in the non-GA group. The positive rate of the DC sign (rs=0.829, p=0.001), hyperechoic spots (rs=0.631, p<0.001), bone erosion (rs=0.268, p=0.001), and SUA (rs=0.542, p<0.001) were positively correlated with GA. Among the single-indicator measures, the DC sign exhibited the highest diagnostic value (AUC=0.907, sensitivity=81.4%, specificity=100%, p<0.001). Among the combined-indicator measures, the DC sign combined with SUA exhibited the highest diagnostic value (AUC=0.929, sensitivity=91.4%, specificity=94.3%, p<0.001), higher than DC sign detection alone.

Conclusion

The DC sign combined with SUA yielded a high diagnostic value and can thus provide a reliable basis for effectively and efficiently diagnosing GA.

Efficacy and safety of Huzhang Granule, a compound Chinese herbal medicine, for acute gouty arthritis: A double-blind, randomized controlled trial

BACKGROUND

Acute gouty arthritis (AGA) is an inflammatory joint disease with a high prevalence. Typical medical interventions, including nonsteroidal anti-inflammatory drugs, colchicine and glucocorticoids, can have serious adverse reactions. Huzhang Granule (HZG), a compound Chinese herbal medicine, has been used to treat AGA for more than 30 years with satisfactory effects and no significant adverse reactions. However, the efficacy and safety of HZG in AGA patients remains unknown.

OBJECTIVE

The present investigation was designed to examine the efficacy and safety profile of HZG in managing AGA patients.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

The current study was conducted as a noninferiority, randomized controlled clinical trial on 180 eligible enrolled participants. Participants were randomly assigned into the HZG and etoricoxib groups. Treatments were administered for 5 d, during which the HZG group received HZG and placebo etoricoxib, while the etoricoxib group received etoricoxib and placebo HZG in the same ratio (1:1).

MAIN OUTCOME MEASURES

The primary outcome was pain experienced by the patient in the gout-afflicted joint from days 2 to 5 of the treatment window. The pain level was measured via a visual analogue scale, ranging from 0 mm to 100 mm. The secondary outcomes comprised joint tenderness and swelling, reduction of inflammatory biomarkers, and the patient's and investigator's global evaluations of therapeutic response.

RESULTS

The mean reduction in pain was -51.22 mm (95% confidence interval [CI], [-53.42, -49.03] mm) for the HZG and -52.00 mm (95% CI, [-54.06, -49.94] mm) for the etoricoxib groups. The mean difference between the two groups was 0.78 mm (95% CI, [-2.25, 3.81] mm). All additional efficacy endpoints, covering decreased inflammation and pain relief, yielded compelling proof of noninferiority. Patients in the HZG group exhibited a comparatively lower rate of adverse events compared to those in the etoricoxib group (4.44% vs 13.33%; P ≤ 0.05).

CONCLUSION

HZG and etoricoxib groups demonstrated similar levels of analgesic effectiveness. The safety and efficacy of HZG indicates that it can be used as a potential therapeutic option for treating AGA.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2000036970). Please cite this article as: Wang H, Chen ST, Ding XJ, Kuai L, Hua L, Li X, Wang YF, Zhang M, Li B, Wang RP, Zhou M. Efficacy and safety of Huzhang Granule, a compound Chinese herbal medicine, for acute gouty arthritis: A double-blind, randomized controlled trial. J Integr Med. 2024; 22(3): 270-278.

Superiority of Low-Dose Benzbromarone Add-On to Low-Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined-Type Hyperuricemia

OBJECTIVE

There is an unmet need for simpler urate-lowering therapy (ULT) regimens that achieve the serum urate target and improve the overall quality of gout care. We report a comparative effectiveness trial of febuxostat monotherapy versus benzbromarone add-on to low-dose febuxostat in gout specifically with combined renal urate underexcretion and overload.

METHODS

A prospective randomized trial was conducted on patients with combined-type hyperuricemia and estimated glomerular filtration rate >60 mL/min/1.73 m2 1:1 randomly assigned to febuxostat and benzbromarone combination therapy (initially febuxostat at 20 mg/day, with benzbromarone at 25 mg/day added onto 20 mg/day of febuxostat if not at target) or febuxostat monotherapy (initially 20 mg/day, escalating to 40 mg/day if not at target). The primary end point at 12 weeks was the proportion achieving a serum urate (SU) level <360 μmol/L. Other outcomes included altered liver and kidney function, new-onset urolithiasis, and gout flares.

RESULTS

There were 250 participants randomized; 219 completed 12-week treatment. More patients in the febuxostat and benzbromarone combination group achieved the SU target compared to patients in the febuxostat monotherapy group (75.5% vs 47.7%; odds ratio 3.37 [95% confidence interval 1.90-5.98]). Safety profiles were comparable between the two groups.

CONCLUSION

Simply adding on low-dose benzbromarone (25 mg/day) to low-dose (20 mg/day) febuxostat showed superior urate lowering compared to febuxostat monotherapy in gout with a combined-type hyperuricemia. For selected patients, expedited achievement of the SU target in more than 75% of patients using one titration step and low xanthine oxidase inhibitor and uricosuric doses is a potential alternative to standard ULT regimens.

Identification of potential biomarkers of gout through weighted gene correlation network analysis

Background

Although hyperuricemia is not always associated with acute gouty arthritis, uric acid is a significant risk factor for gout. Therefore, we investigated the specific mechanism of uric acid activity.

Methods

Using the gout-associated transcriptome dataset GSE160170, we conducted differential expression analysis to identify differentially expressed genes (DEGs). Moreover, we discovered highly linked gene modules using weighted gene coexpression network analysis (WGCNA) and evaluated their intersection. Subsequently, we screened for relevant biomarkers using the cytoHubba and Mcode algorithms in the STRING database, investigated their connection to immune cells and constructed a competitive endogenous RNA (ceRNA) network to identify upstream miRNAs and lncRNAs. We also collected PBMCs from acute gouty arthritis patients and healthy individuals and constructed a THP-1 cell gout inflammatory model, RT-qPCR and western blotting (WB) were used to detect the expression of C-X-C motif ligand 8 (CXCL8), C-X-C motif ligand 2 (CXCL2), and C-X-C motif ligand 1 (CXCL1). Finally, we predicted relevant drug targets through hub genes, hoping to find better treatments.

Results

According to differential expression analysis, there were 76 upregulated and 28 downregulated mRNAs in GSE160170. Additionally, WGCNA showed that the turquoise module was most strongly correlated with primary gout; 86 hub genes were eventually obtained upon intersection. IL1β, IL6, CXCL8, CXCL1, and CXCL2 are the principal hub genes of the protein-protein interaction (PPI) network. Using RT-qPCR and WB, we found that there were significant differences in the expression levels of CXCL8, CXCL1, and CXCL2 between the gouty group and the healthy group, and we also predicted 10 chemicals related to these proteins.

Conclusion

In this study, we screened and validated essential genes using a variety of bioinformatics tools to generate novel ideas for the diagnosis and treatment of gout.

Unsupervised cluster analysis of clinical and ultrasound features reveals unique gout subtypes: Results from the Egyptian College of Rheumatology (ECR)

BACKGROUND

Gout comprises a heterogeneous group of disorders; however, comorbidities have been the focus of most efforts to classify disease subgroups.

OBJECTIVES

We applied cluster analysis using musculoskeletal ultrasound (MSUS) combined with clinical and laboratory findings in patients with gout to identify disease phenotypes, and differences across clusters were investigated.

PATIENTS AND METHODS

Patients with gout who complied with the ACR/EULAR classification criteria were enrolled in the Egyptian College of Rheumatology (ECR)-MSUS Study Group, a multicenter study. Selected variables included demographic, clinical, and laboratory findings. MSUS scans assessed the bilateral knee and first metatarsophalangeal joints. We performed a K-mean cluster analysis and compared the features of each cluster.

RESULTS

425 patients, 267 (62.8 %) males, mean age 54.2 ± 10.3 years were included. Three distinct clusters were identified. Cluster 1 (n = 138, 32.5 %) has the lowest burden of the disease and a lower frequency of MSUS characteristics than the other clusters. Cluster 2 (n = 140, 32.9 %) was mostly women, with a low rate of urate-lowering treatment (ULT). Cluster 3 (n = 147, 34.6 %) has the highest disease burden and the greatest proportion of comorbidities. Significant MSUS variations were found between clusters 2 and 3: joint effusion (p < 0.0001; highest: cluster 3), power Doppler signal (p < 0.0001; highest: clusters 2), and aggregates of crystal deposition (p < 0.0001; highest: cluster 3).

CONCLUSION

Cluster analysis using MSUS findings identified three gout subgroups. People with more MSUS features were more likely to receive ULT. Treatment should be tailored according to the cluster and MSUS features.

Association between the dietary inflammatory index and gout in the National Health and Nutrition Examination Survey 2007-2018

Objective

The aim of our study was to investigate whether the Dietary Inflammatory Index (DII) correlated with gout in American adults.

Method

The study used data from the 2007-2018 National Health and Nutrition Examination Survey, with 27,710 adults participating. Initially, multivariable analysis was performed, with controls for covariates, to assess the link of DII and gout. Then, restricted cubic splines (RCS) were applied to model the nonlinear relationship of DII and gout. Furthermore, propensity score matching (PSM) as a further study of potential relationships was established. Eventually, subgroup analysis was performed.

Result

Participants within the highest DII quartile would be more susceptible to increased risk of gout in the univariate regression model (Q4 vs. Q1, OR = 1.31, CI: 1.05-1.63). Additionally, a positive correlation was detected between gout risk and DII after adjusting on drinking, smoking, gender, race, age, and BMI. Based on RCS analysis, we observed that the risk of gout raised sharply as DII values increased, then flattened, and increased sharply again when the DII was greater than approximately 2.5. After performing the PSM, it was observed that DII correlated in a positive way to the presence of gout on a fully adjusted multivariable model. Subgroup analysis revealed that the link of DII and gout showed no statistical significance in females, blacks, Mexicans, nor in the population that smoked.

Conclusion

Greater degrees of pro-inflammation correlate with a higher risk of gout and might be a predisposing factor for gout. Hence, tactics fostering an anti-inflammatory diet for preventing and improving gout in adults should be regarded.

Emerging Urate-Lowering Drugs and Pharmacologic Treatment Strategies for Gout: A Narrative Review

Hyperuricemia with consequent monosodium urate crystal deposition leads to gout, characterized by painful, incapacitating inflammatory arthritis flares that are also associated with increased cardiovascular event and related mortality risk. This narrative review focuses on emerging pharmacologic urate-lowering treatment (ULT) and management strategies in gout. Undertreated, gout can progress to palpable tophi and joint damage. In oral ULT clinical trials, target serum urate of < 6.0 mg/dL can be achieved in ~ 80-90% of subjects, with flare burden reduction by 1-2 years. However, real-world ULT results are far less successful, due to both singular patient nonadherence and prescriber undertreatment, particularly in primary care, where most patients are managed. Multiple dose titrations commonly needed to optimize first-line allopurinol ULT monotherapy, and substantial potential toxicities and other limitations of approved, marketed oral monotherapy ULT drugs, promote hyperuricemia undertreatment. Common gout comorbidities with associated increased mortality (e.g., moderate-severe chronic kidney disease [CKD], type 2 diabetes, hypertension, atherosclerosis, heart failure) heighten ULT treatment complexity and emphasize unmet needs for better and more rapid clinically significant outcomes, including attenuated gout flare burden. The gout drug armamentarium will be expanded by integrating sodium-glucose cotransporter-2 (SGLT2) inhibitors with uricosuric and anti-inflammatory properties as well as clinically indicated antidiabetic, nephroprotective, and/or cardioprotective effects. The broad ULT developmental pipeline is loaded with multiple uricosurics that selectively target uric acid transporter 1 (URAT1). Evolving ULT approaches include administering selected gut anaerobic purine degrading bacteria (PDB), modulating intestinal urate transport, and employing liver-targeted xanthine oxidoreductase mRNA knockdown. Last, emerging measures to decrease the immunogenicity of systemically administered recombinant uricases should simplify treatment regimens and further improve outcomes in managing the most severe gout phenotypes.

Role of NLRP3 in the pathogenesis and treatment of gout arthritis

Gout arthritis (GA) is a common and curable type of inflammatory arthritis that has been attributed to a combination of genetic, environmental and metabolic factors. Chronic deposition of monosodium urate (MSU) crystals in articular and periarticular spaces as well as subsequent activation of innate immune system in the condition of persistent hyperuricemia are the core mechanisms of GA. As is well known, drugs for GA therapy primarily consists of rapidly acting anti-inflammatory agents and life-long uric acid lowering agents, and their therapeutic outcomes are far from satisfactory. Although MSU crystals in articular cartilage detected by arthrosonography or in synovial fluid found by polarization microscopy are conclusive proofs for GA, the exact molecular mechanism of NLRP3 inflammasome activation in the course of GA still remains mysterious, severely restricting the early diagnosis and therapy of GA. On the one hand, the activation of Nod-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome requires nuclear factor kappa B (NF-κB)-dependent transcriptional enhancement of NLRP3, precursor (pro)-caspase-1 and pro-IL-1β, as well as the assembly of NLRP3 inflammasome complex and sustained release of inflammatory mediators and cytokines such as IL-1β, IL-18 and caspase-1. On the other hand, NLRP3 inflammasome activated by MSU crystals is particularly relevant to the initiation and progression of GA, and thus may represent a prospective diagnostic biomarker and therapeutic target. As a result, pharmacological inhibition of the assembly and activation of NLRP3 inflammasome may also be a promising avenue for GA therapy. Herein, we first introduced the functional role of NLRP3 inflammasome activation and relevant biological mechanisms in GA based on currently available evidence. Then, we systematically reviewed therapeutic strategies for targeting NLRP3 by potentially effective agents such as natural products, novel compounds and noncoding RNAs (ncRNAs) in the treatment of MSU-induced GA mouse models. In conclusion, our present review may have significant implications for the pathogenesis, diagnosis and therapy of GA.