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Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options
Thomas Bardin1,2,3,4, Pascal Richette5,6,7
1Université Paris Diderot, UFR médicale, Paris, France. thomas.bardin@aphp.fr.
Insights
Gout patients frequently have other serious health issues like heart and kidney disease. More research is needed to confirm if treating high uric acid levels can prevent these gout complications.
Area of Science:
- Rheumatology
- Nephrology
- Cardiology
Background:
- Gout is the most common inflammatory arthritis globally.
- Gout is linked to increased risks of cardiovascular and renal diseases, and premature death.
- Patients with gout often present with comorbidities such as obesity, chronic kidney disease (CKD), hypertension, and diabetes.
Purpose of the Study:
- To highlight the importance of screening for and managing comorbidities in gout patients.
- To discuss the impact of comorbidities and their treatments on gout management.
- To review the evidence linking asymptomatic hyperuricemia to various diseases and cardiovascular risk factors.
Main Methods:
- Review of epidemiological studies on gout and associated diseases.
- Inclusion of findings from animal studies on urate's vascular toxicity.
- Consideration of recent studies using Mendelian randomization and therapeutic interventions.
Main Results:
- Epidemiological data consistently show increased frequencies of obesity, CKD, hypertension, diabetes, dyslipidemias, cardiac diseases, stroke, and peripheral arterial disease in gout patients.
- Asymptomatic hyperuricemia is associated with these comorbidities and cardiovascular risk factors.
- Mechanistic studies suggest potential vascular toxicity of soluble urate.
Conclusions:
- Screening and managing comorbidities and cardiovascular risk factors are crucial in gout care.
- Causality between hyperuricemia and associated diseases remains uncertain due to potential confounders.
- Large randomized placebo-controlled trials are necessary to determine the benefits of treating asymptomatic hyperuricemia.
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.
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