Alvarez-Nemegyei José, Cen-Pisté Julio Cesar, Medina-Escobedo Martha, Villanueva-Jorge Salha
Instituto Mexicano del Seguro Social, Calle 57 # 503 x 50 y 62, Col. Centro, 97000 Mérida, Yucatán, México.
J Rheumatol. 2005 Oct;32(10):1923-7.
. To assess the association between a set of sociodemographic, clinical, and biochemical variables and the presence of musculoskeletal (MSK) disability and chronic renal failure in patients with primary gout defined using Wallace criteria.
Subjects were 90 patients with primary gout (98% male, age 54 +/- 12 years, 11.3 +/- 9.8 years with gout). A cohort nested case-control design was used. Analysis was done of the association between MSK disability or renal failure and a series of variables: age; duration of gout; body mass index; education level; income; serum glucose, cholesterol, triglycerides, and uric acid; Health Assessment Questionnaire score; obesity; family history of gout; high blood pressure; alcoholism; smoking habit; presence of tophi; ischemic cardiopathy; and use of colchicine, glucocorticoids, nonsteroidal antiinflammatory drug, or allopurinol.
Forty-two patients (47%) had MSK disability, and 25/80 (31%) had renal failure. On logistic regression, presence of tophi (relative risk 4.3, 95% confidence interval 1.2-15.1), hypertriglyceridemia (RR 3.4, 95% CI 1.1-10), and history of ischemic heart disease (RR 8.3, 95% CI 1.6-41) were associated with MSK disability. Patient age was the only variable associated with renal failure.
Optimal medical control of gout and its comorbidities may improve prognosis of gout, as suggested by our findings, in which a marker for poorly controlled gout such as presence of tophi in addition to high blood triglyceride levels and ischemic heart disease were associated with MSK disability. Older age was the only factor associated with renal failure, although this may only reflect declining renal function in the elderly.
评估一组社会人口学、临床和生化变量与根据华莱士标准定义的原发性痛风患者肌肉骨骼（MSK）残疾和慢性肾衰竭之间的关联。
研究对象为90例原发性痛风患者（98%为男性，年龄54±12岁，痛风病程11.3±9.8年）。采用队列嵌套病例对照设计。分析了MSK残疾或肾衰竭与一系列变量之间的关联：年龄；痛风病程；体重指数；教育水平；收入；血清葡萄糖、胆固醇、甘油三酯和尿酸；健康评估问卷得分；肥胖；痛风家族史；高血压；酗酒；吸烟习惯；痛风石的存在；缺血性心脏病；以及秋水仙碱、糖皮质激素、非甾体抗炎药或别嘌醇的使用情况。
42例患者（47%）有MSK残疾，25/80例（31%）有肾衰竭。逻辑回归分析显示，痛风石的存在（相对风险4.3，95%置信区间1.2 - 15.1）、高甘油三酯血症（RR 3.4，95% CI 1.1 - 10）和缺血性心脏病史（RR 8.3，95% CI 1.6 - 41）与MSK残疾相关。患者年龄是与肾衰竭相关的唯一变量。
正如我们的研究结果所示，痛风及其合并症的最佳医疗控制可能会改善痛风的预后，其中痛风控制不佳的标志物如痛风石的存在，以及高甘油三酯水平和缺血性心脏病与MSK残疾相关。年龄较大是与肾衰竭相关的唯一因素，尽管这可能仅反映了老年人肾功能的下降。
