伴有高尿酸血症的银屑病关节炎患者的特征和结局。
Characteristic and Outcome of Psoriatic Arthritis Patients with Hyperuricemia.
机构信息
From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Taibah University, Medina, Saudi Arabia; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
R. AlJohani, MD, Clinical and Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Department of Medicine, Taibah University; A. Polachek, MD, Clinical and Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; J.Y. Ye, MSc, Biostatistician, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, University of Toronto, Department of Medicine, Division of Rheumatology, University of Toronto, and Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Senior Scientist, Krembil Research Institute, Toronto Western Hospital, University Health Network.
出版信息
J Rheumatol. 2018 Feb;45(2):213-217. doi: 10.3899/jrheum.170384. Epub 2017 Dec 1.
OBJECTIVE
To determine the characteristics of patients with psoriatic arthritis (PsA) who have hyperuricemia (HUC) and their outcomes, especially cardiovascular (CVD) and kidney diseases.
METHODS
Patients have been followed prospectively at the PsA clinic according to a standard protocol at 6- to 12-month intervals. We defined HUC in men > 450 mol/l or women > 360 mol/l. We matched patients with HUC based on sex and age ± 5 years with normal uric acid patients. Demographics information and disease characteristics were reviewed. Outcomes of patients with HUC, especially CVD and kidney diseases, were recorded. Conditional logistic regression was performed to determine factors independently associated with HUC in patients with PsA.
RESULTS
There were 325 (31.9%) out of 1019 patients with PsA who had HUC. Of these, 318 cases were matched to 318 controls. There were 11 (3.4%) out of 325 patients with HUC who had gout. Patients with HUC had longer disease duration and a higher Psoriasis Area and Severity Index. They had more concurrent comorbidities, including CVD and metabolic diseases, as well as higher prevalence of kidney stones and higher creatinine. Only 1 patient with HUC was treated with allopurinol at first evaluation visit and 7 patients during followup. Over the followup, 163 of the 318 patients had persistent HUC (pHUC) for more than 2 visits. Patients with pHUC developed more myocardial infarction, heart failure, and renal impairment. Multivariate analysis showed an association between pHUC, PsA disease duration, and obesity.
CONCLUSION
HUC is common in patients with PsA, especially in those with longer disease duration and obesity. Proper control of HUC and metabolic diseases may play a preventive role in improving PsA outcomes.
目的
确定患有银屑病关节炎（PsA）并伴有高尿酸血症（HUC）的患者的特征及其结局，尤其是心血管（CVD）和肾脏疾病。
方法
根据标准方案，我们对每 6-12 个月一次到 PsA 门诊就诊的患者进行前瞻性随访。我们将男性＞450μmol/L 或女性＞360μmol/L 的患者定义为 HUC。我们根据性别和年龄±5 岁与正常尿酸患者进行 HUC 患者的匹配。我们回顾了患者的人口统计学信息和疾病特征。记录 HUC 患者的结局，尤其是 CVD 和肾脏疾病。采用条件逻辑回归确定与 PsA 患者 HUC 相关的独立因素。
结果
在 1019 例 PsA 患者中，有 325 例（31.9%）患有 HUC。其中 318 例病例与 318 例对照相匹配。在 325 例 HUC 患者中，有 11 例（3.4%）患有痛风。HUC 患者的疾病病程较长，银屑病面积和严重程度指数较高。他们有更多的合并症，包括 CVD 和代谢性疾病，以及更高的肾结石患病率和更高的肌酐水平。在首次评估就诊时，仅有 1 例 HUC 患者接受了别嘌醇治疗，在随访期间有 7 例患者接受了治疗。在随访期间，318 例患者中有 163 例（pHUC）在超过 2 次就诊时仍存在 HUC。pHUC 患者发生更多的心肌梗死、心力衰竭和肾功能不全。多变量分析显示 pHUC、PsA 疾病病程和肥胖之间存在关联。
结论
HUC 在 PsA 患者中很常见，尤其是在疾病病程较长和肥胖的患者中。适当控制 HUC 和代谢性疾病可能对改善 PsA 结局起到预防作用。
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