From the Department of Rheumatology, Rijnstate Hospital, Arnhem; Department of Rheumatology, Radboud University Medical Centre; Departments of Internal Medicine, and Pharmacology and Toxicology, Radboud University Medical Centre; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; Department of Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands.
I.J. Disveld, MD, Department of Rheumatology, Rijnstate Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; G.A. Rongen, Professor, Department of Internal Medicine, and Department of Pharmacology and Toxicology, Radboud University Medical Centre; L.B. Kienhorst, MD, LLM, Department of Dermatology, University Medical Centre Utrecht; S. Zoakman, MD, Department of Rheumatology, Rijnstate Hospital; H.J. Janssens, MD, PhD, Department of Primary and Community Care, Radboud University Medical Centre; M. Janssen, MD, PhD, Department of Rheumatology, Rijnstate Hospital.
J Rheumatol. 2018 Jun;45(6):858-863. doi: 10.3899/jrheum.170555. Epub 2018 Apr 15.
Our aim was to examine the prevalence of cardiovascular disease (CVD) in patients with crystal-proven gout compared to arthritis controls. Further, we analyzed the association between characteristic gout severity factors and CVD to provide further support for a pathogenetic relationship between gout and CVD.
Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers cohort. Joint fluid analysis was performed in all referred patients; controls were negative for crystals. Patients' characteristics and different manifestations of CVD and gout severity factors (disease duration, attack frequency, tophi, affected joints, high serum urate acid level, joint damage) were collected. Gout patients were compared with controls for the prevalence of CVD. In addition, the association between characteristic gout severity factors and presence of CVD was analyzed.
Data from 700 gout patients and 276 controls were collected. CVD was present in 47% (95% CI 44%-51%) and 24% (95% CI 19%-29%) of gout patients and controls, respectively. Corrected for confounders, gout was still strongly associated with an increased prevalence of CVD compared to controls (OR 3.39, 95% CI 2.37-4.84). In patients with gout, disease duration ≥ 2 years, oligo- or polyarthritis, serum urate acid > 0.55 mmol/l at presentation, and joint damage were independently (p < 0.05) associated with prevalent CVD.
Crystal-proven gout was strongly associated with an increased prevalence of CVD. In patients with gout, characteristic gout severity factors were associated with CVD.
本研究旨在比较晶体性痛风患者与关节炎对照者的心血管疾病（CVD）患病率。此外，我们分析了特征性痛风严重程度因素与 CVD 之间的关系，为痛风与 CVD 之间的发病机制关系提供进一步的支持。
连续纳入关节炎患者作为研究对象。所有入组患者均进行关节液分析；对照组为晶体阴性。收集患者特征、不同 CVD 表现和痛风严重程度因素（疾病持续时间、发作频率、痛风石、受累关节、高血清尿酸水平、关节损伤）。比较痛风患者和对照组 CVD 的患病率。此外，还分析了特征性痛风严重程度因素与 CVD 存在之间的关系。
共纳入 700 例痛风患者和 276 例对照者。痛风患者中 CVD 的患病率为 47%（95%CI 44%-51%），对照组为 24%（95%CI 19%-29%）。校正混杂因素后，与对照组相比，痛风患者 CVD 的患病率仍然显著增加（OR 3.39，95%CI 2.37-4.84）。在痛风患者中，疾病持续时间≥2 年、寡关节炎或多关节炎、就诊时血清尿酸>0.55mmol/l 和关节损伤与 CVD 的患病率显著相关（p<0.05）。
晶体性痛风与 CVD 的患病率显著增加密切相关。在痛风患者中，特征性痛风严重程度因素与 CVD 相关。
