Chiou Andrew, England Bryant R, Sayles Harlan, Thiele Geoffrey M, Duryee Michael J, Baker Joshua F, Singh Namrata, Cannon Grant W, Kerr Gail S, Reimold Andreas, Gaffo Angelo, Mikuls Ted R
University of Nebraska Medical Center, Omaha.
University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.
Arthritis Care Res (Hoboken). 2020 Jul;72(7):950-958. doi: 10.1002/acr.23926. Epub 2020 Jun 7.
Although hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes in RA is unclear. We undertook this study to examine associations of coexistent hyperuricemia and gout with RA disease measures, RA treatments, and survival.
Participants from a longitudinal RA study were categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline serum UA levels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses.
Of 1,999 participants with RA, 341 (17%) had serum UA concentrations of >6.8 mg/dl, and 121 (6.1%) were diagnosed with gout. There were no significant associations of serum UA concentration or gout with RA disease activity or treatment at enrollment, with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs. After adjustments for age and sex, moderate hyperuricemia (serum UA >6.8 to ≤8 mg/dl) was associated with an increased risk of CVD-related mortality (hazard ratio 1.56 [95% confidence interval 1.11-2.21]). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompany hyperuricemia. Results corresponding with serum UA concentrations of >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline serum UA concentration with all-cause mortality.
Our study reports the frequency of hyperuricemia and gout in patients with RA. These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity.
尽管高尿酸血症和痛风会使类风湿关节炎（RA）的病程复杂化，但这些因素对RA预后的影响尚不清楚。我们开展这项研究以探讨并存的高尿酸血症和痛风与RA疾病指标、RA治疗及生存率之间的关联。
根据痛风的存在情况和血清尿酸（UA）状态，对一项RA纵向研究的参与者进行分类。通过基线患者特征、RA疾病活动度、治疗情况和合并症对各组进行比较。在多变量生存分析中，研究基线血清UA水平与全因死亡率和心血管疾病（CVD）相关死亡率之间的关联。
在1999例RA患者中，341例（17%）血清UA浓度>6.8mg/dl，121例（6.1%）被诊断为痛风。血清UA浓度或痛风与入组时的RA疾病活动度或治疗之间无显著关联，但痛风患者更可能接受柳氮磺胺吡啶治疗，而接受非甾体抗炎药治疗的可能性较小。在对年龄和性别进行调整后，中度高尿酸血症（血清UA>6.8至≤8mg/dl）与CVD相关死亡率增加的风险相关（风险比1.56[95%置信区间1.11 - 2.21]）。在对更常伴随高尿酸血症的合并症进行进一步调整后，这种关联减弱且无统计学意义。血清UA浓度>8.0mg/dl时的结果相似，尽管在任何模型中均未达到统计学意义。基线血清UA浓度与全因死亡率之间无关联。
我们的研究报告了RA患者中高尿酸血症和痛风的发生率。这些结果表明，在该人群中高尿酸血症与CVD死亡率密切相关，这种风险似乎是由过多的合并症驱动的。
