Landspitalinn University Hospital, Reykjavík, Iceland.
University of Iceland, Reykjavik, Iceland.
PLoS One. 2019 Aug 23;14(8):e0221474. doi: 10.1371/journal.pone.0221474. eCollection 2019.
The debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain.
Participants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07-1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32-2.31), p<0.001) remained significant. The best model for describing the relationship between serum uric acid levels (SUA) and intermittent hand joint pain in ≥10 joints was non-linear with a cut-off at 372 μmol/L. The attributable surplus number of symptomatic females with SUA ≥372 μmol/L was approximately 2.0% of the study population for those reporting pain in ≥10 hand joints. Next after having severe hand osteoarthritis, SUA ≥372 was an independent predictive factor of intermittent pain in ≥10 hand joints. Intermittent hand joint pain was also an independent risk factor for worse general health description.
Results from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.
关于“无症状高尿酸血症”是否应该治疗的争论仍在继续。本横断面研究的目的是分析老年人高尿酸血症是否与关节疼痛有关。
基于人群的 AGES-Reykjavik 研究（男性 2195 人，女性 2975 人，平均年龄 76（6）岁）的参与者回答了关于关节疼痛的标准化问题。此外，他们还通过标记手部示意图来记录间歇性手部关节疼痛。在男性中，高尿酸血症与疼痛之间没有关联。然而，女性中高尿酸血症与许多部位的关节疼痛呈正相关。然而，在调整年龄、BMI 和手部骨关节炎后，只有间歇性手部关节疼痛（OR 1.30（1.07-1.58），p = 0.008）和≥10 个手部关节间歇性疼痛（OR 1.75（1.32-2.31），p<0.001）仍然显著。描述血清尿酸水平（SUA）与≥10 个关节间歇性手部关节疼痛之间关系的最佳模型是非线性的，截断值为 372μmol/L。SUA≥372μmol/L 的有症状女性人数约占报告≥10 个手部关节疼痛的研究人群的 2.0%。在手部严重骨关节炎之后，SUA≥372μmol/L 是≥10 个手部关节间歇性疼痛的独立预测因素。间歇性手部关节疼痛也是一般健康状况恶化的独立危险因素。
这项基于人群的研究结果表明，老年女性的高尿酸血症可能是间歇性手部关节疼痛的一个常见原因，通常涉及多个关节。最可能的解释与低水平尿酸盐晶体诱导的炎症有关。我们的数据不允许评估症状的严重程度或它们是否需要特定的治疗，但间歇性手部关节疼痛是一般健康状况恶化的独立预测因素。这些发现可能是对高尿酸血症是否应该治疗的争论的重要贡献。
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