Ha You-Jung, Chung Sang Wan, Lee Jae Hyun, Kang Eun Ha, Lee Yun Jong, Song Yeong Wook
Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Int J Rheum Dis. 2019 Oct;22(10):1905-1911. doi: 10.1111/1756-185X.13697. Epub 2019 Sep 17.
This study aimed to investigate the clinical features and risk factors of gout attacks during anti-tuberculosis (TB) treatment in South Korea.
We investigated the clinical characteristics of 49 patients who suffered from gout attacks while taking anti-TB medications. Among them, 25 TB patients having newly developed gout attacks without prior history of gout were set to the gout group. Seventy-five age- and sex-matched TB patients without gout attacks during anti-TB therapy were randomly selected as the control group. The demographics, clinical features, and laboratory findings between the two groups were compared to establish risk factors of gout attack during anti-TB treatment.
The gout patients had a mean age of 67.7 ± 13.2 years and 39 patients (79.6%) were male. Approximately half of the patients experienced an attack within 2 months of treatment initiation. The attacks typically involved lower extremity joints (87.8%). The serum uric acid (SUA) levels were significantly elevated at 2 and 6 months after starting anti-TB medication compared with those at baseline. In the case-control study, the factors associated with gout attack were higher body mass index (BMI), higher pre-treatment SUA levels, dyslipidemia, and reduced renal function. In the multivariate model, higher BMI, chronic kidney disease (CKD), and pre-treatment hyperuricemia (SUA ≥ 6.8 mg/dL) were independent risk factors of gout attack while taking anti-TB medication.
Patients with high BMI, CKD, and pre-treatment hyperuricemia are at a higher risk of gout attack during TB treatment.
本研究旨在调查韩国抗结核治疗期间痛风发作的临床特征和危险因素。
我们调查了49例在服用抗结核药物期间发生痛风发作患者的临床特征。其中，25例新发生痛风发作且无痛风病史的结核病患者被纳入痛风组。随机选择75例年龄和性别匹配、在抗结核治疗期间未发生痛风发作的结核病患者作为对照组。比较两组的人口统计学、临床特征和实验室检查结果，以确定抗结核治疗期间痛风发作的危险因素。
痛风患者的平均年龄为67.7±13.2岁，39例患者（79.6%）为男性。约一半的患者在开始治疗后2个月内发作。发作通常累及下肢关节（87.8%）。与基线相比，开始抗结核药物治疗后2个月和6个月时血清尿酸（SUA）水平显著升高。在病例对照研究中，与痛风发作相关的因素包括较高的体重指数（BMI）、治疗前较高的SUA水平、血脂异常和肾功能减退。在多变量模型中，较高的BMI、慢性肾脏病（CKD）和治疗前高尿酸血症（SUA≥6.8mg/dL）是抗结核药物治疗期间痛风发作的独立危险因素。
BMI高、患有CKD和治疗前高尿酸血症的患者在结核病治疗期间发生痛风发作的风险较高。
