Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France.
Laboratoire d'Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France.
Clin Rheumatol. 2020 May;39(5):1405-1413. doi: 10.1007/s10067-020-04981-0. Epub 2020 Feb 15.
Psoriatic arthritis and gout are frequently encountered conditions sharing a number of common risk factors, which render their independent study difficult. Epidemiological studies have demonstrated a strong link between these diseases, suggesting the presence of underlying, intertwined pathophysiological mechanisms that currently remain unknown. Indeed, sodium urate crystals could play a pathogenic role in psoriasis and psoriatic arthritis. In daily practice, the distinction between psoriatic arthritis associated with hyperuricemia and a gouty arthropathy with psoriasis is complex. Several common pathogenic features suggest a more intricate relationship than their mere coexistence in the same patient. Thus, the concurrence of these two diseases should be seen as a novel overlap syndrome, at the boundary between inflammatory and metabolic rheumatism. The present update aims to clarify the determinants of the link and to define this new nosological entity. Its recognition could have therapeutic implications that appear essential for treatment optimization in a personalized setting.Key Points• What is already known about this subject? Psoriatic arthritis (PsA) and gout have strong interconnections, including comorbidities and pathophysiology. One must note that confounding clinical symptoms and radiological signs of PsA and gout are similar and difficult to differentiate in patients whose radiological lesions become too advanced to be differentiated or with less clearly defined phenotypes.• What does this study add? The pathogenic role of chronic hyperuricemia in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These two pathological processes can influence each other.• How might this impact on clinical practice? This new line of thinking regarding the convergence of gout and PsA, involving the role of urate crystals, could prompt a potential new approach to treatment (urate-lowering therapy) among patients with active/refractory PsA.
银屑病关节炎和痛风是两种常见的疾病，它们有许多共同的危险因素，这使得对它们进行独立研究变得困难。流行病学研究表明这两种疾病之间存在很强的关联，表明存在潜在的、相互交织的病理生理机制，而这些机制目前尚不清楚。事实上，尿酸盐晶体可能在银屑病和银屑病关节炎中发挥致病作用。在日常实践中，伴高尿酸血症的银屑病关节炎和伴银屑病的痛风性关节炎之间的鉴别非常复杂。一些常见的发病特征表明，它们之间的关系比单纯共存于同一患者中更为复杂。因此，这两种疾病的同时存在应被视为一种新的重叠综合征，处于炎症性和代谢性风湿病之间的边界。本综述旨在阐明这种关联的决定因素，并定义这一新的分类实体。对其认识可能具有治疗意义，在个体化治疗中对优化治疗非常重要。
关键点
• 关于这个主题，已知的有哪些？银屑病关节炎（PsA）和痛风之间存在很强的相互关联，包括共病和病理生理学。需要注意的是，在影像学病变变得难以区分或表型定义不明确的患者中，PsA 和痛风的临床症状和影像学表现相似，难以区分。
• 本研究增加了哪些新的内容？慢性高尿酸血症在 PsA 的发生和维持中的致病作用基于流行病学、临床和基础研究证据，因此并非偶然。这两个病理过程可以相互影响。
• 这对临床实践可能产生怎样的影响？这种关于痛风和 PsA 趋同的新思维方式，涉及尿酸盐晶体的作用，可能会促使人们对活动性/难治性 PsA 患者采取潜在的新治疗方法（降尿酸治疗）。
