Nada Doaa, Gaber Rasha, Mahmoud Al Shymaa, Elkhouly Radwa, Alashkar Doaa
Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt.
Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt.
Open Access Rheumatol. 2021 Oct 5;13:305-314. doi: 10.2147/OARRR.S331488. eCollection 2021.
To detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients.
A total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints.
SUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level.
Elevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.
检测埃及类风湿关节炎（RA）患者高尿酸血症的患病率，并评估其与这些患者关节炎症严重程度及改善病情抗风湿药物（DMARDs）的相关性。
共招募了150例RA患者；所有患者均接受了以下检查：（1）通过28个关节疾病活动评分（DAS28）和改良健康评估问卷（MHAQ）进行临床和功能评估。（2）实验室检查：血清尿酸（SUA）水平、全血细胞计数（CBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸肽（抗CCP）、肿瘤坏死因子α（TNF-α）、白细胞介素1（IL1）和白细胞介素6（IL6）水平。（3）影像学评估：（A）双手和双足的X线平片；（B）双腕、双手、肩部、踝关节和膝关节的肌肉骨骼超声（MSUS）。
SUA与DAS28评估的疾病活动度显著相关。与SUA正常的患者相比，低尿酸血症和高尿酸血症的RA患者急性期反应物和炎症标志物（IL1β、IL6和TNF-α）也显著升高。低尿酸血症的RA患者中，90%有滑膜增生伴能量多普勒信号（1+和2+），30例有轻度积液（1+），而几乎所有高尿酸血症患者都有低回声滑膜增生（2+和3+），20例有中度积液。然而，血清尿酸正常的RA患者中有70%表现为轻度滑膜炎和积液（1+）。在使用的DMARDs与SUA水平以及炎症标志物之间未发现显著相关性；然而，高剂量类固醇治疗与高SUA水平相关。
埃及RA患者血清尿酸水平升高很普遍，可能是关节炎症严重程度的炎症标志物。此外，较高剂量的类固醇可被认为是高尿酸血症的一个原因。
