Gout Center and Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Ernest Mario School of Pharmacy, Piscataway, NJ, USA.
Clin Exp Rheumatol. 2022 Sep;40(9):1793-1800. doi: 10.55563/clinexprheumatol/hdtge7. Epub 2022 Mar 30.
Gout, the most common inflammatory arthritis worldwide, is an auto-inflammatory metabolic disease that leads to monosodium urate crystal deposition. Hyperuricaemia is a significant risk factor for the development of gout; however, hyperuricaemia alone is not sufficient to induce gout.Gout flares have circadian rhythms. Gout flares vary during the day and have strong seasonality, with flares being more common in the spring. The reasons for the predominance of flares in the spring are unclear since serum urate (SU) levels show seasonal variation; however, SU levels are highest in the summer.Immune function varies significantly throughout the year, with enhanced immune responses increasing during the winter. In addition, chronic disruption of circadian rhythms is associated with metabolic syndrome and diseases driven by metabolism. The most telling example relates to Xanthine oxidase (XOD/XDH). The analysis of XOD/XDH established its circadian regulation and demonstrated that inhibition of the activity of XOD is characterised by distinct, crossregulating diurnal/seasonal patterns of activity.The gastrointestinal microbiota of gout patients is highly distinct from healthy individuals. In a small series of gout patients, Bacteroides caccae and Bacteroides xylanisolvens were found to be enriched. Bacteroidales levels were highest during the spring and summer, and loading values were highest in the spring.Our review discusses gout's circadian rhythm and seasonality, possible influences of the microbiome on gout due to our new knowledge that Bacteroidales levels were highest during spring when gout is most common, and potential opportunities for treatment based on our current understanding of this interaction.
痛风是全球最常见的炎症性关节炎，是一种导致单钠尿酸盐晶体沉积的自体炎症代谢性疾病。高尿酸血症是痛风发展的一个重要危险因素；然而，高尿酸血症本身并不足以诱发痛风。痛风发作具有昼夜节律。痛风发作在一天中变化，具有强烈的季节性，春季更常见发作。春季发作更为普遍的原因尚不清楚，因为血清尿酸（SU）水平存在季节性变化；然而，夏季 SU 水平最高。免疫功能全年差异很大，冬季增强的免疫反应增加。此外，昼夜节律的慢性破坏与代谢综合征和由代谢驱动的疾病有关。最能说明问题的例子与黄嘌呤氧化酶（XOD/XDH）有关。XOD/XDH 的分析确立了其昼夜节律调节，并表明 XOD 活性的抑制具有独特的、相互调节的昼夜/季节性活性模式。痛风患者的胃肠道微生物组与健康个体高度不同。在一小部分痛风患者中，发现拟杆菌属和木聚糖拟杆菌属丰富。Bacteroidales 水平在春季和夏季最高，春季的负荷值最高。我们的综述讨论了痛风的昼夜节律和季节性，由于我们新的认识，即当痛风最常见时，Bacteroidales 水平在春季最高，微生物组对痛风的可能影响，以及基于我们目前对这种相互作用的理解的潜在治疗机会。
