Hyperuricemia in Psoriatic Arthritis: Identifying Features to Improve Outcomes
Optimal control of hyperuricemia and metabolic diseases may play a role in improving psoriatic arthritis outcomes.
Nearly one-third of patients with psoriatic arthritis (PsA) have comorbid hyperuricemia (HUC), particularly those with longer disease duration and obesity, and they are at risk of developing metabolic syndrome, according to the results of a recent prospective Canadian cohort study published in the Journal of Rheumatology.
The investigators sought to examine the characteristics of patients with PsA who have HUC and their outcomes, particularly with respect to cardiovascular disease (CVD) and kidney disease. Patients enrolled in the study were followed at a Canadian PsA clinic at 6- and 12-month intervals. HUC was defined in men as serum uric acid levels >450 μmol/L and in women as levels >360 μmol/L. All patients with HUC were sex- and age-matched (±5 year) with those with normal uric acid levels.
Overall, 318 patients with high serum uric acid levels (HUC group) and 318 with normal serum uric acid levels from the PsA clinic were enrolled in the study. Overall, 3.5% (11 of 318) of those with HUC had gout. Smoking was significantly more common among those in the HUC group (P =.021), but alcohol consumption was similar in the 2 groups. Patients with HUC had significantly longer PsA disease duration (P <.001) and psoriasis disease duration (P =.0016) compared with those with normal uric acid levels.
Psoriatic Area Severity Index was significantly higher among those in the HUC group than in the normal uric acid group (P =.006). In addition, patients with HUC had more concurrent comorbidities, such as cardiovascular disease and metabolic diseases, along with a higher prevalence of kidney stones and higher creatinine levels.
Over the course of follow-up, 163 of the 318 patients with HUC had persistent HUC for more than 2 visits. Myocardial infarction, heart failure, and renal impairment were all reported more often among those with persistent HUC. An association among persistent HUC, PsA, and obesity was demonstrated.
The investigators concluded that it is important to screen patients with PsA for HUC. Appropriate control of HUC and metabolic diseases in patients with PsA may play an important preventive role in improving outcomes.
AlJohani R, Polachek A, Ye JY, Chandran V, Gladman DD. Characteristic and outcome of psoriatic arthritis patients with hyperuricemia [published online December 1, 2017]. J Rheumatol. doi: 10.3899/jrheum.170384