Atypical manifestation of hyperuricemia in the Indian population: a clinical and biochemical assessment and treatment guidelines
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20254108Keywords:
Uricemia, Podagra, Bursitis, Fibrofascitis, Hypertriglyceridemia, Unusual manifestationsAbstract
Background: Podgora, the clinical presentation of gout presents no problem in diagnosis but hyperuricemia leading to some unusual presentation with musculoskeletal disorders and is often missed. This study had been conducted to analyze the disturbances of uric acid metabolism and subsequent role of uric acid in the pathogenesis of various disorder including cardiovascular, renal and various musculoskeletal disorders and to determine the disease related upper level of SUA in Indian population in both vegetarians and non-vegetarians.
Methods: Serum uric acid (by nephelometric method) was assessed in 1084 individuals during January 2018- December 2022 at a single center at Max Super Specialty Hospital, Patparganj, New Delhi with complaint of pain and swelling in joints and various other musculoskeletal problems. Out of these 48.80% were vegetarians and 51.20 were nonvegetarians.
Results: Looking at the symptomatology, only 18.50% presented with podagra as their chief complaint followed by 15.40% with generalized myalgia, 14.39% cases of plantar fasciitis and rest including tennis elbow, knee and ankle synovitis, interscapular fibrofascitis, bursitis anserine and various other musculoskeletal problems. In 76% cases with uric acid level more than 7mg/dl were having hypertriglyceridemia. Mild to moderate hypertension had been noted in 53% cases of those having SUA level more than 7 mg/dl.
Conclusions: In present study, it concluded that musculoskeletal symptoms related uric acid level should be lower around 5.5 mg/dl. SUA levels in vegetarians and non-vegetarians did not differ significantly. The high haemoglobin percent in most of the individuals gives an idea that hyperuricemia is related to good nutritional status.
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References
Ruilope LM, Puig JG. Hyperuricaemia and renal function. Curr Hypertension Rep. Madrid, Spain. 2001;25-30.
Hall AP, Barry PE, Dawber TR, McNamara PM. Epidemiology of gout and hyperuricaemia: A long term population study. Am Jour Med. 1967;42(1):27. DOI: https://doi.org/10.1016/0002-9343(67)90004-6
Zalokar J, Lelluch J, Claude JR. Serum uric acid and gout in 4663 young male workers. Semi Hop Paris 1981;57(13-14):664-8.
Noguera HE. Estudio epidemiologico de hyperuricemia gota Espana. Face I Madrid: Saned 1987;8-19.
Smith C, Menon GN. Practical Rheumatology, Paperback ed. 2000;337-56.
Li L, Zhang Y, Zeng C. Update on the epidemiology, genetics, and therapeutic options of hyperuricemia. Am J Transl Res. 2020;12:3167-81.
Muscelli E, Natali A, Bianchi S. Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am J Hypertension. 1996;9(8):746-52. DOI: https://doi.org/10.1016/0895-7061(96)00098-2
Seegmiller JE, Grayzel AI, Liddle L. Uric acid production in gout. J Clin Invest. 1961;40(7):1304-14. DOI: https://doi.org/10.1172/JCI104360
Campion EW, Glynn RJ, De Labry. Asymptomatic hyperuricemia, risks and consequences in normal aging study. Am J Med. 1987;82(3):421-6. DOI: https://doi.org/10.1016/0002-9343(87)90441-4
Nicholas A, Suiath ML, Scott JT. Effect of estrogen therapy on plasma and urine level of uric acid. BMJ. 1973;1(5851):449-51. DOI: https://doi.org/10.1136/bmj.1.5851.449
Gherghina ME, Ileana P, Mirela T, Tiberiu PN, Andrei N, Ionel AC. Uric Acid and Oxidative Stress-Relationship with Cardiovascular, Metabolic, and Renal Impairment. Int J Mol Sci. 2022;23(6):3188. DOI: https://doi.org/10.3390/ijms23063188
Yang Y, Wei X, Dide W, Zijun H, Shubin H, Yanbing L, et al. The role of obesity, type 2 diabetes, and metabolic factors in gout: A Mendelian randomization study. Front Endocrinol. 2022;13:917056. DOI: https://doi.org/10.3389/fendo.2022.917056
Rathmann W, Funfhouser E, Dyer AR, Roseman JM. Relation of hyperuricemia with various components of insulin resistance syndrome in young black and white adults: The CARDIA study. Ann Epidemiol. 1998;8(4):250-61. DOI: https://doi.org/10.1016/S1047-2797(97)00204-4
Facchini F, Chen YD, Hollenback CB. Relation between resistance to insulin mediated glucose uptake, uric acid level and plasma insulin concentration. JAMA. 1991;266(21):3008-9. DOI: https://doi.org/10.1001/jama.1991.03470210076036
Cappuccio FD, Strazzullo P, Farinaro E. Uric acid metabolism and tubular sodium handling: results from population-based study. JAMA. 1993;270(3):354-9. DOI: https://doi.org/10.1001/jama.1993.03510030078038
Lindau E, Dobson D, Vokonas PS. Uric acid and CHD incidence: a role for obesity in insulin resistant syndrome. Am J Epidemiol. 1995;142(3):288-94. DOI: https://doi.org/10.1093/oxfordjournals.aje.a117634
Krentz AJ. Insulin Resistance. BMJ. 1996;313(7069):1385-9. DOI: https://doi.org/10.1136/bmj.313.7069.1385
Mohan M, Halkin H, and Karasik A, Lusky A. Elevated serum uric acid a facet of hyperinsulinemia. Diabetologia. 1987;30(9):713-8. DOI: https://doi.org/10.1007/BF00296994
Yu S, Ying C, Xu H, Donghua X, Kui C, Changgui L, et al. Serum Uric Acid Levels and Diabetic Peripheral Neuropathy in Type 2 Diabetes: a Systematic Review and Meta-analysis. Mol Neurobiol. 2016;53(2):1045-51. DOI: https://doi.org/10.1007/s12035-014-9075-0
Cannon PJ, Simpson WB, Demartini FE. Hyperuricemia in primary and renal hypertension. N Engl J Med. 1996;275(9):457-65. DOI: https://doi.org/10.1056/NEJM196609012750902
Levya F, Anker S, Swam JW. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Euro Heart J. 1997;18(5):858-65. DOI: https://doi.org/10.1093/oxfordjournals.eurheartj.a015352
Messerli FH, Frohlich ED. Serum uric acid in essential hypertension, an indication of renal vascular involvement. Ann Intern Med. 1980;93(6):817-27. DOI: https://doi.org/10.7326/0003-4819-93-6-817
Borghi C, Davide A, Arrigo FGC, Empar L, Agostino V, et al. Uric Acid and Hypertension: a Review of Evidence and Future Perspectives for the Management of Cardiovascular Risk. Hypertension. 2022;79(9):1927-36. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.122.17956
Iossa F, Farinaro E, Panica S. Serum uric acid and hypertension: The Olivetti heart study. J Hum Hypertension. 1994;8:667-81.
Wang J, Tianqiang Q, Jianrong C, Yulin L, Ling W, He H, et al. Hyperuricemia and risk of incident hypertension: a systematic review and meta-analysis of observational studies. PLOS One. 2014;9(12):e114259. DOI: https://doi.org/10.1371/journal.pone.0114259
Selby IV, Freidmann GD, Quesenberry CP. Precursors of essential hypertension, pulmonary function heart rate, uric acid, serum cholesterol and other serum chemistries. Am J Epidemiol. 1990;10:136-43. DOI: https://doi.org/10.1093/oxfordjournals.aje.a115593
Moriarity JT, Folsom AR. Serum uric acid and risk of CHD: Atherosclerosis risk in communities study. Am J Epidemiol. 2000;10:136-43. DOI: https://doi.org/10.1016/S1047-2797(99)00037-X
Klien R, Klien BE, Cornoni JC. Serum uric acid, its relation to CHD risk factor and CVD causes. Arch Intern Med. 1973;132:401-10. DOI: https://doi.org/10.1001/archinte.1973.03650090077014
Begostsson C, Lapidus L. Hyperuricemia, risk of CVD and overall death: a 12-year prospective population study of women in Gothenburg, Sweden. Acta Med Scand. 1988;224:549-55. DOI: https://doi.org/10.1111/j.0954-6820.1988.tb19625.x
Lehto S, Ronnema T. Predictors of stroke in middle aged, type 2 diabetic and non-diabetic diabetics. Stroke. 1996;27:63-8. DOI: https://doi.org/10.1161/01.STR.27.1.63
Levine W, Dyer AR. Serum uric acid and 11.5 years morbidity of middle-aged women; findings of Chicago heart association detection project in industry. J Clin Epidemio. 1989:42(3);257-67.
Freedman DS, Dyer AR. Serum uric acid and 11.5 years mortality of middle-aged men: findings of Chicago heart study. Am J Epidemiol. 1982;42(3):257-67. DOI: https://doi.org/10.1016/0895-4356(89)90061-9
Al Shanableh Y, Yehia YH, Abdul HS, Al-Mohannadi M, Aljalham B, Nurulhoque H, et al. Prevalence of asymptomatic hyperuricemia and its association with prediabetes, dyslipidemia and subclinical in ammation markers among young healthy adults in Qatar. BMC Endocr. Disord. 2022;22(1):21. DOI: https://doi.org/10.1186/s12902-022-00937-4
Becker BF. Towards the physiological function of uric acid. Free Rad Biol Med. 1993;14:1021-5. DOI: https://doi.org/10.1016/0891-5849(93)90143-I
Hoeschen RJ. Oxidative stress and CVD. Can J Cardiol. 1997;13:1021-5.
Borghi C, Tykarski A, Widecka K, Krzysztof JF, Justyna DK, Katarzyna KJ, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol J. 2018;25(5):545-64. DOI: https://doi.org/10.5603/CJ.2018.0116
Kuriyama S, Maruyama Y, Nishio S, Yasuhito T, Satoshi K, Chisa K, et al. Serum uric acid and the incidence of CKD and hypertension. Clin Exp Nephrol. 2015;19(6):1127-34. DOI: https://doi.org/10.1007/s10157-015-1120-4
Hashimoto H, Takeuchi M, Kawakami K. Association between urate-lowering therapy and cardiovascular events in patients with asymptomatic hyperuricemia. Clin Rheumatol. 2023;42(11):3075-82. DOI: https://doi.org/10.1007/s10067-023-06710-9
FitzGerald JD. American College of Rheumatology Guideline for the Management of Gout. Arthrit. Care Res. 2020;72:744-60.