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At 19:00 on June 2nd, Beijing time, the 2021 European Union Against Rheumatism Annual Conference (EULAR2021) officially opened.
Today's schedule is over half of the schedule.
As one of the most serious diseases in the field of rheumatism-gout, what new developments are there? Highlights at a glance: Obesity, heart failure and osteoarthritis are independent risk factors for the recurrence of multiple joint gout; higher education can reduce the risk of recurrence.
Compared with non-gout people, cardiovascular disease is more common in gout patients.
Regular monitoring of cardiovascular indicators in patients with insulin resistance may increase blood uric acid levels and induce gout; through a reasonable diet and reducing diet to promote insulin secretion, it may be an effective strategy to reduce the risk of gout.
Gout is a kind of monosodium urate deposited in Crystal-related arthropathy caused by joints and the onset of gout are directly related to hyperuricemia caused by disturbances of purine metabolism and/or decreased uric acid excretion
.
Most patients relapse within 1 to 2 years after the first onset, and as the disease progresses, the frequency of attacks gradually increases
.
In addition to joint damage, patients with gout are often accompanied by abnormal metabolism in the body, and are prone to metabolic syndromes such as obesity, hypertension, type 2 diabetes, and cardiovascular disease
.
So, which gout patients are more likely to relapse? How high is the risk of cardiovascular disease in patients with gout? Let's take a look
.
●Risk factors for recurrence of gout with multiple joint involvements The first onset of gout patients is mostly single joint involvement.
As the disease progresses, the number of joints involved in recurrent attacks gradually increases, and a few may affect the sacroiliac joints, shoulder joints, or spine joints
.
When multiple joints are involved in patients, it often causes irreversible structural damage, which can be severely disabled, which greatly increases the difficulty of clinical diagnosis and treatment
.
American scholar J.
Dau et al.
carried out a prospective longitudinal study and included gout patients (n=724) who had gout recurrence ≥1 time in the Boston Online Gout study (n=903; follow-up time 1 year), and extracted the subjects’ Data on the number of gout attacks, the number of joints involved, and treatment drugs
.
Recurrence of gout with multiple joint involvement is defined as the number of recurring joints ≥3
.
Univariate and multivariate analysis were used to determine the risk factors for the recurrence of gout involving multiple joints
.
Research results: The average age of the subjects was 55 years old, and the average duration of gout was 8.
1 years
.
During the follow-up period, 197 subjects (27%) experienced recurrence of gout with multiple joint involvement
.
Univariate analysis showed that women, osteoarthritis, obesity, heart failure, high blood pressure, chronic kidney disease, and history of gout medication were closely related to the higher risk of recurrence of gout with multiple joint involvement
.
However, factors such as higher education, alcohol consumption and aspirin use in patients can reduce the corresponding risk of recurrence
.
In multivariate analysis, obesity, osteoarthritis, and heart failure also increased the risk of recurrence of gout involving multiple joints, while higher education also reduced the risk of recurrence (Table 1)
.
Table 1 Conclusions of risk factors for the recurrence of polyarticular gout: This prospective cohort study suggests that obesity, heart failure, and osteoarthritis are independent risk factors for the recurrence of polyarticular gout; the higher the education level of patients, it can be reduced The corresponding risk of recurrence
.
The results of this study will help identify people at high risk of recurrence of gout with multiple joint involvement, in order to strengthen clinical management and improve the prognosis of the disease
.
●The risk of cardiovascular disease in patients with gout Gout patients often have hyperuricemia, and hyperuricemia is an independent risk factor for cardiovascular disease
.
So, how high is the incidence of cardiovascular disease among people with gout? A meta-analysis conducted by British scholar P.
Cox et al
.
provided answers to the corresponding questions .
The researchers searched PubMed, Scopus and Web of Science databases, and finally screened 30 studies reporting the incidence of cardiovascular disease in patients with gout, and extracted the sample size, prevalence of cardiovascular disease, gout and cardiovascular disease in each study Definition, demographic data, source of patient data, and comparison with non-gout control group
.
It aims to analyze the incidence of cardiovascular disease in patients with gout and compare it with non-gout people
.
Research results: Data analysis shows that the incidence of different cardiovascular diseases in gout patients is as follows: heart failure (8.
73%; 95% confidence interval [CI]: 2.
85~23.
76) cerebrovascular accident (4.
27%; 95% CI: 1.
83~9.
67) ) Myocardial infarction (2.
82%; 95%CI: 1.
58~5.
01) venous thrombosis (2.
05%; 95%CI: 1.
22~3.
43) hypertension (63.
94%; 95%CI: 24.
51~90.
64) cardiovascular mortality (4.
75%) ; 95%CI: 3.
56~6.
31) This meta-analysis based on 20 reports of gout and non-gout populations found that compared with the gout population, the risk of a variety of cardiovascular diseases in gout patients is significantly higher, and the risk of myocardial infarction Especially
.
Research conclusions: Compared with non-gout people, cardiovascular disease is more common in gout patients.
This suggests that clinicians need to assess the risk of cardiovascular disease in gout patients in a timely manner, and pay attention to monitoring cardiovascular related indicators in gout patients
.
More research is needed in the future to clarify the mechanism of the high incidence of cardiovascular disease in patients with gout
.
●Gout and insulin resistance Gout belongs to the category of metabolic rheumatism, and patients often have metabolic syndromes such as type 2 diabetes
.
Previous studies have shown that intravenous insulin can increase blood uric acid (SU) levels, and insulin levels are related to the risk of gout
.
American scholar McCormick et al.
conducted a real-world data analysis for this, including 1,64090 women and 40,598 men (neither gout at baseline)
.
Every 4 years, the subjects’ dietary intake, weight, life>
.
The study aims to determine the relationship between insulin-related dietary index and the incidence of gout
.
The following two indicators are used to assess the patient’s insulin secretion, based on: 1) Hyperinsulinemia Empirical Dietary Index (EDIH), which is based on the C-peptide level and reflects insulin resistance; 2) Dietary Insulin Index (DII), which reflects The level of insulin secretion after a short meal
.
Analyze the relationship between subjects’ EDIH and DII scores and gout, and correct for potential confounding factors
.
Research results: During a follow-up of 5124490 person-years, a total of 2874 cases of gout were diagnosed
.
Data analysis showed that the gout risk of the highest EDIH group was 1.
76 times that of the lowest group (95%CI: 1.
56~1.
99; p<0.
0001)
.
After adjusting for factors such as BMI, the gout risk of the highest EDIH score group was still 1.
30 times that of the lowest group (95%CI: 1.
15 to 1.
48; p<0.
0001); while the DII score was significantly negatively correlated with the risk of gout (RR=0.
66; 95 %CI: 0.
58~0.
74; p<0.
0001)
.
Research conclusion: EDIH score (reflecting insulin resistance) is positively correlated with the risk of gout.
The higher the EDIH score, the higher the risk of gout; after adjusting for BMI factors, the correlation still exists
.
On the contrary, the DII score (reflecting the short-term insulin secretion level after meals) is negatively correlated with the risk of gout
.
The results confirmed that insulin resistance may increase blood uric acid levels and induce gout, and indicated that a reasonable diet and reducing the potential of diet to promote insulin secretion can be used as an effective strategy to prevent gout attacks
.
Yimaitong compiled and compiled from: 1.
J.
Dau, et al.
EULAR 2021 Virtual Congress.
Abstract POS1148.
2.
P.
Cox, et al.
EULAR 2021 Virtual Congress.
Abstract POS1131.
3.
N.
McCormick, et al.
EULAR 2021 Virtual Congress.
Abstract OP0005.
Today's schedule is over half of the schedule.
As one of the most serious diseases in the field of rheumatism-gout, what new developments are there? Highlights at a glance: Obesity, heart failure and osteoarthritis are independent risk factors for the recurrence of multiple joint gout; higher education can reduce the risk of recurrence.
Compared with non-gout people, cardiovascular disease is more common in gout patients.
Regular monitoring of cardiovascular indicators in patients with insulin resistance may increase blood uric acid levels and induce gout; through a reasonable diet and reducing diet to promote insulin secretion, it may be an effective strategy to reduce the risk of gout.
Gout is a kind of monosodium urate deposited in Crystal-related arthropathy caused by joints and the onset of gout are directly related to hyperuricemia caused by disturbances of purine metabolism and/or decreased uric acid excretion
.
Most patients relapse within 1 to 2 years after the first onset, and as the disease progresses, the frequency of attacks gradually increases
.
In addition to joint damage, patients with gout are often accompanied by abnormal metabolism in the body, and are prone to metabolic syndromes such as obesity, hypertension, type 2 diabetes, and cardiovascular disease
.
So, which gout patients are more likely to relapse? How high is the risk of cardiovascular disease in patients with gout? Let's take a look
.
●Risk factors for recurrence of gout with multiple joint involvements The first onset of gout patients is mostly single joint involvement.
As the disease progresses, the number of joints involved in recurrent attacks gradually increases, and a few may affect the sacroiliac joints, shoulder joints, or spine joints
.
When multiple joints are involved in patients, it often causes irreversible structural damage, which can be severely disabled, which greatly increases the difficulty of clinical diagnosis and treatment
.
American scholar J.
Dau et al.
carried out a prospective longitudinal study and included gout patients (n=724) who had gout recurrence ≥1 time in the Boston Online Gout study (n=903; follow-up time 1 year), and extracted the subjects’ Data on the number of gout attacks, the number of joints involved, and treatment drugs
.
Recurrence of gout with multiple joint involvement is defined as the number of recurring joints ≥3
.
Univariate and multivariate analysis were used to determine the risk factors for the recurrence of gout involving multiple joints
.
Research results: The average age of the subjects was 55 years old, and the average duration of gout was 8.
1 years
.
During the follow-up period, 197 subjects (27%) experienced recurrence of gout with multiple joint involvement
.
Univariate analysis showed that women, osteoarthritis, obesity, heart failure, high blood pressure, chronic kidney disease, and history of gout medication were closely related to the higher risk of recurrence of gout with multiple joint involvement
.
However, factors such as higher education, alcohol consumption and aspirin use in patients can reduce the corresponding risk of recurrence
.
In multivariate analysis, obesity, osteoarthritis, and heart failure also increased the risk of recurrence of gout involving multiple joints, while higher education also reduced the risk of recurrence (Table 1)
.
Table 1 Conclusions of risk factors for the recurrence of polyarticular gout: This prospective cohort study suggests that obesity, heart failure, and osteoarthritis are independent risk factors for the recurrence of polyarticular gout; the higher the education level of patients, it can be reduced The corresponding risk of recurrence
.
The results of this study will help identify people at high risk of recurrence of gout with multiple joint involvement, in order to strengthen clinical management and improve the prognosis of the disease
.
●The risk of cardiovascular disease in patients with gout Gout patients often have hyperuricemia, and hyperuricemia is an independent risk factor for cardiovascular disease
.
So, how high is the incidence of cardiovascular disease among people with gout? A meta-analysis conducted by British scholar P.
Cox et al
.
provided answers to the corresponding questions .
The researchers searched PubMed, Scopus and Web of Science databases, and finally screened 30 studies reporting the incidence of cardiovascular disease in patients with gout, and extracted the sample size, prevalence of cardiovascular disease, gout and cardiovascular disease in each study Definition, demographic data, source of patient data, and comparison with non-gout control group
.
It aims to analyze the incidence of cardiovascular disease in patients with gout and compare it with non-gout people
.
Research results: Data analysis shows that the incidence of different cardiovascular diseases in gout patients is as follows: heart failure (8.
73%; 95% confidence interval [CI]: 2.
85~23.
76) cerebrovascular accident (4.
27%; 95% CI: 1.
83~9.
67) ) Myocardial infarction (2.
82%; 95%CI: 1.
58~5.
01) venous thrombosis (2.
05%; 95%CI: 1.
22~3.
43) hypertension (63.
94%; 95%CI: 24.
51~90.
64) cardiovascular mortality (4.
75%) ; 95%CI: 3.
56~6.
31) This meta-analysis based on 20 reports of gout and non-gout populations found that compared with the gout population, the risk of a variety of cardiovascular diseases in gout patients is significantly higher, and the risk of myocardial infarction Especially
.
Research conclusions: Compared with non-gout people, cardiovascular disease is more common in gout patients.
This suggests that clinicians need to assess the risk of cardiovascular disease in gout patients in a timely manner, and pay attention to monitoring cardiovascular related indicators in gout patients
.
More research is needed in the future to clarify the mechanism of the high incidence of cardiovascular disease in patients with gout
.
●Gout and insulin resistance Gout belongs to the category of metabolic rheumatism, and patients often have metabolic syndromes such as type 2 diabetes
.
Previous studies have shown that intravenous insulin can increase blood uric acid (SU) levels, and insulin levels are related to the risk of gout
.
American scholar McCormick et al.
conducted a real-world data analysis for this, including 1,64090 women and 40,598 men (neither gout at baseline)
.
Every 4 years, the subjects’ dietary intake, weight, life>
.
The study aims to determine the relationship between insulin-related dietary index and the incidence of gout
.
The following two indicators are used to assess the patient’s insulin secretion, based on: 1) Hyperinsulinemia Empirical Dietary Index (EDIH), which is based on the C-peptide level and reflects insulin resistance; 2) Dietary Insulin Index (DII), which reflects The level of insulin secretion after a short meal
.
Analyze the relationship between subjects’ EDIH and DII scores and gout, and correct for potential confounding factors
.
Research results: During a follow-up of 5124490 person-years, a total of 2874 cases of gout were diagnosed
.
Data analysis showed that the gout risk of the highest EDIH group was 1.
76 times that of the lowest group (95%CI: 1.
56~1.
99; p<0.
0001)
.
After adjusting for factors such as BMI, the gout risk of the highest EDIH score group was still 1.
30 times that of the lowest group (95%CI: 1.
15 to 1.
48; p<0.
0001); while the DII score was significantly negatively correlated with the risk of gout (RR=0.
66; 95 %CI: 0.
58~0.
74; p<0.
0001)
.
Research conclusion: EDIH score (reflecting insulin resistance) is positively correlated with the risk of gout.
The higher the EDIH score, the higher the risk of gout; after adjusting for BMI factors, the correlation still exists
.
On the contrary, the DII score (reflecting the short-term insulin secretion level after meals) is negatively correlated with the risk of gout
.
The results confirmed that insulin resistance may increase blood uric acid levels and induce gout, and indicated that a reasonable diet and reducing the potential of diet to promote insulin secretion can be used as an effective strategy to prevent gout attacks
.
Yimaitong compiled and compiled from: 1.
J.
Dau, et al.
EULAR 2021 Virtual Congress.
Abstract POS1148.
2.
P.
Cox, et al.
EULAR 2021 Virtual Congress.
Abstract POS1131.
3.
N.
McCormick, et al.
EULAR 2021 Virtual Congress.
Abstract OP0005.
