Scientific journal
European Journal of Natural History
ISSN 2073-4972
ИФ РИНЦ = 0,301

Gout in the Republic of Sakha: Age Distribution, Risk Factors, and Comorbities

Petrova M.N. 1
1 North-Eastern Federal University M.K. Ammosov

Gout is considered a metabolic disease and ranked among the diseases connected with obesity, such as an arterial hypertension, coronary artery disease, stroke, and type 2 diabetes mellitus. It has been proven that intake of a considerable quantity of meat products is predictor of acute gouty arthritis. For this reason there is great interest in studying the prevalence of gout among inhabitants of the Republic of Sakha (Yakutia) where a lipid-protein diet prevails. Though it is reasonable to assume wide spread prevalence of gout, official data on gout in Yakutia are absent. Arterial hypertension was most common feature, followed by high triglycerides and obesity in gouty patients. Preobesity and 1st degree obesity are common.

Gout is a rheumatic disease resulting from deposition of monosodium urate crystals in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications, alcohol, and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain [9]. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis [10]. Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic [11].

Gout is caused by an uncontrolled metabolic disorder, hyperuricemia, which leads to the deposition of uric acid crystals, a metabolic product resulting from the metabolism of purines, in tissue [1]. Hyperuricemia is caused by an imbalance in the production and excretion of urate, i.e., overproduction, underexcretion or both. Underexcretion is the most common cause, thought to account for 80–90 % of hyperuricemia [2]. Hyperuricemia is not the same as gout. Asymptomatic hyperuricemia does not need to be treated.

Risk factors for gout include being overweight or obese, having hypertension, alcohol intake (beer and spirits more than wine), diuretic use, and a diet rich in meat and seafood. Weight loss lowers the risk for gout [4]. Gout is also associated with an increased risk of kidney stones.

It is proved that a predictor of acute gouty arthritis is eating huge quantities of meat products. In this connection it is of greatest interest to examine the prevalence of the disease among residents of Yakutia, where the predominant protein- lipid diet, and might have been expected high incidence of gout.

Currently gout seen as an important medical problem that is related to the data on the impact of hyperuricemia on progression of atherosclerotic vascular disease. Gout is a metabolic disease, and hyperuricemia – one of the most important components of the metabolic syndrome [6, 8]. Found a close relationship between human purine metabolism and hypertriglyceridemia [5] Link between hyperuricemia and insulin resistance is proven now. Hyperuricemia is an independent risk factor for cardiovascular disease, so diagnosis and treatment of gout, hyperuricemia, as well as complications of the disease are the actual problem of therapy [7].

The purpose of the study. Explore contemporary gout in the Republic of Sakha (Yakutia).

Objectives. A research project has been initiated to determine the incidence and characteristics of gout in Yakutia from 2007–2012. Patients hospitalized in the department of rheumatology of Yakut City Hospital with gouty arthritis were studied.

Methods. Patients are being studied by means of a questionnaire developed by the Institute of Rheumatology (Moscow), which includes questions on anamnesis, form of gout, and specifics of treatment. Data also being collected include: laboratory measures (glucose, HDL-C, LDL-C, TC, TG, creatinine, urea, uric acid, TP, bilirubin, ALT, AST, GGTP, alkaline phosphatase, creatine kinase); urinalysis, on admission plus daily analysis of urine (creatinine, protein, uric acid); radiographic assessment of feet and wrists; ultrasound of kidneys.

Results. In 2006–2012 years 44 patients were registered. The majority of patients (n = 35) are inhabitants of Yakutsk City; the remaining 9 are from various other areas of the Republic.

Median age of the subjects is 56 years, with a range of 35–76 years; 4 patients are over 65. Secondary forms of gout and relapses of disease are common. Forms of arthritis include: acute in 3 patients, prolonged in 8 patients, chronic in 2 patients. The tophaseus form was observed at 10 patients.

Accompanying pathology includes: arterial hypertension (AH) in 22 patients, coronary artery disease (CAD) in 7 patient, type 2 diabetes mellitus (DM) in 4 patients, glucose intolerance + obesity in 1 patient, metabolic syndrome + obesity in 1 patient, uncomplicated obesity in 1 patient, metabolic syndrome without obesity in 1 patient, chronic renal insufficiency in 1 patient, and cardiovascular accidents in 3 patients (Fig. 2, 3). Nephrolithiasis in 9 (20 %) patients only in patients with AH.

Median body mass index (BMI) of the patients is 32, 05 [24; 49]. Normal BMI (16 %); preobesity (32 %); 1st degree obesity (26 %); 2nd degrees obesity (10 %); morbid obesity (16 %) (Fig. 4). Waist/hip ratio is 1,094 [0,9–1,46].

Metabolic syndrome (MS) features in patients with gout: obesity-50 %; AH (≥ 130/85 mm.Hg) – 92 %; TG (≥ 1,7 mmol/l) – 71 %; Glucose (> 6,1 mmol/l) – 12,5 % (HDL-C was unavailable) (Fig. 1).

Clinical сase 1. Male, 57 years old with secondary gout, tophaseus form and CAD, atrial fibrillation, AH II was inspected in department of rheumatology of Yakut City Hospital. Patient has such risk factors of gout: alcohol (50 cl vodka/week), smoking, diuretic therapy (antiarythmical therapy also was admitted). Echocardiography data: Atriomegaly (LV 42 mm). LV hypertrophy. Unfortunately stroke occurs in age at 60 years old. Possible reasons of stroke are: gout pathogenesis leads to early atherosclerosis, irregular antihypertension and antihyperuricemy therapy, non-compliance with diet, alcohol abuse.

 

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Fig. 1. Metabolic syndrome status

 

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Fig. 2. Patients with MS components

 

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Fig. 3. Uric acid in patients with MS components

 

 

Clinical case 2. 35 year old man with secondary gout was included in the study in 2007. He had 5 episodes of acute arthritis during the year before his first hospitalization. His second hospitalization was in 2010. His father suffers from DM 2 type. This patient has multiple risk factors: obesity (BMI 44 kg/m2), waist/hip ratio 1,46, AH with blood pressure 130/90 and 180/120 mmHg in 2007 and 2010, respectively. Also he has significant liver function elevation, chronic pancreatitis by ultrasound data, and left (59 mm) and right (35 mm) ventricular dilatation, atriomegaly (right atrium (RA) = 50x37 mm), and LV hypertrophy by echocardiography. During his second hospitalization type 2 DM was diagnosed (glucose ranging from 6,34 to 13,8 mmol/L) along with bilateral nephrolithiasis. Other laboratory data in 2007 and 2010 included: TC 3,6 and 5,03 mmol/L; uric acid 787 and 288–308 mkmol/L; ALT 40 and 94,1 IU/L; and AST 75,9 and 58,2 IU/L.

 

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Fig. 4. Body mass index in patients with gout

 

 

Clinical case 3. Female, 60 years old with CAD, atrial fibrillation, AH II, HF III, Metabolic syndrome, obesity III, secondary hyperuricemia and gout, primary osteoarthritis. Antihypertensive, diuretic, antiischemic therapy was admitted.

Clinical case 4. Male, 51 years old with secondary gout, acute arthritis and CAD, atrial fibrillation, atriomegalia, heart failure (HF) III. Diuretic, antiarrhythmic, antiischemic therapy was admitted.

Conclusion. Thus, we observed gout in both elderly patients, predominately men, and some young men, among them there were repeated hospitalizations and multiple risk factors. Features of MS were common in patients with gout. AH was most common feature, followed by high TG and obesity. Preobesity and 1st degree obesity are common. This association suggests that lifestyle – diet, lack of regular exercise, obesity – may contribute to gout risk.

The research proceeds. Results will be used for characterization of the incidence and diagnostic features of gout in the Republic of Sakha (Yakutia) with the goal of standardizing guidelines for diagnosis and treatment of gout, assuring optimal care for these patients, especially among young patients with accompanying metabolic abnormalities.

Research is performed with use of «Grant of President of the Republic of Sakha (Yakutia) to the young scientist, experts and students on support of scientific researches».