Immunoresistance syndrome in gout patients and its influence on formation of clinical features of the disease

Abstract


Aim. To evaluate the occurrence of immunoresistance (IR) syndrome in gout and its correlation with a gout course.
Material and methods. Anthropometric parameters, blood lipid spectrum, levels of glucose, uric acid (UA), immunoreactive insulin, HOMA index were studied in 55 male patients with gout (mean age 50.1 ± 7.9 years, mean duration of the disease 7.5 ± 7.2 years). Statistic processing was made with computer program Statistica 6.0.
Results. IR was revealed in 49% patients. Immunoresistant patients had visceral obesity, arterial hypertension, abnormal lipid profde, high UA concentrations, longer disease, chronic articular syndrome, high occurrence of diabetes mellitus and vascular events significantly more frequently. Conclusion. IR in gout patients is the risk factor of cardiovascular diseases; combination of IR and hyperinsulinemia is characterized by marked hyperuricemia and a trend to chronic course of the articular syndrome. Longer duration of gout, especially treated inadequately, raises the risk of IR. IR deteriorates prognosis in relation to cardiovascular diseases, diabetes mellitus type 2, course of gout itself.

Keywords

References

  1. De Fronzo R. A., Ferranninni E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-194.
  2. Rodnan G. P. A gallery of gout. Arthr. and Rheum. 1968; 4: 520-528.
  3. Gutman A. B. Views on the pathogenesis and management of primary gout. J. Bone Jt Surg. 1972; 54A: 357-372.
  4. Mayne J. G. Pathological study of the renal lesions found in 27 patients with gout. Ann. Rheum. Dis. 1956; 15: 61-62.
  5. Radio M. Т., Valkenburg H. A., Davidson R. T. et al. Observations on the natural history of hyperuricemia and gout. I. An eighteen year follow-u of nineteen gouty families. Am. J. Med. 1964; 37: 862-871.
  6. Emmerson B. Hyperlipidemia in hyperuricemia and gout. Ann. Rheum. Dis. 1998; 57: 509-510.
  7. Ferns G. A. A., Lanham J., Dieppe P., Galston D. A DNA polymorphism of an apoprotein gene associates with the hypertriglyceridemia of primary gout. Hum. Genet. 1988; 78: 55-59.
  8. Moriwaki Y., Yamamoto Т., Takahashi S. et al. Apolipoprotein E phenotypes in patients with gout: relation with hypertriglyceridaemia. Ann. Rheum. Dis. 1995; 54: 351-354.
  9. Takahashi S., Moriwaki Y., Tsutsumi Z. et al. Increased visceral fat accomulation further aggravates the risk of insulin resistance in gout. Metabolism 2001; 50 (4): 393-398.
  10. Dessein P. H., Stanwix A. E., Shipton E. A. et al. Dislipidemia and insulin resistance in gout: sufficiently common to be considered in the evaluation and management of every patient. III. In: African League Against Rheumatism (AFLAR) Conference. Cape Town, South Africa, September 1999. Cape Town' Ukenza; 1999.
  11. Acheson R. M. Epidemiology of serum uric acid and gout: an example of the complexities of multifactorial causation. Proc. Roy. Soc. Med. 1970; 63: 193-197.
  12. Healy L. A., Hall A. P. The epidemiology of hyperuricemia Bull. Rheum. Dis. 1970; 20: 600-603.
  13. Harris С. M., Lloyd D. C., Lewis J. The prevalence and prophylaxis of gout in England. J. Clin. Epidemiol. 1995; 48: 1153-1158.
  14. Arromdee E., Michel C. J., Crowson С. S. et al. Epidemiology of Gout: Is the Incidence Rising? J. Rheumatol. 2002; 29: 2403-2406.
  15. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Wld Hlth Org. Techn. Rep. Ser. 2000; 894: i-xii, 1.
  16. Ford E. S., Giles W. H., Dietz W. H. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. J. A. M. A. 2002; 287 (3): 356-359.
  17. Khaodhiar L., McCowen K. C., Blackburn G. L. Obesity and comorbid conditions. Clin. Cornerstone 1999; 2 (3): 17-31.
  18. Alderman M. H., Cohen H., Madhavan S., Kivlighn S. Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension 1999; 34: 144-150.
  19. Persky V. W., Dyer A. R., Idris-Soven E. et al. Uric acid: a risk factor for coronary heart disease? Circulation 1979; 59: 969- 977.
  20. Freedman D. S., Williamson D. F., Gunter E. W., Byers T. Relation of serum uric acid to mortality and ischemic heart disease. Am. J. Epidemiol. 1995; 141: 637-644.
  21. Vaccarino V., Krunholz H. M. Risk factors for cardiovascular disease: one down, many more to evaluate. Ann. Intern. Med. 1999; 131: 62-63.
  22. Culleton B. F., Larson M. G., Kannel W. В., Levy D. Serum uric acid and risk of cardiovascular disease and mortality: The Framingham Heart Study. Ann. Intern. Med. 1999; 131: 7- 13.
  23. Gertler M. M., Gam S. M., Levine S. A. Serum uric acid in relation to age and physique in health and in coronary artery disease. Ann. Intern. Med. 1951; 34: 1421 - 1431.
  24. Wallace S. L., Robinson H., Masi A. T. et al. Preliminary criteria for the classification of the acute arthritis of gout. Arthr. and Rheum. 1977; 20: 895-900.
  25. Seidell J. Obesity in Europe. Obes. Res. 1995; 3 (suppl. 2): 89s-93s.
  26. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel HI). J. A. M. A. 2001; 285 (19): 2486-2497.
  27. Alberty K. G., Zimmet P. Z. for the WHO Consultation Group. Definition, diagnosis and classification of diabetes mellitus and its complication. Part I: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet. Med. 1998; 1: 539-553.
  28. Padova J., Patchefsky A., Onesti G. et al. The effect of glucose loads on renal uric acid excretion in diabetic patients. Metabolism 1964; 13: 507-512.
  29. Herman J. В., Кеупап A. Hyperglycemia and uric acid. Isr. J. Med. Sci. 1969; 5: 1048-1052.
  30. Berkowitz D. Gout, hyperlipidemia and diabetes interrelationships. J. A. M. A. 1966; 197: 77-80.
  31. Berkowitz D. Blood lipid and uric acid interrelationships. J. A. M. A. 1964; 190: 856-858.
  32. Takahashi S., Yamamoto Т., Moriwaki Y. et al. Impaired lipoprotein metabolism in patients with primary gout - influence of alcohol intake and body weight. Br. J. Rheumatol. 1994; 33: 731-734.
  33. Reaven G. M. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.
  34. Carey D. G. P. Abdominal obesity. Curr. Opin. Lipidol. 1998; 9: 35-40.
  35. Festa A., D'Agostino R., Howard G. Chronic subclinical inflammation as part of the insulin resistance syndrome. The Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-47.
  36. Liuzzo G., Biasucci L. M., Gallimore J. R. The prognostic value of C-reactive protein and serum amyloid in severe unstable angina. N. Engl. J. Med. 1994; 331: 417-424.
  37. Ridker P. M., Buring J. E. et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-733.
  38. Koenig W., Sund M., Frohlich M. et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovacular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999; 99: 237-242.
  39. Pascual E. Persistence of monosodium urate crystals and low grade inflammation in the synovial fluid of patients with untreated gout. Arthr. and Rheum. 1991; 42 (2): 141-145.
  40. Якунина И. А., Макаров М. А., Северинова М. А. и др. Выявление кристаллов уратов в коленных суставах методом лаважа у больных с подагрой в межприступный период. Ревматология 2002; 2: 52.
  41. Yu Т. F., Berger L. Impaired renal function in gout. Am. J. Med. 1982; 72: 95-100.
  42. Beck L. H. Requiem for gouty nephropathy. Kidney Int. 1986; 30: 280-287.
  43. Cohn G. M., Valdes G. M., Capuzzi D. M. Pathophysiology and treatment of the dyslipidemia of insulin resistance. Curr. Cardiol. Rep. 2001; 3: 416-423.
  44. Borona E., Targer G., Alberiche M. et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity. Diabetes Care 2000; 23: 57- 63.
  45. Masanori E., Yoshiki N., Kiyoshi M. et al. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care 1999; 22: 818-822.
  46. Haffner S. M., Gonzalez C., Miettinen H. et al. A prospective analysis of the HOMA model: the Mexico City Diabetes Study. Diabetes Care 1996; 19: 1138-1141.
  47. Facchini F., Ida Chen Y. D., Hollenbeck С. В., Reaven G. M. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance and plasma uric acid concentration. J. A. M. A. 1991; 266: 3008-3011.
  48. Muscelli E., Natali A., Bianchi S. et al. Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am. J. Hypertens. 1996; 9: 746-752.
  49. Ter Maaten J. C., Voorburg A., Heine R. J. et al. Renal handling during acute physiological hyperinsulinaemia in healthy subjects. Clin. Sci. 1997; 92: 51-58.

Statistics

Views

Abstract - 87

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2020 Barskova V.G., Eliseev M.S., Nasonov E.L., Yakunina I.A., Zilov A.V., Ilyinykh E.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies