Open Access Rheumatology: Research and Reviews (Oct 2021)
Hyperuricemia Among Egyptian Rheumatoid Arthritis Patients. Is It an Association or an Inflammatory Marker? A Cross-Sectional Observational Study
Abstract
Doaa Nada,1 Rasha Gaber,2 Al Shymaa Mahmoud,3 Radwa Elkhouly,1 Doaa Alashkar1 1Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt; 2Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt; 3Radiology Departments, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, EgyptCorrespondence: Doaa NadaRheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Geish Street, Tanta, Al Gharbeia Governorate, EgyptTel +201069579672Fax +23286114040Email [email protected]: To detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients.Methods: A total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints.Results: SUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level.Conclusion: Elevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.Keywords: rheumatoid arthritis, uric acid, inflammatory marker, hyperuricemia
