Gout and diabetes

Czech version

Authors: P. Bradna
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
Published in: Vnitř Lék 2006; 52(5): 488-492
Category: Diabetes and other subjects (infection, dermatovenerology and rheumatology) Hradec Králové 3 to 4 June 2005

Overview

Gout is the most frequent cause of acute arthritis in men over 40 years of age. In the recent years, gout incidence has been increasing in developed countries probably due to dietary changes, alcohol consumption, ageing of population and also application of high-risk medications. Hyperuricemia is one of the symptoms of hyperinsulinism and metabolic syndrome. The level of uricemia correlates with the degree of insulin resistance. Correlation of uric acid levels and the risk of coronary and cerebral accidents were reported both in diabetic and non-diabetic population. It has not been explained satisfactorily whether this is the direct result of hyperuricemia or concurrently present symptom of metabolic syndrome. The study describes symptomatology of clinical signs of gout and discusses about appropriate therapeutic approach in each stage of the disease. New therapeutic possibilities that are still in the stage of clinical studies are mentioned. Also, we focus on alternative dietary recommendations for hyperuricemia and gout patients. The reason of changes in dietary regime is the effort to alleviate the signs of metabolic syndrome. The study emphasises the practical significance of screening of metabolic syndrome signs during examination of gout patients so that appropriate targeted therapeutic intervention could be performed. On the contrary, increased risk of gout-induced movement disorders should be taken into account in patients with diagnosed insulin resistance.

Key words:
gout – metabolic syndrome – insulin resistance

Sources

1. Alderman M, Aiyer JV. Uric acid: Role in cardiovascular disease and effect of losartan. Curr med Res Opin 2004; 20: 369-379.

2. Bickel C, Rupprecht HJ, Blankenberg S et al. Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease. Am J Cardiol 2002; 89: 7-12.

3. Bo S, Cavallo-Perin P, Gentile L. Hypouricemia and hyperuricemia in type II diabetes: two different phenotypes. Eur J Clin Invest 2001; 31: 318-321.

4. Cohen MG, Emmerson BT. Gout. In: Klippel JH, Dieppe PA (eds). Rheumatology. New York: Mosby 1994.

5. Conen D, Wietlisbach V, Bovet P et al. Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health, 2004; 4: 1-9.

6. Culleton BF, Larson MG, Kannell WB et al. Serum uric acid and risk of cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999; 131: 7-13.

7. Dessein PH, Shipton AE, Stanwix AE et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportion intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000; 59: 539-543.

8. Emmerson B. Hyperlipidemia in hyperuricemia and gout. Ann Rheum Dis 1998; 57: 509-510.

9. Enomoto A, Kimura H, Chairoungdua A et al. Molecular identification of renal urate-anion exchanger that regulates blood urate levels. Nature 2002; 417: 447-452.

10. Fam AD. Gout: excess calories, purines and alcohol intake and beyond. Response to a urate-lowering diet. J Rheumatol 2005; 32: 773-777.

11. Fam AD. Gout, diet, and the insulin resistance syndrome. J Rheumatol 2002; 29: 1350-1355.

12. Hoieggen A, Alderman MH, Kjeldsen SE et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney International 2004; 65: 1041-1049.

13. Choi HK, Atkinson K, Karlson EW et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet 2004; 363: 1277-1281.

14. Lehto S, Niskanen L, Ronnemaa T et al. Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke 1998; 29: 635-639.

15. Lin, KC, Tsao HM, Chen CH et al. Hypertension was the major risk factor leading to development of cardiovascular diseases among men with hyperuricemia. J Rheumatol 2004; 31: 1152-1158.

16. Maesaka JK, Fishbane S. Regulation of renal urate excretion: a critical rewiew. Amer J Kidney Dis 1998; 32: 917-933.

17. Mc Gill NW. Gout and other crystal-associated arthropaties. Ballieres Clin Rhematol 2000; 14: 445-460.

18. Mikuls TR, Farrar JT, Bilker WB et al. Gout epidemiology: results from the UK general practice reasearch database, 1990 - 1999. Ann Rheum Dis 2005; 64: 267-272.

19. Niskanen LK, Laaksonen DE, Nyyssonen K et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective study. Arch Intern Med 2004; 164: 1546-1551.

20. Puig JR, Ruilope LM. Uric acid as a cardiovascular risk factor in arterial hypertension. J Hypertens 1999; 17: 869-872.

21. Rathmann W, Funkhouser E, Dyer AR et al. Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Ann Epidemiol 1998; 8: 250-261.

22. Sharpe CR. A case-control study of alcohol consumption and drinking behaviour in patients with acute gout. Can Med Assoc J 1984; 131: 563-567.

23. Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacs of gouty arthritis: Evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51: 321-325.

24. Tseng CH. Independent association of uric acid levels with peripheral arterial disease in Taiwanese patients with type 2 diabetes. Diabet Med 2004; 21: 724-729.

25. Vandenberg, MK, Moxley G, Breitbach SA et al. Gout attacs in chronic alcoholics occur at lower serum urate levels than in nonalcoholics. J Rheumatol 1994; 21: 700-704.

26. Wallace, KL, Riedel AA, Joseph-Ridge N. Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population J Rheumat 2004; 31: 1582-1587.

27. Wortmann RL. Recent advances in the management of gout and hyperuricemia. Curr Opin Rheumatol 2005; 17: 319-324.