Gout, Hyperuricemia and Psoriatic Arthritis: An Evolving Conundrum.

IF 5.7 2区 医学 Q1 RHEUMATOLOGY
Priyanka Chandratre, Ricardo Sabido-Sauri, Sizheng Steven Zhao, Abhishek Abhishek
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Abstract

Purpose of review: The co-existence of gout and psoriatic disease (PD) is long standing but more recently frequently encountered in clinical settings due to increased awareness of their shared comorbidities and clinical phenotypes, often posing diagnostic and management challenges. Here we review the overlap in gout and PD focusing on shared clinical features, common inflammatory pathophysiology and comorbidities which may prompt a diagnosis of 'Psout' and lead to changes in management.

Recent findings: Several epidemiological studies have highlighted the increased incidence of hyperuricemia and gout in those with PD and vice versa. Although the role of monosodium urate (MSU) crystals is well recognized in activation of innate immunity via inflammasome and NETosis, it is likely that they have a role in triggering adaptive immunity via antigen presenting cells and their autocrine effect on keratinocytes in psoriasis (PSO), ultimately leading to T cell secretion of proinflammatory cytokines such as IL17. Hyperuricemia (HU) is common in PD (up to 30%) and underpins metabolic syndrome comorbidities that are common to both gout and PD. Shared clinical phenotypes and co-morbidities are routinely observed in clinical practice yet there is a paucity of evidence evaluating the effect of treating hyperuricemia/gout on PD activity, with small scale clinical trials showing a positive effect. There were no studies to our knowledge assessing gout disease activity with concurrent treatment of PD. The association between gout and PD is likely due to shared multimorbidity and perhaps to a smaller extent, the direct role of HU in triggering the release of proinflammatory cytokines in PD. There is often a significant overlap in clinical and radiological presentation of gout and Psoriatic arthritis (PsA). In those with atypical response to standard treatments of the primary condition (either gout or PsA), it would be plausible to investigate and treat for the other 'secondary' condition. This is particularly relevant and relatively feasible in those with PsA (and features of HU and multimorbidity) who respond poorly to standard immunomodulating treatments.

痛风,高尿酸血症和银屑病关节炎:一个不断发展的难题。
综述目的:痛风和银屑病(PD)的共存由来已久,但最近在临床环境中经常遇到,因为人们对它们共同的合并症和临床表型的认识不断提高,常常给诊断和管理带来挑战。在这里,我们回顾了痛风和PD的重叠,重点是共同的临床特征,共同的炎症病理生理和合并症,这些可能会提示“痛风”的诊断并导致治疗的改变。最近的发现:一些流行病学研究强调了PD患者高尿酸血症和痛风的发生率增加,反之亦然。尽管尿酸钠(MSU)晶体通过炎性体和NETosis激活先天免疫的作用已得到充分认识,但它们可能通过抗原提呈细胞及其对牛皮癣(PSO)角质形成细胞的自分泌作用触发适应性免疫,最终导致T细胞分泌促炎细胞因子,如il - 17。高尿酸血症(HU)在PD中很常见(高达30%),并且是痛风和PD常见的代谢综合征合并症的基础。临床实践中经常观察到共同的临床表型和合共病,但缺乏证据评估治疗高尿酸血症/痛风对PD活动的影响,小规模临床试验显示积极作用。据我们所知,没有研究评估痛风疾病活动性与同时治疗PD。痛风和PD之间的关联可能是由于共同的多病性,或许在较小程度上,HU在PD中触发促炎细胞因子释放的直接作用。痛风和银屑病关节炎(PsA)的临床和影像学表现往往有明显的重叠。对于原发疾病(痛风或PsA)的标准治疗反应不典型的患者,调查和治疗其他“继发”疾病是合理的。对于那些对标准免疫调节治疗反应不佳的PsA(以及HU和多病的特征)患者,这是特别相关和相对可行的。
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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
41
期刊介绍: This journal aims to review the most important, recently published research in the field of rheumatology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of rheumatologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas such as the many forms of arthritis, osteoporosis and metabolic bone disease, and systemic lupus erythematosus. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also occasionally provided.
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