Aggressive Urate Lowering Needed for Gout

In gout, the uric acid crystals activate complement by the alternative pathway, but also by the classical pathway through the accumulation of immunoglobulin. The crystals interact with macrophages, produce cytokine interleukin-1, and then generate other cytokines.

Dr. Pillinger said that uric acid has multiple and complex effects on cells, depending on their concentration and whether they are soluble or crystalline. Some effects have apparently been—and perhaps still are—evolutionarily advantageous. “Understanding uric acid biology may permit more rational targeting of future antiinflammatory and antihyperuricemic agents,” Dr. Pillinger concluded.

Kathy Holliman is a medical journalist based in New Jersey.

References

1. Becker MA, MacDonald P, Chefo S, Jackson RL. Baseline characteristics of gout subjects influence orate-lowering efficacy during febuxostat and allopurinol treatment. #704. Presented at the ACR Annual Scientific Meeting. Oct. 19, 2009. Philadelphia.
2. Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62:1060-1068.
3. Choi HK, Ford ES, Li C, Curhan G. Prevalence of the metabolic syndrome in patients with gout: The Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007:57:109-115.
4. Vazquez-Mellado J, Garcia CG, Vazquez SG, et al. Metabolic syndrome and ischemic heart disease in gout. J Clin Rheumatol. 2004;10:105-109.
5. Rho YH, Choi SJ, Lee YH, et al. The prevalence of metabolic syndrome in patients with gout: A multicenter study. J Korean Med Sci. 2005;20:1029-1033.
6. DeVera M, Rahman MM, Bhole V, et al. The independent impact of gout on risk for coronary heart disease among elderly women: A population-based study. #1509. Presented at the ACR Annual Scientific Meeting. Oct. 20, 2009. Philadelphia.