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发表评论 类风湿关节炎合并高尿酸血症的临床和免疫学特点研究
- 作者: Mazurov V.I.1,2, Gaydukova I.Z.1,2, Fonturenko A.Y.1,2, Bashkinov R.A.1,2, Petrova M.S.1,2, Inamova O.V.1,2
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隶属关系:
- North-Western State Medical University nаmed after I.I. Mechnikov
- Clinical Rheumatology Hospital No 25
- 期: 卷 13, 编号 3 (2021)
- 页面: 43-52
- 栏目: Original research
- URL: https://journals.rcsi.science/vszgmu/article/view/80731
- DOI: https://doi.org/10.17816/mechnikov80731
- ID: 80731
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详细
论证。目前，无症状高尿酸血症对心血管疾病、代谢紊乱和慢性肾脏疾病的发展和进展的负面影响是众所周知的。但文献对高尿酸血症与类风湿关节炎合并病程的特点还不够全面。
本研究的目的是研究高尿酸血症与类风湿关节炎的临床实验室、免疫学、放射学和功能特征之间的关系。
材料与方法。2000年1月至2020年4月期间，对524名类风湿性关节炎患者的数据进行了分析，其中262名患者（主要组）被发现有高尿酸血症—血清尿酸水平超过360 mmol/L。其余262名患者为对比组。主要组被分为两个亚组，即低（<500 mmol/L）和高（≥500 mmol/L）高尿酸血症患者。该研究包括440名女性和84名男性，平均年龄为60±13.6岁。统计分析包括患者人口统计学（性别、年龄）、诊断、是否有高尿酸血症和持续时间、随访时间、类风湿性关节炎的活动和治疗，以及其实验室、免疫学、放射学和功能特点等信息。
结果。在高尿酸血症亚组的患者中，男性多于低尿酸血症亚组和对比组。每三分之一的患者在关节有显著的结构改变（III和IV影像学分期）。在98%的患者中，发现中度和明显的功能限制（功能II和III级）。 主要组的平均年龄最高。与没有高尿酸血症的患者相比，高尿酸血症患者看医生的次数更多，对类风湿关节炎的随访时间更长，放射学进展更少，关节疼痛和肿胀更严重，服用甲氨蝶呤的次数和剂量更少，服用柳氮磺胺吡啶的次数更多。
结论。高尿酸血症对类风湿关节炎的病程有负面影响。它与直接（更疼痛和肿胀的关节）和间接 （更长的观察时间和看医生的次数）症状有关。高尿酸血症与公认的活动标志物（红细胞沉降率、 C-反应蛋白水平、DAS28指数）和类风湿性关节炎的免疫学特征（类风湿因子，环瓜氨酸肽抗体阳性） 缺乏相关性，以及与它的放射学进展、功能性关节衰竭和骨密度下降速度之间的模糊关系，都是由免疫抑制疗法引起的。
作者简介
Vadim I.N. Mazurov
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN 代码: 6823-5482
MD, Dr. Sci. (Med.), Professor, Honoured Science Worker, Academician of the RAS
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgInna Z. Gaydukova
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
Email: ubp1976@list.ru
ORCID iD: 0000-0003-3500-7256
SPIN 代码: 3083-7996
MD, Dr. Sci. (Med.)
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgAleksandra Yu. Fonturenko
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
Email: aleksa.fonturenko@mail.ru
ORCID iD: 0000-0003-4860-0518
SPIN 代码: 5613-9035
врач-ревматолог, старший лаборант кафедры терапии ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи им. Э.Э. Эйхвальда
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgRoman A. Bashkinov
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
Email: bashkinov-roman@mail.ru
ORCID iD: 0000-0001-9344-1304
SPIN 代码: 5169-5066
очный аспирант 3 года обучения кафедры терапии ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи им. Э.Э. Эйхвальда, врач-ревматолог
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgMarianna Semenovna Petrova
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
Email: podagra@bk.ru
ORCID iD: 0000-0001-5261-6614
MD, Cand. Sci. (Med.)
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint PetersburgOksana V. Inamova
North-Western State Medical University nаmed after I.I. Mechnikov; Clinical Rheumatology Hospital No 25
编辑信件的主要联系方式.
Email: b25@zdrav.spb.ru
ORCID iD: 0000-0001-9126-3639
SPIN 代码: 8841-5496
главный врач, к.м.н., доцент кафедры терапии ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи им. Э.Э. Эйхвальда
俄罗斯联邦, 41 Kirochnaya St., Saint Petersburg, 191015; Saint Petersburg参考
- Lussier A de Medicis R, Marquis L, Menard H. Inhibition of adjuvant-induced arthritis in the hyperuricemic rat. Agents Actions. 1978;8(5):536–542. doi: 10.1007/BF02111442
- A Lussier de Medicis R, Tetreault L. Effect of a high serum uric acid diet and injections of urate crystals on adjuvant arthritis in the rat. Rev Rhum Mal Osteoartic. 1980;47(6):393–398. (In French)
- Chang YH, Bluestone RYH. Adjuvant polyarthritis. VI. Effect of oxonate-induced hyperuricemia on the development of acute inflammation, immune response and adjuvant arthritis. J Pharmacol Exp Ther. 1981;219(3):731–734.
- Turner RA, Pisko EJ, Agudelo CA, et al. Uric acid effects on in vitro models of rheumatoid inflammatory and autoimmune processes. Ann Rheum Dis. 1983;42(3):338–342. doi: 10.1136/ard.42.3.338
- Situnayake RD, Thurnham DI, Kootathep S, et al. Chain breaking antioxidant status in rheumatoid arthritis: clinical and laboratory correlates. Ann Rheum Dis. 1991;50(2):81–86. doi: 10.1136/ard.50.2.81
- Agudelo CA, Turner RA, Panetti M, Pisko E. Does hyperuricemia protect from rheumatoid inflammation? A clinical study. Arthritis Rheum. 1984;27(4):443–448. doi: 10.1002/art.1780270412
- Pekhlivanov D, Khadzhiev SN. Correlation between blood levels of uric acid and calcium in rheumatoid arthritis and deforming polyosteoarthrosis. Revmatologiia (Mosk). 1989;(2):12–15.
- Mahajan M, Kaur S, Mahajan S, Kant R. Uric acid a better scavenger of free radicals than vitamin C in rheumatoid arthritis. Indian J Clin Biochem. 2009;24(2):205–207. doi: 10.1007/s12291-009-0038-6
- Wang R, Huang W, Liang X. Involvement of mitogen-activated protein kinases and peroxisome proliferator-activated receptor γ in monosodium urate crystal-induced vascular cell adhesion molecule 1 expression in human rheumatoid arthritis synovial fibroblasts. Int J Mol Med. 2012;29(5):877–882. doi: 10.3892/ijmm.2012.925
- Di Giovine FS, Malawista SE, Thornton E, Duff GW. Urate crystals stimulate production of tumor necrosis factor alpha from human blood monocytes and synovial cells. Cytokine mRNA and protein kinetics, and cellular distribution. J Clin Invest. 1991;87(4):1375–1381. doi: 10.1172/JCI115142
- Magnus JH, Shankar A, Broussard DL. Self-report of depressive symptoms in African American and white women in primary care. J Natl Med Assoc. 2010;102(5):389–395. doi: 10.1016/s0027-9684(15)30573-3
- Mohammed Ali DM, Al-Fadhel SZ, Al-Ghuraibawi NHA, Al-Hakeim HK. Serum chemerin and visfatin levels and their ratio as possible diagnostic parameters of rheumatoid arthritis. Reumatologia. 2020;58(2):67–75. doi: 10.5114/reum.2020.95359
- Chiou A, England BR, Sayles H, et al. Coexistent hyperuricemia and gout in rheumatoid arthritis: associations with comorbidities, disease activity, and mortality. Arthritis Care Res (Hoboken). 2020;72(7):950–958. doi: 10.1002/acr.23926
- Weaver WF, Smyth CJ. Serum urate in degenerative joint disease and rheumatoid arthritis. Arthritis Rheum. 1963;6:372–376. doi: 10.1002/art.1780060408
- Lambert JR, Wright V. Serum uric acid levels in psoriatic arthritis. Ann Rheum Dis. 1977;36(3):264–267. doi: 10.1136/ard.36.3.264
- Ren J, Zhou Y, Wu H, et al. Value of dual-energy computed tomography in the diagnosis of gouty arthritis. Nan Fang Yi Ke Da Xue Xue Bao. 2015;35(3):384–386. (In Chinese)
- Petsch C, Araujo EG, Englbrecht M, et al. Prevalence of monosodium urate deposits in a population of rheumatoid arthritis patients with hyperuricemia. Semin Arthritis Rheum. 2016;45(6):663–668. doi: 10.1016/j.semarthrit.2015.11.014
- Mazurov VI, Bashkirov RA, Fonturenko AYu, et al. Features of the course of rheumatoid arthritis and osteoarthritis in patients with asymptomatic hyperuricemia. Herald of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):63–72. (In Russ). doi: 10.17816/mechnikov44234
- Luczak A, Knevel R, Huizinga TW, et al. No impact of serum uric acid on the outcome of recent-onset arthritis. Ann Rheum Dis. 2012;71(8):1424–1425. doi: 10.1136/annrheumdis-2011-201027
- Hu Z, Xu S, Lin H, et al. Prevalence and risk factors for bone loss in Southern Chinese with rheumatic diseases. BMC Musculoskelet Disord. 2020;21(1):416. doi: 10.1186/s12891-020-03403-1
- Lee HN, Kim A, Kim Y, et al. Higher serum uric acid levels are associated with reduced risk of hip osteoporosis in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore). 2020;99(24):e20633. doi: 10.1097/MD.0000000000020633
- Perez-Ruiz F, Nolla JM, et al. Influence of leflunomide on renal handling of urate and phosphate in patients with rheumatoid arthritis. J Clin Rheumatol. 2003;9(4):215–218. doi: 10.1097/01.rhu.0000081470.31167.8b
- Costa NT, Scavuzzi BM, Iriyoda TMV, et al. Metabolic syndrome and the decreased levels of uric acid by leflunomide favor redox imbalance in patients with rheumatoid arthritis. Clin Exp Med. 2018;18(3):363–372. doi: 10.1007/s10238-018-0500-y
- Choe JY, Kim SK. Association between serum uric acid and inflammation in rheumatoid arthritis: perspective on lowering serum uric acid of leflunomide. Clin Chim Acta. 2015;438:29–34. doi: 10.1016/j.cca.2014.07.039
- Gosselt HR, Muller IB, Jansen G, et al. Identification of metabolic biomarkers in relation to methotrexate response in early rheumatoid arthritis. J Pers Med. 2020;10(4):271. doi: 10.3390/jpm10040271
- Smoleńska Z, Kaznowska Z, Zarówny D, et al. Effect of methotrexate on blood purine and pyrimidine levels in patients with rheumatoid arthritis. Rheumatology (Oxford). 1999;38(10):997–1002. doi: 10.1093/rheumatology/38.10.997
- Lee J.J., Bykerk VP, Dresser GK, et al. Reduction in serum uric acid may be related to methotrexate efficacy in early rheumatoid arthritis: data from the Canadian Early Arthritis Cohort (CATCH). Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:37–43. doi: 10.4137/CMAMD.S38092
- Bilecik NA, Tuna S, Samancı N, et al. Prevalence of metabolic syndrome in women with rheumatoid arthritis and effective factors. Int J Clin Exp Med. 2014;7(8):2258–2265.
- Chen Z, Tu S, Hu Y, et al. Prediction of response of collagen-induced arthritis rats to methotrexate: an (1)H-NMR-based urine metabolomic analysis. J Huazhong Univ Sci Technolog Med Sci. 2012;32(3):438–443. doi: 10.1007/s11596-012-0076-9
- Araiza-Casillas R, Díaz-Molina R, González-Ortiz M, Robinson-Navarro OM. Effects of hydroxychloroquine on insulin sensitivity and lipid profile in patients with rheumatoid arthritis. Rev Med Chil. 2013;141(8):1019–1025. (In Spanish). doi: 10.4067/S0034-98872013000800008
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