Abstract
The rate of gout has increased in recent decades by more than a few times. Metabolic disorders, dyslipidemia, and other comorbidities are often diagnosed in such patients, and the liver is considered as a target organ of the metabolic syndrome while nonalcoholic fatty liver disease as its component.
The objective of the research was to investigate the peculiarities of the clinical course of gout depending on the presence of concomitant nonalcoholic fatty liver disease.
Materials and methods. 120 patients with primary gout were examined. The diagnosis of nonalcoholic fatty liver disease was confirmed by routine ultrasound examination and shear wave elastography as well. The group of examined patients consisted of men (100%) at the age of 24-78 years. Among them there were 12.6% of persons of juvenile age, 39.0% of persons of middle age, 11.0% of persons of elderly age, and 3.3% of persons of senile age. All patients were divided into two groups: persons without liver damage (43.3%) and those with nonalcoholic fatty liver disease (56.7%).
Results and discussions. It was determined that in nonalcoholic fatty liver disease the percentage of elderly (20.6%) and senile (8.8%) persons increased, the parameter of professional incapacitation was 1.7 times higher than that in patients without liver damage and was accompanied with more frequent gout attacks per year and more evident arthritis syndrome. Greater amount of painful and swollen joints was observed in patients with nonalcoholic fatty liver disease and the rate of multiple tophi was 3.5 times higher than the rate of single ones, however in patient without concomitant liver injury this parameter was only 1.4 times higher than that of single tophi. Moderate and severe course of gout in a combination with a greater level of uric acid in blood plasma predominated among patients with nonalcoholic fatty liver disease by 86.7%. Metabolic syndrome was observed 3.8 times more often, hypertension was 3.8 times more common, type 2 diabetes was 3.1 times more likely to develop, and osteoarthritis was detected 1.8 times often in this category of patients in comparison with the group of patients without concomitant liver damage indicating the importance of metabolic disorders in this cohort of patients.
Conclusions. More severe disease progression was observed in patients with gout secondary to nonalcoholic fatty liver disease, which was evident as significantly higher level of hyperuricemia that in turn indicated inadequate doses of hypouricemic drugs and non-achievement of clinical targets in patients due to greater amount of painful and swollen joints, more intensive polyarthritis syndrome and disease prolongation. Moreover, it should be noted that the percentage of comorbidities such as metabolic syndrome, arterial hypertension, diabetes mellitus, osteoarthritis was significantly higher in patients with gout and concomitant nonalcoholic fatty liver disease.
References
Kovalenko VM, Shuba NM. National textbook of rheumatology. MORION. Kyiv. 2013;510.
Povorozniuk VV, Dubetska HS. Hyperuricemia and metabolic syndrome. Bol. Sustavy. Pozvonochnik. 2011;1:
Prosolenko KO. Modern approaches to treatment of nonalcoholic fatty liver disease secondary to metabolic syndrome. Liky Ukraiiny. 2012;3-4:
Palii ІH, Zaika SV, Lifanov AV. Nonalcoholic fatty liver disease in the context of metabolic syndrome: diagnostics and treatment in clinical practice. Ukr. med. chasopys. 2012;VII/VIII:4(90):85-87.
Stepanov YuM, Fillipova OYu. Are steatosis and steatohepatitis triggers of liver fibrogenesis? Hastroenterolohiia. 2013;2(48):
Shuba NM. Hyperuricemia – a multimorbid pathology in rheumatology. Ukr. revmatol. zhurn. 2013;2(52):14-21.
Campbell-Scherer D. Multimorbidity: a chellenge for evidence — based medicine. Evid. Based Med. 2010;15(6):165-166.
Caughey GE, Roughead EE. Multimorbidity research challenges: where to go from here? Co-morbidity. 2011;1(8):10.
Inokuchi T. Increased frequency of metabolic syndrome and its individual metabolic abnormalities in Japanese patients with primary gout. J. Clin. Reumatol. 2010;16(3):109-112.
Speliotes EK, Massaro JM, Hoffmann U, et al. Fatty liver is associated with dyslipidemia and dysglycemia independent of visceral fat: the Framingham Heart Study. Hepatology. 2010;51(6):1979-1987.
Garcia-Ruiz C, Mari M, Colell A, et al. Metabolic therapy: lessons from liver diseases. Curr. Pharm. Des. 2011;17(35):393-344.
Neuschwander-Tetri BA. Hepatic lipotoxicity and the pathogenesis of nonalcoholic steatohepatitis: the central role of nontriglyceride fatty acid metabolites. Hepatology. 2010;52(774):788.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.