PATHOGENETIC AND CLINICAL FEATURES OF COMORBID CONDITIONS IN GOUT
Keywords:
Drug therapy, gout, hyperuricemia, metabolic diseases, uric acid.Abstract
Gout is the most common inflammatory arthritis worldwide and represents a growing global health problem. It develops as a result of hyperuricemia caused by impaired purine metabolism, leading to the deposition of monosodium urate (MSU) crystals and recurrent inflammatory arthritis. Although hyperuricemia is the primary risk factor, genetic predisposition, impaired urate transport, and emerging factors such as the gut microbiota also contribute to disease development. Acute flares are mediated by activation of the NLRP3 inflammasome induced by MSU crystals and the subsequent production of interleukin-1β, whereas chronic inflammation leads to the formation of tophi and structural joint damage. Gout is closely associated with metabolic syndrome, chronic kidney disease, and cardiovascular diseases, which contribute to persistently elevated mortality. Although advances in imaging and pharmacological therapy have improved diagnosis and management, the real-world application of urate-lowering therapy remains suboptimal. Further research and continuous efforts by healthcare professionals are needed to improve long-term disease control.
References
1. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020;16:380–90.
2. Zhang S, Wang Y, Cheng J, Huangfu N, Zhao R, Xu Z, et al. Hyperuricemia and cardiovascular disease. Curr Pharm Des 2019;25:700–9.
3. McCormick N, Lin K, Yokose C, Lu N, Zhang Y, Choi HK. Unclosing premature mortality gap among patients with gout in the US general population, independent of serum urate and atherosclerotic cardiovascular risk factors. Arthritis Care Res (Hoboken) 2024;76:691–702.
4. Singh JA, Gaffo A. Gout epidemiology and comorbidities. Semin Arthritis Rheum 2020;50:S11–6.
5. Pillinger MH, Goldfarb DS, Keenan RT. Gout and its comorbidities. Bull NYU Hosp Jt Dis 2010;68:199–203.
6. Du L, Zong Y, Li H, Wang Q, Xie L, Yang B, et al. Hyperuricemia and its related diseases: mechanisms and advances in therapy. Signal Transduct Target Ther 2024;9:212.
7. Punjwani S, Jani C, Liu W, Kakoullis L, Salciccioli I, Al Omari O, et al. Burden of gout among different WHO regions, 1990-2019: estimates from the global burden of disease study. Sci Rep 2024;14:15953.
8. Yokose C, McCormick N, Lu N, Tanikella S, Lin K, Joshi AD, et al. Trends in prevalence of gout among US Asian adults, 2011-2018. JAMA Netw Open 2023;6:e239501.
9. Ahn JK. Epidemiology and treatment-related concerns of gout and hyperuricemia in Korean. J Rheum Dis 2023;30:88–98.
10. Health Insurance Review & Assessment Service. Medical care expenditure statistical indicators for the first half of 2023 [Internet]. Health Insurance Review & Assessment Service.
