Session Information
Date: Monday, October 22, 2018
Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster I
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Hyperuricemia is common, and along with other comorbidities (CM), is increasing in prevalence. Though often asymptomatic, it is associated with subclinical urate deposition detectable by ultrasound (US) imaging. This study aims to evaluate the association of CM with urate deposition in individuals with aymptomatic hyperuricemia (ASU) via US.
Methods: ASU was defined as serum urate (sUA) >6mg/dl; sUA <6mg/dl served as controls. Demographic factors, CM – (hypertension [HTN], hyperlipidemia [HLD], diabetes mellitus [DM], cardiovascular disease [CVD], renal disease [CKD], metabolic composite [presence of any CM, BMI>30], osteoarthritis [OA]), diuretic use, and dietary data (alcohol [ETOH], red meat, seafood) were collected. US of joints (knee/ 1st MTP) and tendons (triceps, quadriceps/patella, Achilles) was performed via standard procedure, OMERACT parameters of urate deposition documented, and images read by an Expert ultrasonographer blinded to sUA and CM categories. Correlations between sUA levels and urate deposition with CM, medication and dietary risk factors were analyzed by multivariable logistic regression model.
Results: Of 95 predominantly Black patients (mean age 59.7 yrs, BMI ~ 32 kg/m2) ASU subjects (n=71, median sUA= 8.0 mg/dl) were older men, with more frequent HTN, CVD, CKD, and alcohol ingestion versus controls (Table 1). Presence of HTN, CVD, CKD and diuretic use were associated with higher sUA (>8 vs 6-7.9 mg/dl). In multivariate analyses adjusting for demographic and clinical characteristics, sUA>6mg/dl and advanced age were positively associated with joint urate deposition, (OR=5.23; 95%CI: 1.18-23.12, OR=1.06; 95%CI: 1.00-1.11, respectively) [Table 2]. There was however, no significant association between individual or composite CM and urate deposition at either joint or tendon, even when adjusting for sUA levels. Urate deposition at tendons was more frequent in men (OR=9.09; 95%CI: 1.08-76.68), but unrelated to sUA (p=0.23).
Conclusion: While ASU and age predict US urate deposition, the presence of comorbid conditions and diuretic use – though themselves associated with higher levels of sUA, do not. A larger cohort with other imaging modalities such as DECT, may provide additional information.
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Table 1. Cohort Clinical Characteristics and sUA status |
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|
Variable |
All Cohort (N=95) |
Control (n=24) |
ASU (SUA>6.0) (n=71) |
p-value
|
SUA: 6-7.9 (n=35) |
SUA>=8.0 (n=36) |
p-value |
|
|
Demographic Characteristic |
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|
Male |
68(71.6%) |
10(41.7%) |
58(81.7%) |
<.01 |
26(74.3%) |
32(88.9%) |
0.13 |
|
|
Age–mean(SD) |
59.7(10.9) |
54.9(14.2) |
61.4(9.1) |
0.05 |
59.3(10.0) |
63.5(7.7) |
0.06 |
|
|
Race –White –Black –Other/Unk |
10 (10.5%) 76(80.0%) 9 (9.5%) |
2(8.3%) 18(75.0%) 4(16.7%) |
8(11.3%) 58(81.7%) 5(7.0%) |
0.38 |
4(11.4%) 29(82.9%) 2(5.7%) |
4(11.1%) 29(80. 6%) 3(8.3%) |
>.99 |
|
|
BMI–mean(SD) |
31.9 (7.4) |
31.1(8.8) |
32.1(6.9) |
0.55 |
32.0(6.7) |
32.3(7.1) |
0.87 |
|
|
Co-morbidities |
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|
DM |
31 (32.6%) |
5(20.8%) |
26(36.6%) |
0.21 |
10(28.6%) |
16(44.4%) |
0.22 |
|
|
HTN |
58 (61.1%) |
10(41.7%) |
48(67.6%) |
0.03 |
17(48.6%) |
31(86.1%) |
<.01 |
|
|
HLD |
44 (46.3%) |
10(41.7%) |
34(47.9%) |
0.64 |
18(51.4%) |
16(44.4%) |
0.64 |
|
|
Cancer |
8 (8.4%) |
1(4.2%) |
7(9.9%) |
0.67 |
3(8.6%) |
4(11.1%) |
>.99 |
|
|
Renal |
22 (23.2%) |
2(8.3%) |
20(28.2%) |
0.05 |
2(5.7%) |
18(50.0%) |
<.01 |
|
|
OA |
45 (47.4%) |
16(66.7%) |
29(40.8%) |
0.03 |
15(42.9%) |
14(38.9%) |
0.81 |
|
|
CVD |
16(16.8%) |
0(0) |
16(22.5%) |
0.01 |
3(8.6%) |
13(36.1%) |
0.01 |
|
|
Dietary |
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|
Red meat>=3x/wk |
28 (30.1%) |
5(20.8%) |
23(33.3%) |
0.31 |
12(34.3%) |
11(32.4%) |
>.99 |
|
|
Seafood>=3x/wk |
21(22.6%) |
6(25.0%) |
15(21.7%) |
0.78 |
10(28.6%) |
5(14.7%) |
0.24 |
|
|
Alcohol(Current) |
43 (46.7%) |
8(34.8%) |
35(50.7%) |
0.23 |
19(54.3%) |
16(47.1%) |
0.63 |
|
|
Medication |
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|
Diuretic |
45(48.9%) |
7(29.2%) |
38(55.9%) |
0.03 |
12(37.5%) |
26(72.2%) |
<.01 |
|
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Table 2. Multivariate Logistic Regression Results of US Findings on Potential Predictors |
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|
Variable |
Any Deposition |
Joint Deposition |
Tendon Deposition |
|||
|
OR (95%CI) |
p-value |
OR (95%CI) |
p-value |
OR(95%CI) |
p-value |
|
|
ASU (sUA>6mg/dl) |
3.47(0.75-15.96) |
0.11 |
5.23(1.18-23.12) |
0.03 |
0.35(0.06-1.92) |
0.23 |
|
Age |
1.01(0.96-1.07) |
0.70 |
1.06(1.00- 1.11) |
0.05 |
0.94(0.88-1.00) |
0.06 |
|
Male |
1.51(0.38-5.99) |
0.56 |
0.74(0.19- 2.91) |
0.67 |
9.09(1.08-76.68) |
0.04 |
|
African American |
1.51(0.35-6.46) |
0.58 |
1.09(0.27-4.49) |
0.90 |
2.38(0.46-12.43) |
0.30 |
|
CKD |
0.31(0.08-1.19) |
0.09 |
0.37(0.10-1.36) |
0.13 |
0.73(0.16-3.39) |
0.69 |
|
CVD |
0.90(0.18-4.47) |
0.90 |
0.82(0.17-4.05) |
0.81 |
3.65(0.67-19.85) |
0.13 |
|
OA |
1.65(0.49-5.54) |
0.42 |
1.44(0.46-4.52) |
0.53 |
1.75(0.50-6.15) |
0.39 |
|
Metabolic composite |
0.13(0.01-1.61) |
0.11 |
0.16(0.02-1.35) |
0.09 |
0.52(0.09-3.05) |
0.46 |
|
ETOH+ Red meat + Seafood diet |
1.38(0.66-2.88) |
0.39 |
1.42(0.70-2.87) |
0.33 |
1.71(0.78-3.73) |
0.18 |
|
Diuretic medication |
0.99(0.27-3.58) |
0.98 |
1.24(0.36-4.29) |
0.73 |
2.42(0.54-10.84) |
0.25 |
To cite this abstract in AMA style:
Dowell S, Kerr GS, Wells AF, Haddad R, DeMarco P, Joseph J, Quinones M, Hochberg S, Ude J, Huang J, Nashel D. Lack of Association of Comorbidities with Ultrasonographic Urate Deposition in Asymptomatic Hyperuricemia [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lack-of-association-of-comorbidities-with-ultrasonographic-urate-deposition-in-asymptomatic-hyperuricemia/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/lack-of-association-of-comorbidities-with-ultrasonographic-urate-deposition-in-asymptomatic-hyperuricemia/