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Abstract Number: 1270

Lack of Association of Comorbidities with Ultrasonographic Urate Deposition in Asymptomatic Hyperuricemia

Sharon Dowell1, Gail S. Kerr2, Alvin F. Wells3, Richard Haddad4, Paul DeMarco5, Joyce Joseph6, Mercedes Quinones7, Shelby Hochberg8, Jennifer Ude9, Jim Huang10 and David Nashel6, 1Division of Rheumatology, Howard University, Washington, DC, 2Rheumatology, Washington DC VAMC and Georgetown and Howard University, Washington, DC, 3Rheumatology and Immunotherapy Center, Franklin, WI, 4The Hospital for Special Surgery, New York, New York, NY, 5Georgetown University School of Medicine, Washington, DC, 6Internal Medicine, Division of Rheumatology, Washington DC VA Medical Center, Washington, DC, 7Internal Medicine, Division of Rheumatology, Washington DC VA Medical Center and Howard University, Washington, DC, 8Washington DC VA Medical Center and Howard University, Washinton, DC, 9Washington DC VA Medical Center and Howard University, Washington, DC, 10Medstar Health Research Institute, Hyattsville, MD

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Comorbidity, hyperuricemia, ultrasound and uric acid

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Session Information

Date: Monday, October 22, 2018

Session 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.

Table 1. Cohort Clinical Characteristics and sUA status

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

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

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

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

Diuretic

45(48.9%)

7(29.2%)

38(55.9%)

0.03

12(37.5%)

26(72.2%)

<.01

Table 2. Multivariate Logistic Regression Results of US Findings on Potential Predictors

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


Disclosure: S. Dowell, Horizon Pharma, 8,Genetech, 2; G. S. Kerr, Novartis, 2; A. F. Wells, None; R. Haddad, None; P. DeMarco, None; J. Joseph, None; M. Quinones, None; S. Hochberg, None; J. Ude, None; J. Huang, None; D. Nashel, None.

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 February 3, 2023.
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