Rheumatoid arthritis and hyperuricemia: consequences of coexistence

Hyperuricemia (HU) and gout are metabolic conditions associated with an elevated risk of developing renal, cardiovascular, and metabolic comorbidities and complications. Recent findings show that both HU and gout are more prevalent in patients with rheumatoid arthritis (RA) than previously thought and may have important long-term implications for both RA and overall health. However, in daily clinical practice, the potential impact of HU and/or gout on RA activity and therapy, especially in the context of multiple comorbidities remains insufficiently explored.

Objective: to evaluate in real-world clinical practice the impact of gout/HU on the activity and severity of RA, the specifics of its pharmacotherapy, and the profile of metabolic disorders and comorbidities in patients with active RA and coexisting HU.

Material and methods. Data were analyzed from 1091 patients with confirmed RA for whom the prescription or switch to a biologic disease-modifying antirheumatic drug (bDMARD) or targeted synthetic DMARD (tsDMARD) was approved due to previous treatment failure. Patients were divided into two age- and disease-duration-matched groups based on the presence or absence of HU. Clinical and laboratory markers of RA activity, prevalence of extra-articular manifestations, severity and progression of RA, pharmacotherapy characteristics, comorbidities, metabolic syndrome (MetS) variants, and overall multimorbidity (CIRS index) were assessed.  

Results and discussion. Among patients with active RA, 15.6% had HU and 5.2% had gout. The mean serum uric acid concentration was 434.1±34.3 μmol/L (p<0.0001). Uric acid-lowering therapy was administered to 7.8% of patients. RA patients with and without HU were comparable in age, disease duration, RA activity and severity, rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity, and preva-> < 0.0001). Uric acid-lowering therapy was administered to 7.8% of patients. RA patients with and without HU were comparable in age, disease duration, RA activity and severity, rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity, and prevalence of extra-articular RA manifestations. Medication history was also similar in both groups, including the number/duration of use and the range of NSAIDs, glucocorticoids, conventional DMARDs, and bDMARDs/tsDMARDs used. However, patients with RA and HU more frequently had arterial hypertension, chronic kidney disease (CKD), obesity, and MetS, which significantly increased their multimorbidity burden. They were also more likely to use diuretics. Cardiovascular disease prevalence did not differ significantly between the groups.

Conclusion. The findings underscore the potential clinical importance of identifying and managing HU in RA patients, considering its strong association with comorbidities such as hypertension, CKD, MetS, and obesity.

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