A recent study published in BMJ Open has linked asymptomatic hyperuricemia (AH) to a higher risk of arthritis, particularly osteoarthritis (OA), with potential susceptibility in older and female populations.
The cross-sectional study conducted by Liang and colleagues analyzed data from the 2007-2018 National Health and Nutrition Examination Survey, including adult US civilians aged 20 years and above. The study focused on individuals with and without hyperuricemia prior to gout, revealing a connection between AH and the onset of arthritis, with an odds ratio (OR) of 1.34 and a 95% confidence interval of 1.07 to 1.69. However, this association was attenuated after adjusting for demographic and socioeconomic variables. Among the participants aged 40-49 years, AH was significantly associated with the development of arthritis, with an OR of 1.96 and a 95% confidence interval of 1.23 to 2.99. This relationship persisted even after controlling for factors such as education level, income to poverty ratio, body mass index, diabetes, hypertension, and smoking, with an OR of 2.00 and a 95% confidence interval of 1.94 to 3.36. Furthermore, the study highlighted a gender disparity, indicating that female participants with AH were more prone to developing arthritis, particularly OA (with an OR of 1.35 and a 95% confidence interval of 1.14 to 1.60), compared to their male counterparts.
Both hyperuricemia and OA share common risk factors such as obesity and aging. This mutual association between risk factors implies a potential link between hyperuricemia and OA, where intra-articular urate may contribute to crystallization and cartilage disruption within the context of these shared risk factors. The joint preference observed in both OA and gout strongly suggests that OA might predispose to localized deposition of monosodium urate crystals, thereby influencing structural joint damage. Monosodium urate crystals have been found to impede osteocyte viability and, by interacting with macrophages, indirectly stimulate a shift in osteocyte function that favors bone resorption and inflammation. Uric acid serves as a danger signal, indicating an elevated risk of OA through the activation of inflammasomes.
The findings of the present study indicate that patients with AH could benefit significantly from vigilant monitoring for the onset of arthritis. Understanding the intricate relationship between hyperuricemia and arthritis, along with identifying the contributing factors to their elevated risk, holds paramount importance. These insights may ontribute to the development of prevention and management strategies for these conditions, thereby improving patient care and outcomes.
Reference
Liang Z, Wu D, Zhang H, Gu J. Association between asymptomatic hyperuricemia and risk of arthritis, findings from a US National Survey 2007–2018. BMJ Open. 2024 Feb 1;14(2):e074391.