Cardiovascular
Asymptomatic Hyperuricemia and Serum Uric Acid Concentration Correlate with Subclinical Atherosclerosis in Psoriatic Arthritis Patients Without Clinically Evident Cardiovascular Disease1

https://doi.org/10.1016/j.semarthrit.2008.06.001Get rights and content

Objective

To establish whether serum uric acid concentration correlates with carotid intima-media wall thickness (IMT) in a cohort of psoriatic arthritis (PsA) patients without overt cardiovascular (CV) disease or classic CV risk factors who attended a community hospital.

Methods

A series of 52 PsA patients were assessed by carotid ultrasonography. Carotid IMT and carotid plaques were measured in the right common carotid artery. A correlation between serum uric acid concentration and carotid IMT was assessed and receiver operating characteristic curves to evaluate the ability of serum uric acid to predict carotid IMT > 0.90 mm and carotid plaques were performed.

Results

PsA patients with hyperuricemia (n = 6 [11.5%]) had greater carotid IMT (mean ± standard deviation: 0.89 ± 0.20 mm) than those without hyperuricemia (n = 46 [89%]; 0.67 ± 0.16 mm) (P = 0.01). Patients with carotid IMT < 0.60 mm had lower mean serum uric acid levels (4.7 ± 1.2 mg/dL) than those with greater carotid IMT (5.3 ± 1.7 mg/dL for patients with carotid IMT 0.76-0.90 mm and 6.4 ± 1.3 mg/dL for those with carotid IMT > 0.90 mm; P for trend = 0.02). A significant correlation between carotid IMT and serum uric acid concentration was observed (r = 0.337; P = 0.01). High serum uric acid levels were associated with an increased risk of having carotid IMT > 0.90 mm (Odds ratio = 2.66 [95% confidence interval: 1.08-6.53], P = 0.03, area under receiver operating characteristic curve: 0.80) or with the presence of carotid plaques (Odds ratio = 1.85 [95%; confidence interval: 1.01-3.38], P = 0.05, area under receiver operating characteristic curve: 0.72).

Conclusions

In PsA patients without clinically evident CV disease there is a correlation between serum uric acid concentration and subclinical atherosclerosis.

Section snippets

Patients

A cohort of 52 PsA patients who fulfilled the Moll and Wright criteria (15) without traditional CV risk factors or clinically evident CV disease, followed at the outpatient rheumatology clinic of the Hospital Xeral-Calde, Lugo, Spain, was studied.

These patients formed part of an ongoing study on CV disease in PsA (5, 6, 16). Briefly, from the time of diagnosis of PsA, all patients included in this study were actively treated with nonsteroidal anti-inflammatory drugs (indomethacin 100 mg/d,

Results

The mean serum uric acid level in our 52 PsA patients was 4.9 ± 1.4 mg/dL (median: 4.7 mg/dL; range: 2.2-7.7; interquartile range: 4.0-6.0). Six (11.5%) of the 52 patients fulfilled the definition of HU and all were men. None of the patients included in this series had a history of gout.

The main differences between PsA patients with and without HU are shown in Table 1. Although no significant differences in the age at the onset of PsA or in the duration of the disease were observed, patients

Discussion

In this study we report, for first time, a significant correlation between serum uric acid concentration and subclinical atherosclerosis in PsA patients without clinically evident CV or classic CV risk factors. The distribution of PsA patients into 4 quartiles according to the carotid artery IMT yielded statistically significant differences in the mean serum uric acid levels of these patients; patients with carotid IMT values > 0.90 mm had significantly higher serum uric acid levels than those

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    Drs. Gonzalez-Gay, Gonzalez-Juanatey, and Llorca contributed equally to this study.

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