Gout in the course of systemic lupus erythematosus: Literature review and case study report
Abstract
Gout is one of the relatively common inflammatory diseases of the joints. It is caused by the deposition of uric acid crystals in the tissues, which induces an acute or chronic inflammatory process. Elevated serum uric acid levels are usually found long before symptoms appear, and it is worth emphasizing that not every hyperuricemic patient will ever develop gout symptoms. The onset of gout is characterized by periodic joint inflammation, which may be triggered by various stress factors (trauma, infection), certain medications, dietary mistakes, and excessive exercise. Over time, repeated joint inflammation causes permanent joint damage. Most often, deposits of urate crystals are located in places with poorer blood supply and exposed to increased pressure, such as joints and soft tissues (e.g., auricles). The coexistence of gout and autoimmune diseases is relatively rare. While for many years it was believed that gout was not associated with other systemic connective tissue diseases, gout has been described in the course of systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. The presented systematic review also describes a case of a patient with longlasting systemic lupus erythematosus who was diagnosed with gout.
Keywords: goutsystemic lupus erythematosusdiagnosistreatment
References
- Jin M, Yang F, Yang I, et al. Uric acid, hyperuricemia and vascular diseases. Front Biosci (Landmark Ed). 2012; 17(2): 656–669.
- Majdan M. Dna moczanowa. PZWL, Warszawa 2019.
- Shi Y, Evans JE, Rock KL. Molecular identification of a danger signal that alerts the immune system to dying cells. Nature. 2003; 425(6957): 516–521.
- Barabé F, Gilbert C, Liao N, et al. Crystal-induced neutrophil activation VI. Involvment of FcgammaRIIIB (CD16) and CD11b in response to inflammatory microcrystals. FASEB J. 1998; 12(2): 209–220.
- Liu-Bryan Ru, Scott P, Sydlaske A, et al. Innate immunity conferred by Toll-like receptors 2 and 4 and myeloid differentiation factor 88 expression is pivotal to monosodium urate monohydrate crystal-induced inflammation. Arthritis Rheum. 2005; 52(9): 2936–2946.
- Dinarello CA. Blocking interleukin-1β in acute and chronic autoinflammatory diseases. J Intern Med. 2011; 269(1): 16–28.
- Madej M, Morgiel E, Łuczak A, et al. Coexistence of systemic sclerosis and gout? Hyperuricemia in systemic sclerosis: case report and literature review [article in Polish]. Ann Acad Med Stetin. 2012; 58(1): 28–32.
- Simpson CE, Damico RL, Hummers L, et al. Serum uric acid as a marker of disease risk, severity, and survival in systemic sclerosis-related pulmonary arterial hypertension. Pulm Circ. 2019; 9(3): 2045894019859477.
- Huang CM. Gouty arthritis in a female patient with mixed connective tissue disease. Clin Rheumatol. 2000; 19(1): 67–69.
- Ho HH, Lin JL, Wu YJJ, et al. Gout in systemic lupus erythematosus and overlap syndrome - a hospital-based study. Clin Rheumatol. 2003; 22(4–5): 295–298.
- Singh JA, Cleveland JD. The risk of Sjogren's syndrome in the older adults with gout: A medicare claims study. Joint Bone Spine. 2019; 86(5): 615–619.
- Olaru L, Soong L, Dhillon S, et al. Coexistent rheumatoid arthritis and gout: a case series and review of the literature. Clin Rheumatol. 2017; 36(12): 2835–2838.
- Chiou A, England BR, Sayles H, et al. Coexistent hyperuricemia and gout in rheumatoid arthritis: associations with comorbidities, disease activity, and mortality. Arthritis Care Res (Hoboken). 2020; 72(7): 950–958.
- Zhao G, Wang X, Fu P. Recognition of gout in rheumatoid arthritis: A case report. Medicine (Baltimore). 2018; 97(50): e13540.
- Turan Y, Kocaağ Z, Korhan B, et al. Coexistence of psoriatic spondyloarthropathy and gout: a case report. Archives of Rheumatology. 2009; 24(3): 159–162.
- Gonen T, Tiosano S, Comaneshter D, et al. The coexistence of gout in ankylosing spondylitis patients: a case control study. Rheumatol Int. 2020; 40(3): 465–470.
- Bajaj S, Fessler BJ, Alarcón GS. Systemic lupus erythematosus and gouty arthritis: an uncommon association. Rheumatology (Oxford). 2004; 43(3): 349–352.
- Yang Z, Liang Y, Xi W, et al. Association of serum uric acid with lupus nephritis in systemic lupus erythematosus. Rheumatol Int. 2011; 31(6): 743–748.
- Elera-Fitzcarrald C, Reátegui-Sokolova C, Gamboa-Cardenas RV, et al. Serum uric acid is associated with damage in patients with systemic lupus erythematosus. Lupus Sci Med. 2020; 7(1): e000366.
- Senthelal S, Li J, Goyal A, et al. Arthritis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022.
