Comorbidities in gout and hyperuricemia: causality or epiphenomena?

Abstract:

PURPOSE OF REVIEW:To review advances in the understanding of potentially causal relationships between gout, hyperuricemia and comorbidities. RECENT FINDINGS:Observational studies reveal 4-5 comorbidity clusters in gout patients. There tend to be gout alone, gout with chronic kidney disease and gout with other metabolic comorbidities. However, heterogeneous study populations and confounding make inference difficult for causal relationships. Mendelian randomization leverages genetic information as an instrumental variable to indicate putatively causal relationships between traits of epidemiological interest. Thus far, Mendelian randomization has not indicated widespread causal relationships of serum urate for comorbid traits. However, BMI has a small causal effect on serum urate, which may partially explain the increased prevalence of metabolic syndrome and cardiovascular disease among those with gout and hyperuricemia. There is a lack of robust and sufficiently powered Mendelian randomization studies for many serum urate-associated traits, such as hypertension. No adequately powered studies have been completed for gout and its comorbidities. SUMMARY:Although observational studies indicate putative causal effects of serum urate on comorbidities, Mendelian randomization studies suggest that serum urate does not have a causal role on the various tested comorbidities. There remains work to be done in clarifying the causal role of gout per se on the same traits.

journal_name

Curr Opin Rheumatol

authors

Sumpter NA,Saag KG,Reynolds RJ,Merriman TR

doi

10.1097/BOR.0000000000000691

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

126-133

issue

2

eissn

1040-8711

issn

1531-6963

pii

00002281-202003000-00003

journal_volume

32

pub_type

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