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Gout and Its Comorbidities (Report)

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eBook details

  • Title: Gout and Its Comorbidities (Report)
  • Author : Bulletin of the NYU Hospital for Joint Diseases
  • Release Date : January 01, 2010
  • Genre: Health & Fitness,Books,Health, Mind & Body,
  • Pages : * pages
  • Size : 195 KB

Description

Gout is a chronic multisystem disease in which metabolic and excretory abnormalities, often compounded by excessive purine intake, result in hyperuricemia. In turn, hyperuricemia promotes the formation of monosodium urate crystals that induce inflammation (acute gouty arthritis) or deposit in tissues (tophaceous gout), or both. The complexity of gout is often underestimated, and recent studies suggest that the quality of gout care in the United States is frequently inadequate. (1) One aspect of gout's complexity is that patients with hyperuricemia or gout, or both, often experience high rates of comorbidities, raising management challenges. (1,2) In a recent pilot survey of more than 500 patients with gout at our own VA hospital, we observed that the average gout patient endures approximately four comorbidities, and that as many as 5% to 10% of gout patients have seven or more comorbid conditions (MHP, DSG, RTK, unpublished observations). Indeed, the most common comorbidity seen in our cohort, hypertension, was present in more than three-quarters of our patients. In considering the role of particular comorbidities in patients with gout, it is worth asking whether hyperuricemia and gout, or either, are a consequence of the comorbidity or a cause of the comorbidity, or whether the patient's hyperuricemia-gout and their comorbidity derive from a common antecedent. In many cases, there is clear evidence that gout may be a consequence of a comorbidity. For example, gout occurs frequently in patients with chronic kidney disease, where the loss of glomerular filtration promotes hyperuricemia. In other cases, a common antecedent appears to connect the presence of gout with a particular comorbidity. For example, to the extent that hyperuricemia and cardiovascular disease may coexist in the same patient, obesity may be a common risk factor for both. On the other hand, it is important to consider the extent to which hyperuricemia or gout per se may contribute to the genesis of comorbidities; since both hyperuricemia and gout are treatable, their participation in causing other problems may suggest the potential for intervention. The issue of determining cause and effect in patients with gout can be a challenging one; in some cases, hyperuricemia or gout may be both a consequence of, and a contributor to, a particular comorbidity. In this article, we briefly review some of the major comorbidities that occur in gout patients, with special consideration for the possibility that gout and hyperuricemia may represent modifiable risk factors for the comorbid condition in question.


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