Clinical features of patients with normouricemia during acute gouty attack
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Abstract
Background: Most of the general practitioners diagnose acute gouty arthritis from acute joint pain and hyperuricemia, but in some of patients, the serum uric acid level is still normal during the attack.
Objective: To determine the clinical features of gouty patient with normal serum uric acid level during acute attack. Influencing factors with this condition were also evaluated.
Study design: Retrospective descriptive study
Methods: The medical records of gouty arthritis patients treated in inpatient department at Surin hospital between July 1,2014 and December 31, 2015 were reviewed. Acute gouty attack was defined by rheumatologist based on either the presence of monosodium urate crystal in synovial fluid or clinical criteria. Serum uric acid was collected in all of the patients during acute gouty arthritis.
Results: One hundred and forty seven acute gouty arthritis patients were recruited with mean (SD) age and disease duration of 65.3 (13.7) years and 5.5 (4.4) years, respectively. 80.3% were male. Normal serum uric level was found in 27.9% of the patients with acute gouty attack. The normouricemic group had underlying diseases, especially chronic kidney disease and mean serum uric acid level before gouty attack lower than the hyperuricemic group (p=0.049, p = 0.027, and p = 0.012 respectively), but the number of previously taking urate lowering agents in normouricemic group was higher (p = 0.031). There were no significantly difference in clinical settings during gouty attack between the two groups, except post myocardial infarction or congestive heart failure that found higher in the nomouricemic group (p=0.039). Serum creatinine level during gouty attack was also significantly lower in the normouricemia group (p=0.001). However, using multivariable logistic regression analysis; underlying disease of CKD stage 3 (OR 0.858; 95%CI 0.766-0.972), serum uric acid level last time before gouty attack (OR 0.997; 95%CI 0.996-0.998), especiallyClinical features of patients with normouricemia during acute gouty attack
7 mg/dl (OR 1.821; 95%CI 1.109-2.646), and serum creatinine during gouty attack (OR 0.993; 95%CI 0.984-0.999), especially
1.3 mg/dl (OR 0.320; 95%CI 0.211-0.657) were significantly association with normouicemia during acute attack.
Conclusion: The prevalence of acute gouty arthritis with normouricemia in Surin hospital was 27.9%. Previously taking urate lowering agents, the last serum uric acid level before attack and renal function were affected the serum uric acid level during acute gouty attack. Therefore, the diagnosis of acute gouty attack by using serum uric acid level should be caution, particularly in patients who having chronic kidney disease or history of taking urate lowering agents
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References
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