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Gout and Metabolic Syndrome: a Tangled Web.
Curr Rheumatol Rep. 2017 Aug 26; 19(10):60.CR

Abstract

PURPOSE OF REVIEW

The complexity of gout continues to unravel with each new investigation. Gout sits at the intersection of multiple intrinsically complex processes, and its prevalence, impact on healthcare costs, and association with important co-morbidities make it increasingly relevant. The association between gout and type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, renal disease, and obesity suggest that either gout, or its necessary precursor hyperuricemia, may play an important role in the manifestations of the metabolic syndrome. In this review, we analyze the complex interconnections between gout and metabolic syndrome, by reviewing gout's physiologic and epidemiologic relationships with its major co-morbidities.

RECENT FINDINGS

Increasing evidence supports gout's association with metabolic syndrome. More specifically, both human studies and animal models suggest that hyperuricemia may play a role in promoting inflammation, hypertension and cardiovascular disease, adipogenesis and lipogenesis, insulin and glucose dysregulation, and liver disease. Fructose ingestion is associated with increased rates of hypertension, weight gain, impaired glucose tolerance, and dyslipidemia and is a key driver of urate biosynthesis. AMP kinase (AMPK) is a central regulator of processes that tend to mitigate against the metabolic syndrome. Within hepatocytes, leukocytes, and other cells, a fructose/urate metabolic loop drives key inhibitors of AMPK, including AMP deaminase and fructokinase, that may tilt the balance toward metabolic syndrome progression. Preliminary evidence suggests that agents that block the intracellular synthesis of urate may restore AMPK activity and help maintain metabolic homeostasis. Gout is both an inflammatory and a metabolic disease. With further investigation of urate's role, the possibility of proper gout management additionally mitigating metabolic syndrome is an evolving and important question.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Thottam GE
Department of Medicine, Roger Williams Medical Center, Providence, RI, USA. Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA.
Krasnokutsky S
Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA.
Pillinger MH
Crystal Diseases Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Suite 1410, New York, NY, 10003, USA. michael.pillinger@nyumc.org. Rheumatology Section, Department of Medicine, VA New Harbor Health Care System, New York Campus, New York, NY, USA. michael.pillinger@nyumc.org.

MeSH

Cardiovascular DiseasesComorbidityDiabetes Mellitus, Type 2FructoseGoutHumansHyperlipidemiasHyperuricemiaInflammationMetabolic SyndromeObesityUric Acid

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28844079

Citation

Thottam, Gabrielle E., et al. "Gout and Metabolic Syndrome: a Tangled Web." Current Rheumatology Reports, vol. 19, no. 10, 2017, p. 60.
Thottam GE, Krasnokutsky S, Pillinger MH. Gout and Metabolic Syndrome: a Tangled Web. Curr Rheumatol Rep. 2017;19(10):60.
Thottam, G. E., Krasnokutsky, S., & Pillinger, M. H. (2017). Gout and Metabolic Syndrome: a Tangled Web. Current Rheumatology Reports, 19(10), 60. https://doi.org/10.1007/s11926-017-0688-y
Thottam GE, Krasnokutsky S, Pillinger MH. Gout and Metabolic Syndrome: a Tangled Web. Curr Rheumatol Rep. 2017 Aug 26;19(10):60. PubMed PMID: 28844079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gout and Metabolic Syndrome: a Tangled Web. AU - Thottam,Gabrielle E, AU - Krasnokutsky,Svetlana, AU - Pillinger,Michael H, Y1 - 2017/08/26/ PY - 2017/8/28/entrez PY - 2017/8/28/pubmed PY - 2018/1/4/medline KW - Diabetes KW - Fructose KW - Gout KW - Hypertension KW - Metabolic syndrome KW - Uric acid SP - 60 EP - 60 JF - Current rheumatology reports JO - Curr Rheumatol Rep VL - 19 IS - 10 N2 - PURPOSE OF REVIEW: The complexity of gout continues to unravel with each new investigation. Gout sits at the intersection of multiple intrinsically complex processes, and its prevalence, impact on healthcare costs, and association with important co-morbidities make it increasingly relevant. The association between gout and type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, renal disease, and obesity suggest that either gout, or its necessary precursor hyperuricemia, may play an important role in the manifestations of the metabolic syndrome. In this review, we analyze the complex interconnections between gout and metabolic syndrome, by reviewing gout's physiologic and epidemiologic relationships with its major co-morbidities. RECENT FINDINGS: Increasing evidence supports gout's association with metabolic syndrome. More specifically, both human studies and animal models suggest that hyperuricemia may play a role in promoting inflammation, hypertension and cardiovascular disease, adipogenesis and lipogenesis, insulin and glucose dysregulation, and liver disease. Fructose ingestion is associated with increased rates of hypertension, weight gain, impaired glucose tolerance, and dyslipidemia and is a key driver of urate biosynthesis. AMP kinase (AMPK) is a central regulator of processes that tend to mitigate against the metabolic syndrome. Within hepatocytes, leukocytes, and other cells, a fructose/urate metabolic loop drives key inhibitors of AMPK, including AMP deaminase and fructokinase, that may tilt the balance toward metabolic syndrome progression. Preliminary evidence suggests that agents that block the intracellular synthesis of urate may restore AMPK activity and help maintain metabolic homeostasis. Gout is both an inflammatory and a metabolic disease. With further investigation of urate's role, the possibility of proper gout management additionally mitigating metabolic syndrome is an evolving and important question. SN - 1534-6307 UR - https://www.unboundmedicine.com/medline/citation/28844079/Gout_and_Metabolic_Syndrome:_a_Tangled_Web_ L2 - https://dx.doi.org/10.1007/s11926-017-0688-y DB - PRIME DP - Unbound Medicine ER -