Asymptomatic hyperuricemia and radiographic progression of rheumatoid arthritis

Background: clinical and radiological studies on this issue remain unknown, despite the existing pathomorphological prerequisites, indicating the mutually potentiative effect of hyperuricemia (HU) on the radiographic progression (RP) in rheumatoid arthritis (RA). Aim: to study the association between the HU, the activity of RA, RP and the possibilities of their correction. Patients and Methods: among 967 patients included in the St. Petersburg City Register of HU from January 2011 to October 2021, 232 patients with RA and HU (uric acid (UA) level > 360 μmol/L) were selected, for which 232 patients of the comparison group with RA without HU were selected by random selection from the same register. A comparison of the demographic characteristics of patients (gender, age), their clinical, laboratory and radiological patterns and the ongoing treatment was conducted. Results: patients with RA and HU and without HU were comparable in age, gender, activity, disease course and the received baseline therapy. In patients with RA and HU, there was a higher (p=0.03) increase in the joint space narrowing (JSN) value of the feet. In patients with RA and HU, RP in all evaluated parameters (p<0,001) exceeded RP in patients with RA without HU. The article reveales direct correlations in the JSN of the feet and hands with the UA level, UA clearance, UA daily excretion, daily protein loss, as well as blood glucose and cholesterol levels, despite the well-known risk factors for the RA progression (age, disease duration, positivity according to RF and CCPA, elevated ESR and CRP level). Patients with HU and RP only reached the target UA levels in 27% of cases when treated with allopurinol, while patients without RP reached the target level in 80% of cases. Conclusion: HU in patients with RA is associated with RP, which indicates the need for its timely detection and correction. KEYWORDS: rheumatoid arthritis, asymptomatic hyperuricemia, radiographic progression, urate-lowering therapy, allopurinol. FOR CITATION: Tsinserling A.Yu., Mazurov V.I., Gaydukova I.Z. et al. Asymptomatic hyperuricemia and radiographic progression of rheumatoid arthritis. Russian Medical Inquiry. 2022;6(8):470–479 (in Russ.). DOI: 10.32364/2587-6821-2022-6-8-470-479.