Psoriatic arthritis with hyperuricemia: more peripheral, destructive, and challenging to treat

L Widawski; T Fabacher; L Spielmann; J E Gottenberg; J Sibilia; P M Duret; L Messer; R Felten

doi:10.1007/s10067-022-06061-x

Psoriatic arthritis with hyperuricemia: more peripheral, destructive, and challenging to treat

Clin Rheumatol. 2022 May;41(5):1421-1429. doi: 10.1007/s10067-022-06061-x. Epub 2022 Jan 20.

Authors

L Widawski¹, T Fabacher², L Spielmann¹, J E Gottenberg³, J Sibilia³, P M Duret¹, L Messer^#^{1

4}, R Felten^#⁵

Affiliations

¹ Rheumatology Department, Colmar Civil Hospital, 39 Avenue de la Liberté, 68024, Colmar Cedex, France.
² Department of Epidemiology and Public Health, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France.
³ Rheumatology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares RESO, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France.
⁴ UMR 7367, MISHA, Allée du Général Rouvillois, Dynamiques Européennes, 67083, Strasbourg Cedex, France.
⁵ Rheumatology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares RESO, Strasbourg University Hospital, 1 Avenue Molière, 67098, Strasbourg, France. renaud.felten@chru-strasbourg.fr.

^# Contributed equally.

Abstract

Objective: To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA).

Methods: Retrospective bicentric case-control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L.

Results: We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10^-6) with higher body mass index (30.9 vs 28.7 kg/m², p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15-7.75; p = 0.025) and less good response to treatment (0.35; 0.15-0.87; p = 0.024).

Conclusion: Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients. Key Points • Gout and psoriatic arthritis (PsA) can co-exist in the same patient. • Monosodium urate crystals might have a deleterious impact on PsA. • Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA. • PsA with hyperuricemia should lead to more personalized medicine.

Keywords: Crystal arthropathies; Gout; Hyperuricemia; Psoriatic arthritis; Psout.

MeSH terms

Arthritis, Psoriatic* / complications
Arthritis, Psoriatic* / drug therapy
Case-Control Studies
Gout* / complications
Humans
Hyperuricemia* / complications
Retrospective Studies