Background Gout is phenotypically and genotypically heterogeneous. In most cases, renal mechanism plays an important role in the development of gout. At the same time, gout, as a rule, occurs on the basis of pre-existing comorbid pathology.
Objectives To determine clinic-pathogenetic variants of gout depending on a leading comorbid pathology at the gout onset.
Methods We included 604 patients with confirmed gout from our Center database. During 2010–2016, comorbidities were registered before the gout onset, at its appearance, during and at the last examination. Metabolic syndrome (MS) was defined by 5 components. CVD included CHD, atrial fibrillation, CHF and stroke. Patients after organ transplantation and with terminal renal failure observed in specialized centers were not recruited.
Results In 67,1% (n=405) of patients, the gout developed on the basis of pre-existing MS, thus, this variant may be called a metabolic gout (MG) and considered as a component of MS. The patients with MG were younger, the mean age of symptoms onset was 42 (35–48) years. At the first gout attack, all patients had BMI≥25 kg/m2, 8,2% (n=33) had pre-existing HTN, and in 14,3% (n=58) of cases the diagnosis of HTN was firstly made. No one patient had diabetes mellitus (DM). Frequent regular or single abundant alcohol intake together with overeating as factors more often favoring gout attack were revealed in all patients. At the last examination, only 38,1% (n=230) of patients had MS without any CVD, the mean age was 50 (45–55) years; 98,7% (n=227) had BMI≥25 kg/m2; 73,9% (n=170) presented with HTN; 59,1% (n=136) showed dyslipidemia; 6,5% (n=15) had DM. In 8,3% (n=19) of patients, changing the lifestyle and normalizing the weight resulted not only in decreased hyperuricemia but lower attacks rate or even their total disappearance during a 5 year follow-up. The second variant of gout onset developing in patients with pre-existing CVD, can be called a CV gout or cardiorenovascular (CRV) gout. This type of gout was revealed in 28,5% (n=172) of patients, the disease debuted later, at the age of 60 (55–64) years (p<0,001). 97,7% (n=163) had HTN (χ2=30,1, p<0,001) and 27,3% (n=47) – DM (χ2=32,65, p<0,001), both features were more common in CV gout. 85,5% (n=147) had BMI≥25 kg/m2 (F=0,066, p<0,001). Regular alcohol intake was considerably lower – 33,7% (n=58) (χ2=167,4, p<0,001), but medication use was higher – diuretics in 14,5% (n=25) (χ2=21,77, p<0,001) and low-dose aspirin in 37,2% (n=64) of patients (F=0,24, p<0,001). At the last examination, the mean age of patients was 63 (59–69) years (p<0,001), chronic GFR <60 ml/min was observed in 47,7% (n=82) of patients (F=0,34, p<0,001).
The secondary gout developed in 4,4% (n=27) of patients with various diseases: myelo-, lymphoproliferative and other blood diseases - 6 cases, renal gout - 13, gut gout after partial gut resection - 2, and anorexic gout - 2. Alcoholic gout without MS was diagnosed in 4 patients, all men with body mass deficiency.
Conclusions In our opinion, there are two main clinic-pathogenetic variants of debuting gout – metabolic and cardiovascular, the both with different conditions of occurrence, progression and prognosis. In clinical practice, it is reasonable to differentiate these variants, that is determined by the need to simplify complex multimodal diagnostic and therapeutic approach to the patients with gout.
Disclosure of Interest None declared