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The association of obesity with the development of gout has been attributed to hyperuricaemia.1 ,2 However, in patients with poorly controlled gout, weight loss leads to profound suppression of gout flares, despite a relatively small reduction in urate concentrations.3 Monosodium urate (MSU) crystals are frequently identified in asymptomatic, uninflamed joints in patients with gout,4 suggesting that local or systemic factors regulate the inflammatory response to intra-articular crystals. Since weight loss is associated with reduced chronic inflammation,5 we hypothesised that weight loss influences the presentation of gout through regulation of inflammatory responses to MSU crystals.
Twenty patients with morbid obesity (body mass index ≥35 kg/m2) and type 2 diabetes, with no history of gout, were prospectively recruited from two public hospitals in Auckland, New Zealand. The Northern X Ethics Committee approved the study and all patients provided …