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Bariatric surgery as urate-lowering therapy in severe obesity
  1. Hyon K Choi1,2,
  2. Yuqing Zhang2
  1. 1Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Clinical Epidemiology and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Hyon K Choi, Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118, USA; hchoius{at}

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Gout represents a metabolically driven inflammatory arthropathy, which could be substantially influenced by adiposity and lifestyle risk factors. As such, influenced by the trends in lifestyle factors associated with Westernisation,1 ,2 gout prevalence has increased in the last few decades worldwide (eg, 3.9% of US adults (8.3 million) in 2007–20083).4 The disease burden of gout has been further complicated by a high level of cardiovascular (CV)–metabolic comorbidities (eg, hypertension in 74%; obesity in 53%5) and their sequelae (eg, increased future risk of myocardial infarction and premature death6 ,7).

Among many known modifiable risk factors for hyperuricaemia and gout, obesity is one of the strongest, as observed in many prospective cohort studies.8–12 To date, few medical interventions, except bariatric surgery, have been effective in the treatment of obesity. Indeed, studies have shown that bariatric surgery not only induces substantial weight loss but also greatly improves key obesity-related CV–metabolic abnormalities and outcomes,13–15 including blood pressure, glucose, insulin, triglycerides, high-density lipoprotein (HDL)-cholesterol, serum uric acid (SUA) levels16 and overall mortality.17

In their timely study, Dalbeth et al18 sought to examine the potential pathogenetic and clinical relevance of the urate-lowering benefits of bariatric surgery. Over 1 year of prospective follow-up of 60 individuals with severe obesity (body mass index (BMI) ≥35 kg/m2) and type 2 diabetes, bariatric surgery led to a weight reduction of 34 kg, and proportions of those with SUA levels higher than the urate saturation point and the usual urate-lowering therapy (ULT) target (SUA=0.36 mmol/L)19 declined by 37% and 41%, respectively. Among the 12 gout patients included in this study, the proportion of SUA above 0.36 mmol/L declined from 83% (10/12) at baseline to 33% (4/12) 1 year after surgery; the corresponding proportion of ULT use also declined from 75% (9/12) …

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