Effects of asymptomatic hyperuricemia on the disease course of hidradenitis suppurativa

Yıl 2024, Cilt: 15 Sayı: 3, 406 - 412, 30.09.2024

Özge Sevil Karstarlı , Umut Bakay

https://doi.org/10.18663/tjcl.1529053

Öz

Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful abscesses and nodules, sinus tracts, and scars significantly affecting patients' quality of life. HS is accompanied by comorbidities such as metabolic syndrome, cardiovascular diseases, and arthritis. The frequency of asymptomatic hyperuricemia is increasing nowadays, and it is widely known that it exacerbates inflammation. In this study we aimed to investigate the possible association of hyperuricemia with disease severity, clinical and laboratory findings in HS patients.
Material and Methods: Patients diagnosed with HS at Pamukkale University Dermatology Department were included in this cross-sectional study. Individuals with similar body mass index (BMI), age, and gender, and without inflammatory dermatoses were included in the control group. Serum uric acid (SUA), C-reactive protein (CRP), fasting blood glucose, high-density lipoprotein cholesterol (HDL), total cholesterol, and triglyceride levels were assessed. Hurley classification and International Hidradenitis Suppurativa Severity Score (IHS4) were used to determine disease severity. Dermatology Life Quality Index (DLQI) was used to assess the effect of the disease on their quality of life.
Conclusion: 53 patients with HS and 44 controls were included in the study. Hyperuricemia was present in 23 (43.4%) of HS patients. SUA levels of the patients were higher than the control group (6.4±1.4 mg/dL and 4.8±1.4 mg/dL, respectively, p<0.001). The IHS4 score was significantly higher in patients with hyperuricemia than in patients without hyperuricemia. (14.8±12.5 and 8.5±5.6, respectively, p<0.05). Serum C-reactive protein (CRP) levels were also higher in patients with hyperuricemia, but the difference was not statistically significant (p>0.05). There was a positive correlation between serum CRP levels and SUA levels in the patient group.
Results: The frequency of asymptomatic hyperuricemia is increased in HS patients and is associated with disease severity. There is a close relationship between Hyperuricemia and HS and associated comorbidities, and patients should be evaluated.

Anahtar Kelimeler

Hidradenitis suppurativa, uric acid, asymptomatic hyperuricemia

Asemptomatik hiperüriseminin hidradenitis süppürativa hastalık seyrine etkileri

Öz

Amaç: Hidradenitis süppürativa (HS) hastaların hayat kalitesini belirgin olarak etkileyen ağrılı abse ve nodüller, sinus traktüsleri ve skarlarla karakterize kronik inflamatuar bir hastalıktır. Hastalığa metabolik sendrom, kardiyovasküler hastalıklar ve artrit gibi komorbiditeler eşlik etmektedir. Asemptomatik hiperüriseminin sıklığı günümüzde giderek artmaktadır ve inflamasyonu şiddetlendirdiğine dair veriler mevcuttur. Bu çalışmada hiperüriseminin HS hastalarında hastalık şiddeti, klinik ve laboratuvar bulgularıyla ilişkisini incelemeyi amaçladık.
Gereç ve Yöntemler: Bu kesitsel çalışmaya Pamukkale Üniversitesi dermatoloji kliniğinde HS tanısı alan hastaların yanı sıra beden kitle indeksi (BKİ), yaş, cinsiyet açısından benzer nitelikte olan, inflamatuar dermatolojik hastalığı olmayan gönüllüler dahil edildi. Serum ürik asit (SÜA), C-reaktif protein (CRP), açlık glukoz, yüksek yoğunluklu lipoprotein kolesterol (HDL), total kolesterol ve trigliserid değerleri kaydedildi. Hastalık şiddetinin belirlenmesi için Hurley sınıflaması ve Uluslararası Hidradenitis Suppurativa Şiddet Skorlaması (IHS4) kullanıldı. Tüm hastalara dermatoloji yaşam kalite indeksi (DYKİ) uygulanarak hastalığın hayat kaliteleri üzerine etkisi incelendi.
Bulgular: Çalışmaya 53 HS tanılı hasta, 44 gönüllü dahil edildi. HS hastalarının 23’ünde (%43.4) hiperürisemi mevcuttu. Hastaların ortalama SÜA seviyeleri, kontrol grubundan yüksek olarak saptandı (6.4±1.4 mg/dL, 4.8±1.4 mg/dL, sırasıyla p<0.001). Hiperürisemisi olan hastalarda IHS4 skoru hiperürisemisi olmayan hastalardan belirgin olarak yüksekti (14.8± 12.5 ve 8.5 ±5.6, sırasıyla, p<0.05). CRP düzeyleri benzer şekilde hiperürisemisi olan hastalarda daha yüksekti, ancak aralarındaki farklılık istatistiksel açısından anlamlı değildi (p>0.05). Hasta grubunda serum CRP düzeyleri ile SÜA seviyeleri arasında pozitif korelasyon vardı (r=0.342, p=0.012).
Sonuçlar: HS hastalarında asemptomatik hiperürisemi sıklığı artmıştır ve hastalık şiddetiyle ilişkili bulunmuştur. Hiperürisemi, HS ve ilişkili komorbiditeler arasında yakın ilişki bulunmaktadır ve hasta takibinde SÜA düzeyi rutin inceleme arasına alınmalıdır.

Anahtar Kelimeler

hidradenitis süppürativa, ürik asit, asemptomatik hiperürisemi

Etik Beyan

Bu çalışma, Helsinki Bildirgesi'ne uygun olarak Pamukkale Üniversitesi Etik Kurulu (No: E-60116787-020-557565) tarafından onaylandı

Destekleyen Kurum

Yok

Kaynakça

• Kokolakis G, Wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Kleindienst S, Sabat R. Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System. Dermatology. 2020;236(5):421-430.
• Scala E, Cacciapuoti S, Garzorz-Stark N, Megna M, Marasca C, Seiringer P, Volz T, Eyerich K, Fabbrocini G. Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells. 2021;10(8):2094.
• Bukvić Mokos Z, Markota Čagalj A, Marinović B. Epidemiology of hidradenitis suppurativa. Clin Dermatol. 2023;41(5):564-575.
• Dobrowolski P, Prejbisz A, Kuryłowicz A, Baska A, Burchardt P, Chlebus K ve ark. Metabolic syndrome - a new definition and management guidelines: A joint position paper by the Polish Society of Hypertension, Polish Society for the Treatment of Obesity, Polish Lipid Association, Polish Association for Study of Liver, Polish Society of Family Medicine, Polish Society of Lifestyle Medicine, Division of Prevention and Epidemiology Polish Cardiac Society, "Club 30" Polish Cardiac Society, and Division of Metabolic and Bariatric Surgery Society of Polish Surgeons. Arch Med Sci. 2022;18(5):1133-1156.
• Sodagar S, Ghane Y, Heidari A, Heidari N, Khodadust E, Ahmadi SAY, Seirafianpour F, Baradaran H, Goodarzi A. Association between metabolic syndrome and prevalent skin diseases: A systematic review and meta-analysis of case-control studies. Health Sci Rep. 2023;6(9):e1576.
• Sabat R, Chanwangpong A, Schneider-Burrus S, Metternich D, Kokolakis G, Kurek A, Philipp S, Uribe D, Wolk K, Sterry W. Increased prevalence of metabolic syndrome in patients with acne inversa. PLoS One. 2012;7(2):e31810.
• Joosten LAB, Crişan TO, Bjornstad P, Johnson RJ. Asymptomatic hyperuricaemia: a silent activator of the innate immune system. Nat Rev Rheumatol. 2020;16(2):75-86.
• Cabău G, Gaal O, Badii M, Nica V, Mirea AM, Hotea I; HINT-consortium; Pamfil C, Popp RA, Netea MG, Rednic S, Crișan TO, Joosten LAB. Hyperuricemia remodels the serum proteome toward a higher inflammatory state. iScience. 2023;26(10):107909.
• Pinter A, Kokolakis G, Rech J, Biermann MHC, Häberle BM, Multmeier J, Reinhardt M. Hidradenitis Suppurativa and Concurrent Psoriasis: Comparison of Epidemiology, Comorbidity Profiles, and Risk Factors. Dermatol Ther (Heidelb). 2020;10(4):721-734.
• Hu M, Wang Y, Xu W, Bai J, Tang X. The impact of serum uric acid on psoriasis: NHANES 2005-2014 and Mendelian randomization. Front Genet. 2024;15:1334781.
• AlJohani R, Polachek A, Ye JY, Chandran V, Gladman DD. Characteristic and Outcome of Psoriatic Arthritis Patients with Hyperuricemia. J Rheumatol. 2018;45(2):213-217.
• Akdogan N, Alli N, Uysal PI, Topcuoglu C, Candar T, Turhan T. Visfatin and insulin levels and cigarette smoking are independent risk factors for hidradenitis suppurativa: a case-control study. Arch Dermatol Res. 2018;310(10):785-793.
• Yip K, Cohen RE, Pillinger MH. Asymptomatic hyperuricemia: is it really asymptomatic? Curr Opin Rheumatol. 2020;32(1):71-79.
• Chen-Xu M , Yokose C , Rai SK , Pillinger MH , Choi HK. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the National Health and Nutrition Examination Survey. Arthritis Rheumatol 2019;71:991–9.
• Luis-Rodríguez D, Donate-Correa J, Martín-Núñez E, Ferri C, Tagua VG, Pérez Castro A, Mora-Fernández C, Navarro-González JF. Serum urate is related to subclinical inflammation in asymptomatic hyperuricaemia. Rheumatology (Oxford). 2021 ;60(1):371-379.
• Inaba S, Sautin Y, Garcia GE, Johnson RJ. What can asymptomatic hyperuricaemia and systemic inflammation in the absence of gout tell us? Rheumatology (Oxford). 2013;52(6):963-5.
• Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, Wamsley A, Sheikh-Hamad D, Lan HY, Feng L, Johnson RJ. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003;41(6):1287-93.
• Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Physiol. 2007;293(2):C584-96.
• Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol. 2005;16(12):3553-62.
• Kityo A, Lee SA. Longitudinal changes in high sensitivity C-reactive protein associated with serum uric acid in the Korean Genome and Epidemiology Study. Sci Rep. 2024;14(1):374. .
• Kwon HH, Kwon IH, Choi JW, Youn JI. Cross-sectional study on the correlation of serum uric acid with disease severity in Korean patients with psoriasis. Clin Exp Dermatol. 2011;36(5):473-8. .
• Griffiths CE, Christophers E, Barker JN, Chalmers RJ, Chimenti S, Krueger GG, Leonardi C, Menter A, Ortonne JP, Fry L. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258-62.
• Lewandowski M, Świerczewska Z, Barańska-Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol. 2022;61(9):1152-1164.
• Rosi E, Fastame MT, Silvi G, Guerra P, Nunziati G, Di Cesare A, Scandagli I, Ricceri F, Prignano F. Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines. 2022;10(11):2973.