This study examined the association between one-year changes in serum urate levels and the risk of all-cause and cardiovascular mortality in health checkup participants, using a nationwide database of specific health checkups. The subjects were 144,142 people (58,148 men and 85,994 women, mean age 65.3 years) who received specific health examinations in 2008 and 2009 and had sequential data on serum urate levels. The association between one-year change in serum urate level and risk of total and cardiovascular mortality was analyzed by Cox proportional hazard model adjusting for background factors (age, gender, smoking, alcohol consumption, BMI, eGFR, systolic blood pressure, HbA1c, triglycerides, LDL-C, HDL-C, medications (antihypertensive, antidiabetic, lipid-lowering), one-year change in these clinical parameters, and serum urate levels in 2008 and 2009). During the 7-year follow-up period, there were 1,206 total deaths (829 men and 377 women) and 234 cardiovascular deaths (161 men and 73 women). Cox proportional hazards analysis adjusted for background factors showed a significant increase in the hazard ratio (HR) of 1.77 (95% confidence interval [CI] 1.04-3.01) in the group of 2.0 or more decrease and HR of 2.73 (95% CI 1.57-4.72) in the group of 2 or more increase compared with the reference group (serum urate change: -0.9 to +0.9 mg/dL). This result suggests that a significant change in serum urate level during one year may be a risk of mortality independent of absolute serum urate level in the community population.

Objective: Four clinical studies of dotinurad in patients with hyperuricemia with or without gout conducted in Japan were pooled to evaluate the relationship between the cumulative number of cardiovascular risk factors (obesity, hypertension, dyslipidemia, and impaired glucose tolerance) and the uric acid-lowering effect of dotinurad.

Methods: The full analysis set populations in each study were pooled, of which 421 and 59 patients were administered dotinurad and the placebo, respectively. Dotinurad was evaluated at doses of 0.5, 1, 2, and 4 mg in these studies. Endpoints were the rate of decrease in serum uric acid levels and the rate of achievement of serum uric acid levels ≤ 6.0 mg/dL with the cumulative number of cardiovascular risk factors.

Results: Dotinurad showed serum uric acid-lowering effect in hyperuricemic patients with multiple cardiovascular risk factors. Administering 2 mg dotinurad exhibited a lower rate of achieving serum uric acid levels ≤ 6.0 mg/dL in patients with more cardiovascular risk factors than in those with fewer cardiovascular risk factors. However, serum uric acid levels ≤ 6.0 mg/dL were achieved in almost all patients treated with 4 mg dotinurad regardless of the cumulative number of cardiovascular risk factors.

Conclusion: Dotinurad lowered serum uric acid levels in hyperuricemic patients with multiple cardiovascular risk factors. Adjusting the dose of dotinurad while taking into consideration the patient's background of multiple cardiovascular risk factors may be a new therapeutic strategy to control serum uric acid levels.

People's lifestyles have been changing during the COVID-19 pandemic. Staying at home and teleworking are likely to increase the risk of lifestyle-related diseases due to imbalanced diets, lack of exercise, and increased psychological stress. Hyperuricemia was also reported to be a risk factor for COVID-19 death. In this study, we examined the changes in consciousness, physical measurements, and blood test results of patients with gout during the COVID-19 pandemic, and found that they stayed at home more, ate out less, and were more stressed. They ate more takeaway meals and snacks. In addition, the ratio of patients with an increased awareness of the need for exercise to those who actually increased their physical activity was low, and the rate of patients with an increased body weight was high. In terms of physical measurements and blood test results, BMI increased significantly from a mean of 25.8 kg/m² to 26.2 kg/m² (P<0.001), and serum ALT increased significantly from a mean of 29.7 IU/L to 33.3 IU/L (P<0.05). During the COVID-19 pandemic, patients with gout were more conscious of exercise, but their physical activity decreased, and they showed weight gain and progression of fatty liver. Although the patients were aware of the need for exercise, they did not actually change their behavior, and so it is necessary to devise ways to help them change their behavior to avoid obesity and weight gain. As a limitation of the study, it was considered that the timing of the survey and regional characteristics may have affected the results.

A 25-year-old male patient. He had symptoms of pain and redness at the front of his right knee.

Initially, it was suspected to be gouty arthritis; however, a bony prominence was found in the area, and it was necessary to distinguish it from sequelae of Osgood-Schlatter disease (OSD) that occurred in childhood.

Synovial hypertrophy and hyperechoic spots (aggregates) were noted on his right knee joint, and a double contour sign (DCS) was observed on his left toe MTP joint by musculoskeletal ultrasonography (MUS).

Based on blood and urine biochemical test results and clinical findings, it was considered to be gouty arthritis.

The disease type was diagnosed as hyperuricemia with reduced excretion. Treatment with benzbromarone improved serum uric acid levels, and there was recurrence of gouty arthritis.

OSD is a typical disease of sports injuries in children, and it improves after the growth period, but a detached ossicle may cause chronic inflammation such as patellar tendinitis and bursitis.

When performing MUS in patients with a history of OSD, it is considered necessary to carry out examination with the presence of an ossicle in mind.

Objective: To investigate the frequency and findings of monosodium urate (MSU) deposition in gout flares compared to those in asymptomatic hyperuricemia.

Methods: A total of 109 consecutive patients with gout or asymptomatic hyperuricemia who visited our clinic between 2017 and 2020 were enrolled in this study. The inflamed joints of patients with gout and one of the two metatarsophalangeal joints of patients with asymptomatic hyperuricemia were examined for MSU deposition on ultrasonography. We investigated whether imaging findings were related to the history of gout flares and comorbidities of the patients.

Results: A total of 52 patients were eligible for this study. The patients with gout were older than the asymptomatic patients. All patients with gout showed the double contour sign and a hyperechoic aggregate representing MSU deposition, whereas three of the 15 patients with asymptomatic hyperuricemia had any of these ultrasonography signs. There was no relationship between comorbidities and gout flares.

Conclusions: The presence of MSU deposition on ultrasonography indicated a history of gout flare, and it rarely occurred in patients with asymptomatic hyperuricemia.

About 60% of hyperuricemia patients are of the uric acid excretion-reducing type, and they are basically treated with uricosuric agents. Uricosuric agents increase urinary uric acid excretion and the risk of urolithiasis, so it is necessary to select uric acid production inhibitor agents to prevent this. Therefore, we investigated the degree and duration of the effect of drugs on urinary uric acid excretion during treatment.

Of the 123 patients with gout / hyperuricemia, the serum uric acid level (s-UA) in 58 could be controlled to 6.0 mg/dL or lower with a single agent. We divided them into group B (Benzbromarone) and groups A, F, and T (Allopurinol, Febuxostat, and Topiroxostat, respectively), and we compared their uric acid/creatinine ratio (U-UA/Cr) before and after 6 months of medication. This was because U-UA/Cr shows a relatively strong correlation (r=0.640) with daily uric acid excretion (mg/day).

In group B (n=24), s-UA reduced (p <0.01) and U-UA /Cr increased (p <0.05) significantly after treatment. In groups A, F, and T (n=3, 24, and 7, respectively), s-UA and U-UA/Cr significantly decreased (p <0.05). There was no difference in s-UA among them (p =0.9969) after treatment, but U-UA/Cr increased in group B (p <0.05) and decreased in groups A, F, and T (p <0.05) significantly.

This indicates that the amount of urinary uric acid excretion changes depending on the drug selection, and it is considered that uric acid production inhibitor drugs may reduce the risk of urolithiasis. It is also considered that prevention is needed for at least 6 months.

In patients who could continue treatment with the same drug for 12 months (Febuxostat, 20 mg (n=5); Benzbromarone, 25 mg (n=8)), there was no significant change in U-UA/Cr during the course. It remains unclear how long prevention of urolithiasis is required.