Hyperuricemia is associated with intermittent hand joint pain in a cross sectional study of elderly females: The AGES-Reykjavik Study

BackgroundThe debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain.Methods and findingsParticipants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07–1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32–2.31), pConclusionResults from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.

背景 关于「无症状高尿酸血症（asymptomatic hyperuricemia）」是否应当接受治疗的争议至今仍未停歇。本横断面研究旨在探讨老年人群的高尿酸血症（hyperuricemia）与关节疼痛之间是否存在关联。
方法与结果 基于人群的雷克雅未克AGES研究（AGES-Reykjavik Study）共纳入5170名参与者（男性2195名，女性2975名，平均年龄76±6岁），所有受试者均完成了关于关节疼痛的标准化问卷调研。此外，受试者还通过标记手部示意图的方式记录了间歇性手部关节疼痛情况。在男性受试者中，未发现高尿酸血症与关节疼痛存在关联；而女性受试者则显示，高尿酸血症与多部位关节疼痛呈正相关。在校正年龄、体质量指数（body mass index, BMI）及手部骨关节炎（hand osteoarthritis）的影响后，仅间歇性手部关节疼痛（优势比odds ratio, OR=1.30，95%置信区间confidence interval, CI：1.07~1.58，P=0.008）以及≥10个手部关节出现间歇性疼痛（OR=1.75，95%CI：1.32~2.31，P
结论 本基于人群的研究结果显示，老年女性的高尿酸血症可能是引发间歇性手部多关节疼痛的常见病因。其最可能的发病机制与低度尿酸盐结晶诱导的炎症反应相关。本研究数据无法评估症状的严重程度，亦无法明确此类疼痛是否需要针对性治疗，但间歇性手部关节疼痛是总体健康状况较差的独立预测因子。上述研究结果可为「高尿酸血症是否应当接受治疗」的临床争议提供重要参考依据。