Gout is the oldest known type of arthritis, with a global prevalence of 0.08% and is higher in developed
countries.
The evidences are in favor of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on serum uric acid (sUA), achieving sUA target and gout attacks, respectively.
Gout is the oldest known type of arthritis, with a global prevalence of 0.08% and is higher in developed countries. Gout is characterized by painful swelling and inflammation in one or more joints caused due to crystal-deposition of monosodium urate (MSU) or raised in level of serum uric acid (sUA) in the body. The general principle to manage the increased sUA levels is by allowing MSU crystals to dissolve, thereby reducing acute attacks or disappearance of tophi (deposits of UA). Literature suggest that excessive amount of weight in adulthood were more likely to develop gout later in life. Therefore, weight loss is strongly recommended treatment for the gout. While, those who already suffered from type 2 diabetes are more likely to have high level of UA in the blood which is root cause of the gout. Therefore, improving the insulin level in the blood may results in decreased sUA in overweight patients. The information for effectiveness of weight loss in clinical studies has not been previously evaluated in any systematic review. Therefore, this systematic review determined the pros and cons associated with weight loss in overweight and obese individuals with gout. In addition, the effect of weight loss on the dose-response relationship was assessed.
Rationale behind the research:
Objective:
To assess the benefits and harms associated with weight loss in overweight and obese patients with gout.
Study outcome measures:
Time points:
Short-term (<3 months), medium (3–12 months) and long-term (>12 months)
Study Outcomes
In conclusion, the available results are in favor of weight loss for overweight gout patients at medium-term/long-term follow-up for sUA, achieving sUA target and gout attacks. The present study suggests that a weight loss of >7 kg and/or >2 kg per week from either surgery or diet results in a beneficial effect on sUA at medium-term/long-term follow-up based on three studies and that weight loss of >3.5 kg showed beneficial effects on gout attacks at medium-term/long-term follow-up based on six studies. However, two studies reported that weight loss from bariatric surgery results is temporarily increased in sUA levels and gout attacks at short term.
A study conducted by Kang et al compared the gout patients who suffered gout attacks after the surgery with those who did not. They found that the first group had higher presurgical sUA and a more rapid and larger decrease in sUA 3 days after the surgery. Another study conducted by Dalbeth et al reported an extreme increase in sUA after 2 weeks from surgery, which may be due to renal dysfunction or metabolic effects from fasting or rapid weight loss (catabolic state). It is suggested that increase in sUA is linked to decrease in the estimated glomerular filtration rate (eGFR), thus affecting blood pressure due increased vascular stiffness. Therefore, reducing sUA may have beneficial effect on cardiovascular disease and diminished renal function. Gout attacks is also not well defined and was reported in various ways and over various follow-up times in earlier studies. Therefore, stating fewer gout attacks following weight loss is not very specific and not necessarily assessable in smaller sample sizes, or when attacks were not systematically assessed. Three studies did not focus at reduced frequency of attacks, of which Friedman et al did not report any baseline and Perez-Ruizet al did show less increase compared with control. Other studies can mask increasing number of attacks by reporting number of patients experiencing ≥1 attack over various follow-ups. Therefore, one could consider rating the evidence for gout attacks further down for indirectness.
Weight
loss for overweight/obese gout patients could be a beneficial treatment at
medium/long-term follow-ups. Future research focusing
at identifying the optimal magnitude and intensity of weight loss, the
preferred method of weight loss, including prevention of flare, which result in
a better effect, and which gout patients will benefit the most are warranted.
Ann Rheum Dis. 2017 Sep 2
Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies
Sabrina M Nielson et al.
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