Serum uric acid as biomarker for mania: An exploratory prospective study

Bipolar Disorder is a major mental illness characterized by episodic occurrence of mood symptoms which can be of mania, depression or a mixed episode. The role of Uric Acid in the etiopathogenesis of episodic mental illnesses might be considered recognized long back in 19th century. Lithium was used as treatment for gouty arthritis and that in some cases helped to control mental illnesses. Multiple role of uric acid in the Central Nervous System have been recognized now. In the present study 30 patients in manic episodes were included and their serum Uric Acid level was compared to age and sex matched healthy controls twice at the interval of three weeks. It was found that Uric Acid level of cases was significantly higher than in controls before the initiation of treatment. Uric Acid level of manic group showed a significant decline after three weeks of treatment initiation. There was no significant change in Uric Acid level of control group after three weeks Serum Uric Acid levels are elevated during manic phase of Bipolar Disorder and decreases after initiation of treatment. There may be more research to find whether uric acid can be considered a biomarker for Bipolar illnesses and also an indicator for treatment response.

Efficacy of Chinese herbal medicine Jiangniaosuan formula for treatment of hyperuricemia: study protocol for a double-blinded non-inferiority randomized controlled clinical trial

Background Jiangniaosuan formula (JNSF) is commonly used in China for treating hyperuricemia, but there is little research-based evidence to support its use. This randomized controlled trial aims to assess the efficacy and safety of JNSF. Methods A total of 72 patients with hyperuricemia will be selected and randomly assigned in a ratio of 1:2 to receive either Western medicine, i.e., febuxostat 40 mg (WG group; n = 24), or Chinese herbal medicine, i.e., Jiangniaosuan formula + febuxostat 20 mg (WJNSG group; n = 48). After 12 weeks, the WJNSG will be randomly divided into two groups of 24 patients each; one group (WJNSG; n = 24) still will receive febuxostat 20 mg + Jiangniaosuan formula, and the other group (JNSG; n = 24) will continue to receive Jiangniaosuan formula + placebo. Participants will be followed up at 4-week intervals. The primary outcome will be the change in serum uric acid level, and the secondary outcome will be the change in traditional Chinese medicine (TCM) syndrome scores. Serum creatinine, blood glucose, and insulin levels will also be measured. Discussion We hypothesize that patients with hyperuricemia will benefit from JNSF. This study will provide evidence-based recommendations for clinicians. Dissemination The results will be published in a peer-reviewed journal and disseminated by academic conferences. The datasets analyzed during the current study are available from the corresponding author on reasonable request. Trial registration Chinese Clinical Trials Register ChiCTR2000041083. Registered on 3 May 2021. The protocol version number is V3.0, 20210301.

Uric Acid: Friend or Foe?

Introduction. Adverse Pregnancy outcomes (APO) continue to trouble physicians worldwide, and uric acid has become a marker of interest in its prediction. Despite this, the correlation of uric acid in the third trimester is rarely studied, and the reference value for normal uric acid levels in pregnancy has yet to be established. This study was done to evaluate the association of uric acid levels in the third trimester of pregnancy and the development of APO, specifically gestational hypertension (GH), pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA) and to determine a cut-off value of serum uric acid levels for screening of the APO. Materials and methods. A retrospective observational study was conducted among 374 women who delivered at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and developed the APO of interest and had serum uric acid levels taken during the third trimester of pregnancy. A cut off value of 309 µmol/L was used to assess the sensitivity and specificity in predicting the APO. Results. Associations are observed between 309 µmol/L and the development of GH (p<0.0005), PE (p<0.0005), GDM (p<0.0005), SGA (p=0.0264). Plotted ROC curves with cutoff point of 309 µmol/L demonstrated moderate predictive value of serum uric acid and the development of GH (AUC 0.639), PE (AUC 0.713), SGA (AUC 0.649) and low predictive value for GDM (AUC 0.4). Conclusion. Serum uric acid level of 309 µmol/L in the third trimester of pregnancy is a moderate predictor of GH, PE, SGA and a poor predictor of GDM. KEYWORDS: Uric acid; pregnancy trimester, third; pregnancy outcome

Dietary Inflammatory Index and the Risk of Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents

Background: Dietary Inflammatory Index (DII) scores have been consistently associated with several chronic diseases. This study explored the correlation between the DII and hyperuricemia in Chinese adult residents. Methods: The study included 7880 participants from the China Health and Nutrition Survey (CHNS), which was taken in in 2009. A 3-day 24 h meal review method was used to collect diet data and to calculate the DII score. Serum uric acid was obtained to determine hyperuricemia levels. Subjects were divided into a hyperuricemia group and a non-hyperuricemia group, according to their serum uric acid level. Multilevel logistic regression models were used to examine the association between DII scores and hyperuricemia. Results: After adjusting for covariates, a higher DII score was determined to be associated with a higher risk of hyperuricemia. Compared to those in the highest DII score group, the lower DII score group had an inverse association with hyperuricemia risk (Q2: 0.83, 95% CI: 0.70–0.99; Q3: 0.72, 95% CI: 0.60–0.86; Q4: 0.73, 95% CI: 0.61–0.88). The intake of energy-adjusted protein, total fat, MUFAs, PUFAs and saturated fatty acid was higher in the hyperuricemia group. Conclusions: A higher DII score is significantly associated with a higher risk of hyperuricemia. Controlling the intake of pro-inflammatory food may be beneficial to reduce the risk of hyperuricemia.

Effect of colchicine, methotrexate, and hydroxychloroquine therapy on cardiovascular outcomes in patients with calcium pyrophosphate crystal deposition disease

Anti-inflammatory therapy, such as colchicine (COL), has been suggested to affect the incidence of cardiovascular events in patients with calcium pyrophosphate crystal deposition disease (CPPD).Objective: to study the effect of anti-inflammatory therapy with COL, hydroxychloroquine (HC), and methotrexate (MT) on cardiovascular outcomes in patients with CPPD.Patients and methods. The study included 305 patients with CPPD, the majority (62.30%) were women. The average follow-up period was 3.9±2.7 years. Among factors influencing cardiovascular outcome were considered: gender; age; smoking; alcohol intake >20 conventional doses per week; arterial hypertension; a history of cardiovascular diseases (CVD), in particular ischemic heart disease, acute myocardial infarction, acute cerebrovascular accident, chronic heart failure >III stage according to NYHA, as well as type 2 diabetes mellitus (DM); body mass index >25 kg/m2 and >30 kg/m2; cholesterol level (CHOL) >5.1 mmol/l; glomerular filtration rate (GFR) < 60 ml/min/1.73 m2; serum uric acid level >360 μmol/l; hypercalcemia (serum calcium level >2.62 mmol/L); CRP level >2 mg/l; the presence of hyperparathyroidism (parathyroid hormone level >65 pg/ml); CPPD phenotypes (asymptomatic, osteoarthritis with calcium pyrophosphate crystals, chronic arthritis, acute arthritis); intake of COL, HC, MT, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs).Results and discussion. 264 patients were under dynamic observation. Any of the studied cardiovascular events were registered in 79 (29.9%) patients. During the observation period, 46 (17.4%) patients died, in 76.1% of cases the cause of death was CVD. Death from other causes was diagnosed in 11 (23.9%) patients. Non-fatal cardiovascular events were reported in 44 (16.7%) cases. The risk of cardiovascular events was higher in patients over 65 years of age (odds ratio, OR 5.97; 95% confidence interval, CI 3.33–10.71), with serum cholesterol levels ≥5.1 mmol/L (OR 1,95; 95% CI 1.04–3.65), GFR <60 ml/min/1.73 m2 (OR 2.78; 95% CI 1.32–5.56), history of CVD (OR 2,32; 95% CI 1.22–4.44). COL therapy reduced the risk of cardiovascular events (OR 0.20; 95% CI 0.11–0.39).Conclusion. Poor CVD outcomes in CPPD are associated with age, hypercholesterolemia, chronic kidney disease, and a history of CVD. The use of COL, in contrast to MT and HC, was accompanied by a decrease in cardiovascular risk.

U-Shaped Association Between Serum Uric Acid Level and Hypertensive Heart Failure: A Genetic Matching Case-Control Study

Background: Heart failure (HF) is a global pandemic and lays an added burden on public healthcare. Previous studies indicated that high and low serum uric acid levels are associated with worse outcomes in many diseases. Reduced serum uric acid may not result in a better outcome.Methods: A comparative, matched cross-sectional study design was implemented. The matching variables were age, sex, BMI, BP, and histories of CKD, CVD, diabetes mellitus, stroke, hyperlipidemia. We reviewed the electronic medical records to identify patients diagnosed with hypertension or hypertensive heart failure (HHF) admitted to Beijing Hospital's cardiology department.Results: The median age of the two groups after matching are 71. There are 55.6% males in the hypertension group and 53.8% in the heart failure group. Univariate logistic regression analysis showed that UA's quadratic term is significant (OR = 1.00, 95% CI 1.00 to 1.00; P = 0.03), which indicated a u-shaped relationship between hypertension and HHF. FBS (OR = 0.22, 95% CI 0.05 to 0.95, p = 0.07) and HDL (OR = 1.23, 95% CI 1.00 to 1.54, P = 0.05) were not significant but close.Conclusion: Our results supported that both low and high uric acid levels were predictive of hypertensive heart failure. Besides, high-density lipoprotein cholesterol and fasting blood sugar were also associated with hypertensive heart failure. Low-density lipoprotein cholesterol was not associated with hypertensive heart failure.

Effects of washed microbiota transplantation on serum uric acid levels, symptoms and intestinal barrier function in patients with acute and recurrent gout: a pilot study

Introduction: Gut dysbiosis has been reported to be closely associated with gout. Washed microbiota transplantation (WMT) is considered as an effective way to restore a healthy gut microbiota with less adverse events than the conventional fecal microbiota transplantation. In this study, we aimed to evaluate the effects of WMT on serum uric acid levels, symptoms and the intestinal barrier function in patients with acute and recurrent gout. Methods: We performed a pilot study of WMT for acute and recurrent gout. The primary outcome was the changes in serum uric acid level and gout symptoms. The secondary outcomes included the changes in levels of diamine oxidase (DAO), D-lactic acid and endotoxin. Results: Eleven patients received WMT treatment. The averaged serum uric acid levels in patients with gout reduced after WMT (P = 0.031), accompanied with a decrease in the frequency and duration time of acute gout flares (P < 0.01). The levels of DAO, D-lactic acid and endotoxin were higher in patients than in healthy donors (P < 0.05). After WMT treatment, the levels of DAO and endotoxin decreased (P < 0.05). Conclusions: WMT is effective for reducing serum uric acid levels and improving gout symptoms in patients with gout, and contributes to improve their impaired intestinal barrier function.