Rheumatology International

, Volume 31, Issue 4, pp 485–491 | Cite as

Prevalence of insulin resistance and metabolic syndrome in patients with gouty arthritis

  • Han-Gyul Yoo
  • Sang-Il Lee
  • Han-Jung Chae
  • Seoung Ju Park
  • Yong Chul Lee
  • Wan-Hee Yoo
Original Article


The study was performed to confirm the high prevalence of metabolic syndrome in gouty patients and to define the relationship between insulin resistance and gouty arthritis. We recruited 83 patients with gouty arthritis and checked clinical factors according to the diagnostic criteria of metabolic syndrome from the ATP III guidelines and WHO Asia-Pacific obesity criteria recommendations. We also assessed the clinical characteristics of subjects and homeostasis model assessment of insulin resistance (HOMA-IR) and compared with previous study groups as controls. The prevalence of metabolic syndrome in patients with gout was 30.1% according to ATP III criteria and 50.6% with WHO Asia-Pacific adjustment and is significantly higher than the previous control study groups (ATP III: 5.2, 10.6%, WHO Asia-Pacific adjustment: 9.8, 13.9%). The mean value of HOMA-IR in patients with gout was 2.63 ± 1.36 and is significantly higher than control study (1.91 ± 1.01, P < 0.05). There were significant correlations between 24-h urinary uric acid excretion and waist circumference (r 2 = 0.225, P = 0.049), fasting insulin (r 2 = 0.241, P = 0.035), and insulin resistance (HOMA-IR) (r 2 = 0.271, P = 0.017). There were significant correlations between insulin resistance and waist circumference (r 2 = 0.341, P < 0.01), BMI (r 2 = 0.390, P < 0.01). The value of HOMA-IR (insulin resistance) and the prevalence of metabolic syndrome in patients with gout are significantly higher than normal healthy control groups. The hyperuricemia in gout might be caused by the increased adiposity associated with insulin resistance.


Gout Insulin resistance Metabolic syndrome 



This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A084144).


  1. 1.
    Emmerson B (1998) Hyperlipidaemia in hyperuricaemia and gout. Ann Rheum Dis 57(9):509–510PubMedCrossRefGoogle Scholar
  2. 2.
    Fam AG (2002) Gout, diet, and the insulin resistance syndrome. J Rheumatol 29(7):1350–1355PubMedGoogle Scholar
  3. 3.
    Choi HK, Mount DB, Reginato AM; American College of Physicians; American Physiological Society (2005) Pathogenesis of gout. Ann Intern Med 143(7):499–516Google Scholar
  4. 4.
    Vázquez-Mellado J, García CG, Vázquez SG, Medrano G, Ornelas M, Alcocer L, Marquez A, Burgos-Vargas R (2004) Metabolic syndrome and ischemic heart disease in gout. J Clin Rheumatol 10(3):105–109PubMedCrossRefGoogle Scholar
  5. 5.
    Rho YH, Choi SJ, Lee YH, Ji JD, Choi KM, Baik SH, Chung SH, Kim CG, Choe JY, Lee SW, Chung WT, Song GG (2005) The prevalence of metabolic syndrome in patients with gout: a multicenter study. J Korean Med Sci 20(6):1029–1033PubMedCrossRefGoogle Scholar
  6. 6.
    Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ (2004) Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 65(2):143–149PubMedCrossRefGoogle Scholar
  7. 7.
    Rho YH, Choi SJ, Lee YH, Ji JD, Choi KM, Baik SH, Song GG (2004) Prevalence of the metabolic syndrome in patients with gout. J Korean Rheum Assoc 11(4):349–357Google Scholar
  8. 8.
    Trevisan M, Liu J, Bahsas FB, Menotti A (1998) Syndrome X and mortality: a population-based study. Risk Factor and Life Expectancy Research Group. Am J Epidemiol 148(10):958–966PubMedGoogle Scholar
  9. 9.
    Ford ES (2005) Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28(7):1769–1778PubMedCrossRefGoogle Scholar
  10. 10.
    Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST (1995) Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity-insulin resistance syndrome. The Normative Aging Study. Am J Epidemiol 142(3):288–294PubMedGoogle Scholar
  11. 11.
    Rathmann W, Funkhouser E, Dyer AR, Roseman JM (1998) Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Coronary artery risk development in young adults. Ann Epidemiol 8(4):250–261PubMedCrossRefGoogle Scholar
  12. 12.
    Facchini F, Chen YD, Hollenbeck CB, Reaven GM (1991) Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 266(21):3008–3011PubMedCrossRefGoogle Scholar
  13. 13.
    Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20(3):895–900PubMedCrossRefGoogle Scholar
  14. 14.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419PubMedCrossRefGoogle Scholar
  15. 15.
    Park SH, Lee WY, Kim SW (2003) The relative risks of the metabolic syndrome defined by adult treatment panel 3 according to insulin resistance in Korean population. Korean J Med 64(5):552–561Google Scholar
  16. 16.
    National Institutes of Health (2001) Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). NIH Publication 01-3670. National Institutes of Health, BethesdaGoogle Scholar
  17. 17.
    Steering Committee of the WHO Western Pacific Region, IASO & IOTF (2000) The Asia-Pacific perspective: Redefining obesity and its treatment. Steering Committee of the WHO Western Pacific Region, IASO & IOTF, AustraliaGoogle Scholar
  18. 18.
    Park JS, Park HD, Yun JW, Jung CH, Lee WY, Kim SW (2002) Prevalence of the metabolic syndrome as defined by NCEP—ATPIII among the urban Korean population. Korean J Med 63(3):290–299Google Scholar
  19. 19.
    Lebovitz HE (2001) Insulin resistance: definition and consequences. Exp Clin Endocrinol Diabetes 109:S135–S148PubMedCrossRefGoogle Scholar
  20. 20.
    Bogardus C, Lillioja S, Mott DM, Hollenbeck C, Reaven G (1985) Relationship between degree of obesity and in vivo insulin action in man. Am J Physiol 248:E286–E291PubMedGoogle Scholar
  21. 21.
    Lin KC, Lin HY, Chou P (2000) Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kinmen. J Rheumatol 27(4):1045–1050PubMedGoogle Scholar
  22. 22.
    Kim EH, Jeon KM, Park KW, Kim HJ, Ahn JK, Jeon CH, Cha HS, Koh EM (2004) The prevalence of gout among hyperuricemic population. J Korean Rheum Assoc 11(1):7–13Google Scholar
  23. 23.
    Vuorinen-Markkola H, Yki-Järvinen H (1994) Hyperuricemia and insulin resistance. J Clin Endocrinol Metab 78(1):25–29PubMedCrossRefGoogle Scholar
  24. 24.
    Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O (1998) Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. Eur J Endocrinol 138(1):63–69PubMedCrossRefGoogle Scholar
  25. 25.
    Rocić B, Vucić-Lovrencić M, Poje N, Bertuzzi F (2005) Uric acid may inhibit glucose-induced insulin secretion via binding to an essential arginine residue in rat pancreatic beta-cells. Bioorg Med Chem Lett 15(4):1181–1184PubMedCrossRefGoogle Scholar
  26. 26.
    Hara H, Egusa G, Yamakido M (1996) Incidence of non-insulin-dependent diabetes mellitus and its risk factors in Japanese-Americans living in Hawaii and Los Angeles. Diabet Med 13(6):S133–S142PubMedGoogle Scholar
  27. 27.
    Lin KC, Tsai ST, Lin HY, Chou P (2004) Different progressions of hyperglycemia and diabetes among hyperuricemic men and women in the kinmen study. J Rheumatol 31(6):1159–1165PubMedGoogle Scholar
  28. 28.
    Chou P, Li CL, Wu GS, Tsai ST (1998) Progression to type 2 diabetes among high-risk groups in Kin-Chen, Kinmen. Exploring the natural history of type 2 diabetes. Diabetes Care 21(7):1183–1187PubMedCrossRefGoogle Scholar
  29. 29.
    Nakanishi N, Okamoto M, Yoshida H, Matsuo Y, Suzuki K, Tatara K (2003) Serum uric acid and risk for development of hypertension and impaired fasting glucose or Type II diabetes in Japanese male office workers. Eur J Epidemiol 18(6):523–530Google Scholar
  30. 30.
    Taniguchi Y, Hayashi T, Tsumura K, Endo G, Fujii S, Okada K, Taniguchi Y, Hayashi T, Tsumura K, Endo G, Fujii S, Okada K (2001) Serum uric acid and the risk for hypertension and Type 2 diabetes in Japanese men: The Osaka Health Survey. J Hypertens 19(7):1209–1215PubMedCrossRefGoogle Scholar
  31. 31.
    Bakker SJ, Gans RO, ter Maaten JC, Teerlink T, Westerhoff HV, Heine RJ (2001) The potential role of adenosine in the pathophysiology of the insulin resistance syndrome. Atherosclerosis 155(2):283–290PubMedCrossRefGoogle Scholar
  32. 32.
    Roubenoff R, Klag MJ, Mead LA, Liang KY, Seidler AJ, Hochberg MC (1991) Incidence and risk factors for gout in white men. JAMA 266(21):3004–3007PubMedCrossRefGoogle Scholar
  33. 33.
    Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 59(7):539–543PubMedCrossRefGoogle Scholar
  34. 34.
    Boden G (1996) Fatty acids and insulin resistance. Diabetes Care 19(4):394–395PubMedCrossRefGoogle Scholar
  35. 35.
    Boden G (1997) Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes 46(1):3–10PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Han-Gyul Yoo
    • 1
  • Sang-Il Lee
    • 2
  • Han-Jung Chae
    • 3
    • 5
  • Seoung Ju Park
    • 4
    • 5
  • Yong Chul Lee
    • 4
    • 5
  • Wan-Hee Yoo
    • 4
    • 5
  1. 1.Department of Pharmacy PracticeUniversity of Rhode IslandKingstonUSA
  2. 2.Department of Internal MedicineGyeongsang National University School of MedicineJinjuSouth Korea
  3. 3.Department of PharmacologyChonbuk National University Medical SchoolJeonjuSouth Korea
  4. 4.Department of Internal MedicineChonbuk National University Medical School and Research Institute of Clinical MedicineJeonjuSouth Korea
  5. 5.Research Center for Pulmonary DisordersChonbuk National University Medical School and Research Institute of Clinical MedicineJeonjuSouth Korea

Personalised recommendations