Increased serum uric acid levels are associated with digital ulcers in patients with systemic sclerosis
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Endothelial injury/dysfunction is thought to be one of the earliest events in the development of vascular diseases in systemic sclerosis (SSc). Although hyperuricemia is also known to induce endothelial dysfunction and vascular inflammation, the effect of uric acid on the microvascular involvement in SSc has not been well established. We investigated whether increased serum uric acid (SUA) levels are associated with digital ulcers (DUs) in SSc. In this cross-sectional study, we consecutively recruited 71 women with SSc and 349 age- and sex-matched healthy subjects, and SUA levels were measured in all study subjects. SSc patients had significantly higher mean SUA levels than healthy subjects (4.5 ± 1 mg/dL vs 4.2 ± 0.9 mg/dL, p = 0.017), although a significantly lower body mass index (BMI) was observed in SSc patients than in controls. Among 71 SSc patients, 22 (31%) had DUs ever (active DUs, 8; healed DUs, 14). SSc patients presenting with DUs ever showed significantly higher SUA levels than those without this feature (median, 5.2 mg/dL vs 4.1 mg/dL, p = 0.009). In multivariable logistic regression models adjusted for confounders such as BMI and estimated glomerular filtration rate, increased SUA levels were associated with a significantly higher risk for the presence of DUs ever (OR 2.3, 95% CI 1.16–4.57, p = 0.018). Our data revealed that elevated SUA levels are independently associated with the presence of DUs in SSc patients, thereby suggesting the potential role of hyperuricemia in the pathogenesis of SSc vasculopathy.
KeywordsSystemic scleroderma Uric acid Ulcers Vascular endothelium
We specially thank the late Professor Sung-Il Kim who devoted himself to education, research, and patient care in Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine (1963 to 2011).
EK: study design, data collection, analysis and interpretation and writing manuscript, HNL: data collection and analysis, YKK: data interpretation, GTK: data interpretation, MWS: data analysis and interpretation, EA: data analysis and interpretation, DHS: revision of manuscript, SGL: study design, data analysis and interpretation, writing manuscript and coordination of entire study.
Compliance with ethical standards
Conflict of interest
The authors have declared no conflicts of interest.
The present study was approved by the Research and Ethical Review Board of Pusan National University Hospital (IRB no. H-1402-005-014). All study participants provided written informed consent in accordance with the principles of the Declaration of Helsinki.
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