Hyperuricemia and osteoarthritis: Aspects of immunobiochemical interaction

The aim of this single‑center study was to investigate the relationship between hyperuricemia (HU) and biochemical and immunological parameters in patients with knee osteoarthritis (KOA).

Materials and methods. The study included 255 patients aged 40–75 years with a confirmed diagnosis of KOA, Kellgren – Lawrence radiological stages I–III, who provided informed consent. The mean age of the patients was 53.0±10.5 years, body mass index (BMI) was 28.8±6.7 kg/m² , and the median disease duration was 2 [0.8; 7] years. The following assessments were performed: questionnaire survey, laboratory testing, standard radiography, knee ultrasound, magnetic resonance imaging (MRI) of the target joint, and dual-energy X‑ray absorptiometry of the axial skeleton.

Results. HU was detected in 16.9 % of cases. These patients exhibited significantly higher values (p < 0.05 in all cases) for: pain on the visual analogue scale, total WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, including all its components, and general health status, as well as worse scores on the KOOS (Knee injury and Osteoarthritis Outcome Score), compared with participants without HU. Furthermore, elevated uric acid levels were significantly associated with higher incidence of synovitis, neuropathic pain component, advanced radiological stages, and more severe joint structural damage on MRI (WORMS (WholeOrgan Magnetic Resonance Imaging Score)). However, after adjusting for BMI and waist circumference (WC), these differences lost statistical significance. At the same time, patients with HU showed higher bone mineral density values in the proximal femur and a higher prevalence of coronary artery disease. Additionally, associations were found with higher levels of triglycerides, creatinine, alkaline phosphatase, and lower levels of high-density lipoprotein (p < 0.05 in all cases). No associations were found with pro- and anti-inflammatory cytokines (interleukin (IL) 1β, IL-6, IL-10, IL-34), metalloproteinase (MMP) 3, MMP-9, markers of cartilage and bone tissue degradation (CTX-I, CTX-II, COMP), or C‑reactive protein.

Conclusion. The relationship between HU and KOA severity is most likely indirect and is determined by excess body weight and visceral obesity (as indicated by WC). The lack of associations between HU and CRP levels, pro‑inflammatory cytokines, and cartilage degradation markers suggests that uric acid does not have a direct effect on these parameters in patients with KOA.

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