Urate continuum: stages of clinical development

Urate continuum: stages of clinical development

A.E. Pikhlak A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow 

The article proposes and substantiates the concept of the urate continuum. The following clinical development stages are consistently described: normouricemic, hyperuricemic and gouty (autoinflammatory). The processes associated with the possible negative effect of uric acid (UA) on organs and tissues are considered within each stage. Thus, already at the stage of normouricemia with increased excretion of UA by the kidneys, uric acid nephropathy onset is possible. At the stage of hyperuricemia, an excessive amount of UA contributes to the development and aggravates the course of hypertension, coronary heart disease, metabolic syndrome, diabetes mellitus and a number of other socially significant diseases. At the stage of gout, all the factors associated with the transition of sodium urate from the dissolved form to the crystalline state (crystal-induced inflammation, tophi, etc.) are additionally added: qualitatively new physicochemical and pathophysiological processes with significant clinical manifestations arise in the body. Thus, the concept of the urate continuum allows to generalize the clinical picture as a whole and based on it, to offer treatment approaches for physicians of different specialties.

Keywords: uric acid, hyperuricemia, uric acid continuum, gout, allopurinol, auto-inflammatory disease, sodium urate, crystals.

For citation: Pikhlak A.E. Urate continuum: stages of clinical development. RMJ. 2023;7:2–5.