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At the crossroads of gout and psoriatic arthritis: “psout”

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Abstract

Psoriatic arthritis and gout are frequently encountered conditions sharing a number of common risk factors, which render their independent study difficult. Epidemiological studies have demonstrated a strong link between these diseases, suggesting the presence of underlying, intertwined pathophysiological mechanisms that currently remain unknown. Indeed, sodium urate crystals could play a pathogenic role in psoriasis and psoriatic arthritis. In daily practice, the distinction between psoriatic arthritis associated with hyperuricemia and a gouty arthropathy with psoriasis is complex. Several common pathogenic features suggest a more intricate relationship than their mere coexistence in the same patient. Thus, the concurrence of these two diseases should be seen as a novel overlap syndrome, at the boundary between inflammatory and metabolic rheumatism. The present update aims to clarify the determinants of the link and to define this new nosological entity. Its recognition could have therapeutic implications that appear essential for treatment optimization in a personalized setting.

Key Points

• What is already known about this subject? Psoriatic arthritis (PsA) and gout have strong interconnections, including comorbidities and pathophysiology. One must note that confounding clinical symptoms and radiological signs of PsA and gout are similar and difficult to differentiate in patients whose radiological lesions become too advanced to be differentiated or with less clearly defined phenotypes.

• What does this study add? The pathogenic role of chronic hyperuricemia in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These two pathological processes can influence each other.

• How might this impact on clinical practice? This new line of thinking regarding the convergence of gout and PsA, involving the role of urate crystals, could prompt a potential new approach to treatment (urate-lowering therapy) among patients with active/refractory PsA.

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Abbreviations

bDMARD:

Biological disease-modifying antirheumatic drug

csDMARD:

Conventional synthetic disease-modifying antirheumatic drug

MSU:

Monosodium urate

MTP:

Metatarsophalangeal

NSAID:

Non-steroidal anti-inflammatory drug

PsA:

Psoriatic arthritis

PUVA:

Psoralen and ultraviolet A

SUA:

Serum uric acid

Tx:

Treatment

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Authors and Affiliations

  1. Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France

    Renaud Felten, Pierre-Marie Duret & Jacques-Eric Gottenberg

  2. Laboratoire d’Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France

    Renaud Felten & Jacques-Eric Gottenberg

  3. Service de Rhumatologie, Hospices Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar Cedex, France

    Lionel Spielmann & Laurent Messer

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  1. Renaud Felten
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Contributions

RF, PMD, LS, and LM: conception of the concept of “psout,” article design, manuscript writing, drafting, and revision.

JEG: article design, manuscript drafting, and revision.

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Correspondence to Renaud Felten.

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Felten, R., Duret, PM., Gottenberg, JE. et al. At the crossroads of gout and psoriatic arthritis: “psout”. Clin Rheumatol 39, 1405–1413 (2020). https://doi.org/10.1007/s10067-020-04981-0

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