array:23 [
  "pii" => "S1699258X19300294"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2019.01.001"
  "estado" => "S300"
  "fechaPublicacion" => "2021-01-01"
  "aid" => "1318"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Reumatol Clin. 2021;17:55-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5
    "formatos" => array:2 [
      "HTML" => 3
      "PDF" => 2
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1699258X19300087"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2018.12.003"
    "estado" => "S300"
    "fechaPublicacion" => "2021-01-01"
    "aid" => "1314"
    "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Reumatol Clin. 2021;17:56-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8
      "HTML" => 8
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
      "titulo" => "Valvulopat&#237;a en la esclerodermia&#44; no siempre es autoinmunidad"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "56"
          "paginaFinal" => "57"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Valvulopathy in scleroderma is not always autoimmunity"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1590
              "Ancho" => 1583
              "Tamanyo" => 121418
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen de PET-TC con 18F-FDG que muestra captaci&#243;n presacra con escasa avidez gluc&#237;dica&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luc&#237;a Su&#225;rez P&#233;rez, Luis Caminal Montero, Luis Trapiella Mart&#237;nez, Jessica Rugeles Ni&#241;o"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Luc&#237;a"
              "apellidos" => "Su&#225;rez P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Caminal Montero"
            ]
            2 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Trapiella Mart&#237;nez"
            ]
            3 => array:2 [
              "nombre" => "Jessica"
              "apellidos" => "Rugeles Ni&#241;o"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574320300010"
        "doi" => "10.1016/j.reumae.2018.12.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300010?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19300087?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001700000001/v1_202101090658/S1699258X19300087/v1_202101090658/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1699258X19301056"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2019.05.005"
    "estado" => "S300"
    "fechaPublicacion" => "2021-01-01"
    "aid" => "1347"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2021;17:52-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2
      "HTML" => 2
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
      "titulo" => "S&#237;ndrome confusional y vasculitis retiniana"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "52"
          "paginaFinal" => "54"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Confusional syndrome and retinal vasculitis"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 669
              "Ancho" => 900
              "Tamanyo" => 42884
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Angiofluoresceingrafia&#58; Isquemia en &#225;rea temporal&#44; oclusi&#243;n arterial y vasculitis activa en polo nasal&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luc&#237;a Su&#225;rez-P&#233;rez, Sara E&#46; Herrero Su&#225;rez, Jorge Pe&#241;a Su&#225;rez, Luis Caminal-Montero"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Luc&#237;a"
              "apellidos" => "Su&#225;rez-P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "Sara E&#46;"
              "apellidos" => "Herrero Su&#225;rez"
            ]
            2 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Pe&#241;a Su&#225;rez"
            ]
            3 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Caminal-Montero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574320301726"
        "doi" => "10.1016/j.reumae.2019.05.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301726?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19301056?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001700000001/v1_202101090658/S1699258X19301056/v1_202101090658/es/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Revisiting the association between systemic lupus erythematosus and gout"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "55"
        "paginaFinal" => "56"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisca Aguiar, Iva Brito, Jean Sibilia"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Francisca"
            "apellidos" => "Aguiar"
            "email" => array:1 [
              0 => "francisca.ra@hotmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Iva"
            "apellidos" => "Brito"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jean"
            "apellidos" => "Sibilia"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Department&#44; of Rheumatology&#44; Centro Hospitalar S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Faculty of Medicine of Porto University&#44; Porto&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Rheumatology&#44; University Hospital of Strasbourg&#44; France"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centre National de R&#233;f&#233;rence &#8220;Maladies auto-immunes syst&#233;miques rares&#8221;&#44; France"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Revisitando la asociaci&#243;n entre lupus eritematoso sist&#233;mico y gota"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the literature there have been few case reports of systemic lupus erythematosus &#40;SLE&#41; and gout occurring concomitantly in the same patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a> Hyperuricaemia is relatively frequent in SLE&#44; with a reported prevalence of 25&#8211;41&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> for which there are several predisposing factors&#58; many patients have nephritis and renal insufficiency&#44; receive diuretics and some are on low-dose aspirin&#44; all contributing to decreased uric acid excretion&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a> Nevertheless&#44; they rarely develop gout clinically&#46; Besides age and gender distribution of both diseases&#44; many other factors may play a role in this association&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">First&#44; it is known that the inflammatory response in acute gouty arthritis largely arises from the interaction between polymorphonuclear leukocytes and monosodium urate &#40;MSU&#41; crystals&#46; In SLE&#44; it has been demonstrated that these cells have impaired chemotactic activity and phagocytosis&#44; which may hamper the reaction to MSU crystals&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly&#44; it is thought that complement plays an important role in the pathogenesis of gouty arthritis&#44; as MSU crystals activate both classical and alternative pathways of complement in synovial fluid&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> As active SLE is characterized by decreased serum and synovial complement levels&#44; in these situations it is expected that inflammatory response to MSU crystals will be impaired&#46; This view is further supported by the fact that most cases of gout occur when SLE is quiescent&#44; with complement levels in the normal range&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Alterations in the structure of MSU crystals may provide another explanation&#46; It has been demonstrated that Apo B lipoprotein binds to the crystal surface&#44; thereby physically inhibiting particle&#8211;cell interaction and subsequent phagocytosis of MSU and membrane activation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Apo B lipoprotein levels may be elevated in SLE&#44; by a process that can be related to the disease itself and&#47;or induced by corticosteroids&#44; one of the cornerstone treatments in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Additionally&#44; it is well known that corticosteroids are powerful suppressors of the inflammatory response&#44; blocking vasodilatation and increased vascular permeability and reducing neutrophils chemotaxis and phagocytosis&#44; and likely impede clinical typical gout attacks&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Furthermore&#44; in clinical practice routine microscopy evaluation of synovial fluid is unfortunately underused&#44; so gout attacks may be misdiagnosed as lupus arthritis flares&#46; Consequently&#44; gout diagnosis is late&#44; with high rates of tophaceous forms&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">More recently&#44; the knowledge about inflammasome contribution to the pathogenesis of certain diseases has progressed&#46; Inflammasome is a term used to describe multimeric cytoplasmic protein complexes that detect pathogen-associated and danger-associated molecular patterns &#40;PAMPS and DAMPs respectively&#41; and mediate the activation of caspase-1&#44; the primary enzyme responsible for activation of the pro-inflammatory cytokines IL-1&#946; and IL-18&#46; Several types of inflammasomes exist&#44; but the best studied is the Nod-like receptor protein 3 &#40;NLRP3&#41; inflammasome&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> The importance of inflammasome and IL-1 &#946; activation in gout is clearly established&#44; however in SLE it is an emerging concept&#46; It is noteworthy that both uric acid and DNA are DAMPs&#44; and both induce NLRP3 inflammasome&#44; although the exact molecular details of this pathway in both conditions are not entirely known&#46; It has been demonstrated that NLRP3 plays an important role in lupus nephritis animal models&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Moreover&#44; it has been shown that anti-dsDNA antibodies activate NLRP3 inflammasome in monocytes&#47;macrophages by binding to toll-like receptor 4 and inducing the production of mitochondrial reactive oxygen species&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> As gout and SLE share this pathway in their pathogenesis&#44; that appears to be related with SLE activity and nephritis&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a> it seems reasonable to think that it could play a role in the interplay between both diseases&#46; As previously stated&#44; gout attacks are less common in active lupus&#46; The authors hypothesize there could be a counterregulatory mechanism in inflammasome pathway&#46; However&#44; further research is needed to clarify this subject&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A strong association between gout and diuretic use among lupus patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Wise"
                            1 => "E&#46; Lewis"
                            2 => "P&#46; Khanna"
                            3 => "L&#46; Zhao"
                            4 => "W&#46;J&#46; McCune"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2015"
                        "volumen" => "67"
                        "numero" => "Suppl&#46; 10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AB0890 systemic lupus erythematosus and gout&#58; really an unusual association&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Quilis"
                            1 => "M&#46; Andr&#233;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2017"
                        "volumen" => "76"
                        "paginaInicial" => "1367"
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356519305270"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic lupus erythematosus and gouty arthritis&#58; an uncommon association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Bajaj"
                            1 => "B&#46;J&#46; Fessler"
                            2 => "G&#46;S&#46; Alarc&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2004"
                        "volumen" => "43"
                        "paginaInicial" => "349"
                        "paginaFinal" => "352"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gout in systemic lupus erythematosus and overlap syndrome &#8211; a hospital based-study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;H&#46; Ho"
                            1 => "J&#46;L&#46; Lin"
                            2 => "Y&#46;J&#46;J&#46; Wu"
                            3 => "K&#46;H&#46; Yu"
                            4 => "J&#46;Y&#46; Chen"
                            5 => "S&#46;F&#46; Luo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "295"
                        "paginaFinal" => "298"
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356516304384"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunoglobulin G independent activation of the classical complement pathway by monosodium urate crystals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;C&#46; Giclas"
                            1 => "M&#46;H&#46; Ginsberg"
                            2 => "N&#46;R&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI109360"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "1979"
                        "volumen" => "63"
                        "paginaInicial" => "759"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/438335"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970502913X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dyslipidemia in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Szodoray"
                            1 => "E&#46; Kiss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12026-016-8892-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Immunol Res"
                        "fecha" => "2017"
                        "volumen" => "65"
                        "paginaInicial" => "543"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28168401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Inflammasome and lupus &#8211; another innate immune mechanism contributing to disease pathogenesis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Kahlenberg"
                            1 => "M&#46;J&#46; Kaplan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Opin Rheumatol"
                        "fecha" => "2014"
                        "volumen" => "26"
                        "paginaInicial" => "475"
                        "paginaFinal" => "481"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of the NLRP3 inflammasome in gout"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;R&#46; Kingsbury"
                            1 => "P&#46;G&#46; Conaghan"
                            2 => "M&#46;F&#46; McDermott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/JIR.S11330"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Inflamm Res"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "39"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22096368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deregulated NLRP3 and NLRP1 inflammasomes and their correlations with disease activity in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Yang"
                            1 => "C&#46; Yu"
                            2 => "Z&#46; Yang"
                            3 => "Q&#46; Wei"
                            4 => "K&#46; Mu"
                            5 => "Y&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "444"
                        "paginaFinal" => "452"
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508517300914"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-dsDNA antibodies bind to TLR4 and activate NLRP3 inflammasome in lupus monocytes&#47;macrophages"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Zhang"
                            1 => "R&#46; Fu"
                            2 => "C&#46; Guo"
                            3 => "Y&#46; Huang"
                            4 => "H&#46; Wang"
                            5 => "S&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12967-016-0911-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Transl Med"
                        "fecha" => "2016"
                        "volumen" => "14"
                        "paginaInicial" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27250627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001700000001/v1_202101090658/S1699258X19300294/v1_202101090658/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17506"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Cartas al editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001700000001/v1_202101090658/S1699258X19300294/v1_202101090658/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X19300294?idApp=UINPBA00004M"
]
Compartir
Información de la revista
Vol. 17. Núm. 1.
Páginas 55-56 (enero 2020)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 17. Núm. 1.
Páginas 55-56 (enero 2020)
Letter to the Editor
Acceso a texto completo
Revisiting the association between systemic lupus erythematosus and gout
Revisitando la asociación entre lupus eritematoso sistémico y gota
Visitas
2762
Francisca Aguiara,b,
Autor para correspondencia
francisca.ra@hotmail.com

Corresponding author.
, Iva Britoa,b, Jean Sibiliac,d
a Department, of Rheumatology, Centro Hospitalar São João, Porto, Portugal
b Faculty of Medicine of Porto University, Porto, Portugal
c Department of Rheumatology, University Hospital of Strasbourg, France
d Centre National de Référence “Maladies auto-immunes systémiques rares”, France
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Texto completo
Dear Editor,

In the literature there have been few case reports of systemic lupus erythematosus (SLE) and gout occurring concomitantly in the same patient.1–3 Hyperuricaemia is relatively frequent in SLE, with a reported prevalence of 25–41%,4 for which there are several predisposing factors: many patients have nephritis and renal insufficiency, receive diuretics and some are on low-dose aspirin, all contributing to decreased uric acid excretion.1–3 Nevertheless, they rarely develop gout clinically. Besides age and gender distribution of both diseases, many other factors may play a role in this association.

First, it is known that the inflammatory response in acute gouty arthritis largely arises from the interaction between polymorphonuclear leukocytes and monosodium urate (MSU) crystals. In SLE, it has been demonstrated that these cells have impaired chemotactic activity and phagocytosis, which may hamper the reaction to MSU crystals.4

Secondly, it is thought that complement plays an important role in the pathogenesis of gouty arthritis, as MSU crystals activate both classical and alternative pathways of complement in synovial fluid.5 As active SLE is characterized by decreased serum and synovial complement levels, in these situations it is expected that inflammatory response to MSU crystals will be impaired. This view is further supported by the fact that most cases of gout occur when SLE is quiescent, with complement levels in the normal range.1,3

Alterations in the structure of MSU crystals may provide another explanation. It has been demonstrated that Apo B lipoprotein binds to the crystal surface, thereby physically inhibiting particle–cell interaction and subsequent phagocytosis of MSU and membrane activation.3 Apo B lipoprotein levels may be elevated in SLE, by a process that can be related to the disease itself and/or induced by corticosteroids, one of the cornerstone treatments in these patients.6

Additionally, it is well known that corticosteroids are powerful suppressors of the inflammatory response, blocking vasodilatation and increased vascular permeability and reducing neutrophils chemotaxis and phagocytosis, and likely impede clinical typical gout attacks.3

Furthermore, in clinical practice routine microscopy evaluation of synovial fluid is unfortunately underused, so gout attacks may be misdiagnosed as lupus arthritis flares. Consequently, gout diagnosis is late, with high rates of tophaceous forms.2,4

More recently, the knowledge about inflammasome contribution to the pathogenesis of certain diseases has progressed. Inflammasome is a term used to describe multimeric cytoplasmic protein complexes that detect pathogen-associated and danger-associated molecular patterns (PAMPS and DAMPs respectively) and mediate the activation of caspase-1, the primary enzyme responsible for activation of the pro-inflammatory cytokines IL-1β and IL-18. Several types of inflammasomes exist, but the best studied is the Nod-like receptor protein 3 (NLRP3) inflammasome.7,8 The importance of inflammasome and IL-1 β activation in gout is clearly established, however in SLE it is an emerging concept. It is noteworthy that both uric acid and DNA are DAMPs, and both induce NLRP3 inflammasome, although the exact molecular details of this pathway in both conditions are not entirely known. It has been demonstrated that NLRP3 plays an important role in lupus nephritis animal models.9 Moreover, it has been shown that anti-dsDNA antibodies activate NLRP3 inflammasome in monocytes/macrophages by binding to toll-like receptor 4 and inducing the production of mitochondrial reactive oxygen species.10 As gout and SLE share this pathway in their pathogenesis, that appears to be related with SLE activity and nephritis,9,10 it seems reasonable to think that it could play a role in the interplay between both diseases. As previously stated, gout attacks are less common in active lupus. The authors hypothesize there could be a counterregulatory mechanism in inflammasome pathway. However, further research is needed to clarify this subject.

References
[1]
E. Wise, E. Lewis, P. Khanna, L. Zhao, W.J. McCune.
A strong association between gout and diuretic use among lupus patients.
Arthritis Rheumatol, 67 (2015),
[2]
N. Quilis, M. Andrés.
AB0890 systemic lupus erythematosus and gout: really an unusual association?.
Ann Rheum Dis, 76 (2017), pp. 1367
[3]
S. Bajaj, B.J. Fessler, G.S. Alarcón.
Systemic lupus erythematosus and gouty arthritis: an uncommon association.
Rheumatology (Oxford), 43 (2004), pp. 349-352
[4]
H.H. Ho, J.L. Lin, Y.J.J. Wu, K.H. Yu, J.Y. Chen, S.F. Luo.
Gout in systemic lupus erythematosus and overlap syndrome – a hospital based-study.
Clin Rheumatol, 22 (2003), pp. 295-298
[5]
P.C. Giclas, M.H. Ginsberg, N.R. Cooper.
Immunoglobulin G independent activation of the classical complement pathway by monosodium urate crystals.
J Clin Invest, 63 (1979), pp. 759-764
[6]
P. Szodoray, E. Kiss.
Dyslipidemia in systemic lupus erythematosus.
Immunol Res, 65 (2017), pp. 543-550
[7]
J.M. Kahlenberg, M.J. Kaplan.
The Inflammasome and lupus – another innate immune mechanism contributing to disease pathogenesis?.
Curr Opin Rheumatol, 26 (2014), pp. 475-481
[8]
S.R. Kingsbury, P.G. Conaghan, M.F. McDermott.
The role of the NLRP3 inflammasome in gout.
J Inflamm Res, 4 (2011), pp. 39-49
[9]
Q. Yang, C. Yu, Z. Yang, Q. Wei, K. Mu, Y. Zhang, et al.
Deregulated NLRP3 and NLRP1 inflammasomes and their correlations with disease activity in systemic lupus erythematosus.
J Rheumatol, 41 (2014), pp. 444-452
[10]
H. Zhang, R. Fu, C. Guo, Y. Huang, H. Wang, S. Wang, et al.
Anti-dsDNA antibodies bind to TLR4 and activate NLRP3 inflammasome in lupus monocytes/macrophages.
J Transl Med, 14 (2016), pp. 156
Copyright © 2019. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Descargar PDF
Idiomas
Reumatología Clínica
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?