URIC ACID PROFILE IN PATIENTS WITH CHRONIC NONSPECIFIC MUSCULOSKELETAL PAIN
AbstractBackground: The present study was undertaken to determine the uric acid profile in patients with unexplained chronic musculoskeletal complaints, and to establish any possible causal role for altered uric acid profile in such patients. Method: A comparative study of 36 patients and 36 controls of both sexes and ages between 25-60 years was carried out at Shaikh ZayedHospital, Lahore from November 2001-May 2002. Patient included were those who had at least 4-24 weeks duration of complaints. Uric acid profile for serum uric acid, uric acid excretion, uric acid clearance and total uric acid production was done. Additional tests included renal functions test, liver function test, cardiac enzymes, haematology and serology to exclude other underlying causes of complaints. Results: Mean serum uric acid levels were higher in patients as compared to controls (p=0.05), with 9 (25%) patients showing hyperuricemia. Uric acid clearance (female patients 5.86+0.42 ml/min, female controls 8.06+0.24 ml/min) and daily uric acid excretion (female patients 412.38+28.52 mg/24 hours, female controls 487.79+18.64 mg/24 hours) in female patients was significantly lower than control females (P=0.034 and P<0.001 respectively). Twenty patients (55.55%, 3 males and 17 females) were classified as under excretors of uric acid, while there were no under excretors in the control group (p<0.001). Conclusion: We conclude that abnormalities of uric acid profile, particularly under excretor status may be an underlying biochemical abnormality in a significant number of patients. Female patients appear more predisposed to abnormal uric acid profile such as hyperuricemia and under excretor status. Key words: Uric acid, musculoskeletal diseases, gout.
Croft P, Rigby AS, Baswell R. The prevalence of chronic widespread pain in the general population. J Rheumatol 1993; 20:710-13.
Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 1993; 9:174-182.
Mills KR, Edwards RH. Investigative strategies for muscle pain. J Neurological Sciences 1983; 58:73-88.
Crook J, Weir R, Tunks E. An epidemiological follow up survey of persistent pain sufferers in a group family practice and specialty pain. Clinic. Pain 1989; 36(1): 49-61.
Andersson HI, Ejtertsson G, Leden I, Rosenberg C. Characteristics of subjects with chronic pain, in relation to local and widespread pain. Scand J Rheumatol 1996; 25: 146-154.
Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. The Lancet 1999; .354(9156): 1248-1252.
ISAP Subcommittee on Taxonomy. Classification of chronic pain. Pain (suppl 3) 1986; S25-S214.
Potter RG, Jones JM. The evolution of chronic pain among patients with musculoskeletal problems: a pilot study in primary care. Br J Gen Pract 1992; 42: 462-64.
Brattbeg G, Thorsiund M, Wikman A. The prevalence of pain in a general population. The result of a postal survey in a county of Sweden. Pain 1989; 37:215-222.
Dworin SF, Von-Korff M, LeReche L. Multiple pains and psychiatric disturbance. Arch Gen Psychiatry 1990; 47:239-244.
Croft P, Scholum J, Silman A. Population study of tender paints count and pain as evidence of fibromyalgia. BMJ 1994; 309(6956):696-99.
Eisinger J, Plantamura A, Ayavou T. Glycolysis abnormalities in fibromyalgia. J A Coll Nutr 1994; 13(2):144-148.
Salet A, Haanen HC. Chronic arthralgia not a precursor of rheumatoid arthritis but part of fibromyalgia syndrome. Ned Tijdschr Geneeskd 1995; 139(14):727-30.
Hickman PF, Kemp GJ, Thompson CH, Salisbury AJ, Wade K, Hariss AL et al. Bryostatin I, a novel antineoplastic agent and protein kinase C activator, induces human myalgia and muscle metabolic defects; a 31p magnetic resonance spectroscopic study. Br J Cancer 1995; 72(4):998-1003.
Issberner U, Rech RW, Steen KH. Pain due to tissue acidosis: a mechanism for inflammatory and ischemic myalgia. Neurosci Lett 1996; 208(3):191-4.
Hellsten Y, Frandsen V, Orthenblol N, Sjodin B, Richter EA. Xanthine oxidase in human skeletal muscle following eccentric exercise: a role in inflammation. J Physiol Cond 1997; 498(pt 1):239-248.
Yamasaki T, Hamaguchi T, Nakajina H, Matsuzawa Y. Myogenic hyperuricemia. Nippon Rinsho 1996; 54(12):3343-8.
Nakamura T, Takagi K, Ueda T. Dynamics of uric acid metabolism in hyperuricemia. Nippon-Rinsho 1996; 54(12):3230-36.
McLauchian DM. Creatinine, urate and urea. In: Goweniock, AH, McMurray JR, McLauchan DM (Eds), Varley’s Practical Clinical Biochemistry 1988, 6th edition. Heineman Publishing Ltd. Jordan Hill, Oxford: pp. 350-66.
Yeldadi AV, Kaufman DG, Reddy JK. Cell injury and cellular adaptation. In: Damjanov I, Linder J, (Eds.) Anderson’s Pathology 1996; 10th edition, Mosby Year Book Inc., St. Louis, Missouri: pp. 357-85.
Hough AJ Jr. Joints. In: Damjanov I, Linder J. (Eds.) Anderson’s Pathology 1996, 10th edition, Mosby Year Book Inc., St. Louis Missouri: pp 2612-2645.
Aarflot T, Bruusgaard D. Chronic musculoskeletal complaints and subgroups with special reference to uric acid. Scand J Rheumatol 1994; 23:25-29.
Simkin PA. Gout and hyuperuricemia. Curr Opin Rheumatol 1997; 9(3):268-73.
Von Kroff M, Dworkin SF, LeReshe L, Kryger A. An epidemiologic comparison of pain complaints. Pain 1988; 32:173-83.
Aloaka I, Kamataini N. Abnormalities in urate metabolism: concept and classification. Nippon Rinsho 1996; 54(12):3243-3247.