Rheumatology International

, Volume 39, Issue 7, pp 1249–1255 | Cite as

Presence of tophi is a predictive factor of arterial stiffness in patients with gout

  • WooSeong Jeong
  • Seung-Jae Joo
  • Jinsoek Kim
  • Jae-Geun Lee
  • Joon Hyouk ChoiEmail author


The objective of this study is to determine whether the presence of tophi could predict an increase in arterial stiffness. Between June 2017 and June 2018, the augmentation index (AI) was measured using SphygmoCor® for patients with gout who visited the Jeju National University Hospital in South Korea. Patients were divided into the following groups: group with tophi and group without tophi. Medical records, laboratory data, and AI were retrospectively analyzed. One hundred and twenty patients with gout or participated in the study, with most (96.7%) of the patients being male. The mean duration of the disease was 7.0 years. At the time of the examination, 99 patients (82.5%) were treated with a uric acid-lowering agent. Of the total patients, 24 (19.7%) had tophi. Patients with tophi were significantly older (60.2 ± 11.6 years vs. 53.8 ± 13.0 years, p = 0.031), had longer disease duration (13.0 ± 6.5 years vs 5.5 ± 5.4 years, p < 0.001), and higher AI@75 (28.7 ± 7.8 vs 20.9 ± 10.0, p = 0.001) than those without tophi. In the multiple linear regression analysis, tophi was shown to be a significant predictor of high AI (p = 0.040). The presence of tophi is a predictor of increased arterial stiffness in patients with gout. Therefore, more strict control of cardiovascular disease risk factors is needed in the treatment of patients with tophi.


Gout Uric acid Arterial stiffness 


Author contributions

Conceptualization: WSJ and JHC. Data curation: WSJ. Formal analysis: WSJ, JHC, and JGL. Investigation: WSJ and JHC. Methodology: WSJ and JHC. Resources: JHC. Supervision: JHC, SJJ, and JSK. Writing—original draft: WSJ. Writing—review and editing: WSJ, JHC, SJJ, and JSK.



Compliance with ethical standards

Conflict of interest

WooSeong Jeong, Seung-Jae Joo, Jinsoek Kim, Jae-Geun Lee, and Joon Hyouk Choi declare that they have no conflict of interest.

Ethical standards

This hospital-based observational study was approved by the ethical committee of the institutional review board of Jeju National University Hospital, and all participants provided informed and written consent.


  1. 1.
    Choi HK, Mount DB, Reginato AM (2005) Pathogenesis of gout. Ann Intern Med 143(7):499–516CrossRefGoogle Scholar
  2. 2.
    Kuo C-F, Grainge MJ, Zhang W, Doherty M (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11:649. CrossRefGoogle Scholar
  3. 3.
    Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH (2008) Long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med 168(10):1104–1110. CrossRefGoogle Scholar
  4. 4.
    Choi HK, Curhan G (2007) Independent impact of gout on mortality and risk for coronary heart disease. Circulation 116(8):894–900. CrossRefGoogle Scholar
  5. 5.
    Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, Lin CM, Chen HW, Yu KH (2010) Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatol (Oxford, England) 49(1):141–146. CrossRefGoogle Scholar
  6. 6.
    Chien KL, Hsu HC, Sung FC, Su TC, Chen MF, Lee YT (2005) Hyperuricemia as a risk factor on cardiovascular events in Taiwan: the Chin-Shan Community Cardiovascular Cohort Study. Atherosclerosis 183(1):147–155. CrossRefGoogle Scholar
  7. 7.
    Tsai WC, Huang YY, Lin CC, Li WT, Lee CH, Chen JY, Chen JH (2009) Uric acid is an independent predictor of arterial stiffness in hypertensive patients. Heart Vessels 24(5):371–375. CrossRefGoogle Scholar
  8. 8.
    Chuang SY, Chen JH, Yeh WT, Wu CC, Pan WH (2012) Hyperuricemia and increased risk of ischemic heart disease in a large Chinese cohort. Int J Cardiol 154(3):316–321. CrossRefGoogle Scholar
  9. 9.
    Clarson LE, Chandratre P, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD (2015) Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prevent Cardiol 22(3):335–343. CrossRefGoogle Scholar
  10. 10.
    Fantin F, Mattocks A, Bulpitt CJ, Banya W, Rajkumar C (2007) Is augmentation index a good measure of vascular stiffness in the elderly? Age Ageing 36(1):43–48. CrossRefGoogle Scholar
  11. 11.
    Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27(21):2588–2605. CrossRefGoogle Scholar
  12. 12.
    Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55(13):1318–1327. CrossRefGoogle Scholar
  13. 13.
    Mehta T, Nuccio E, McFann K, Madero M, Sarnak MJ, Jalal D (2015) Association of uric acid with vascular stiffness in the Framingham heart study. Am J Hypertens 28(7):877–883. CrossRefGoogle Scholar
  14. 14.
    Vlachopoulos C, Xaplanteris P, Vyssoulis G, Bratsas A, Baou K, Tzamou V, Aznaouridis K, Dima I, Lazaros G, Stefanadis C (2011) Association of serum uric acid level with aortic stiffness and arterial wave reflections in newly diagnosed, never-treated hypertension. Am J Hypertens 24(1):33–39. CrossRefGoogle Scholar
  15. 15.
    Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M (2007) Higher serum uric acid is associated with increased arterial stiffness in Japanese individuals. Atherosclerosis 192(1):131–137. CrossRefGoogle Scholar
  16. 16.
    Saijo Y, Utsugi M, Yoshioka E, Horikawa N, Sato T, Gong YY, Kishi R (2005) Relationships of C-reactive protein, uric acid, and glomerular filtration rate to arterial stiffness in Japanese subjects. J Hum Hypertens 19(11):907–913. CrossRefGoogle Scholar
  17. 17.
    Angalla R, Mounir A, Driouich S, Abourazzak FZ, Harzy T (2016) Chronic tophaceous gout. QJM Mon J Assoc Phys 109(10):681–682. Google Scholar
  18. 18.
    Choi JH, Kim J (2017) Augmentation index in connective tissue diseases. J Rheum Dis 24(4):185–191CrossRefGoogle Scholar
  19. 19.
    Rott KT, Agudelo CA (2003) Gout. JAMA 289(21):2857–2860. CrossRefGoogle Scholar
  20. 20.
    Song JS (2010) Clinical manifestations and diagnosis of gout. J Korean Med Assoc 53(8):695–704CrossRefGoogle Scholar
  21. 21.
    Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, Umans JG, Howard BV (2007) Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension (Dallas, Tex : 1979) 50(1):197–203. CrossRefGoogle Scholar
  22. 22.
    Yang L, Qin B, Zhang X, Chen Y, Hou J (2017) Association of central blood pressure and cardiovascular diseases in diabetic patients with hypertension. Medicine 96(42):e8286–e8286. CrossRefGoogle Scholar
  23. 23.
    Perez-Ruiz F, Martinez-Indart L, Carmona L, Herrero-Beites AM, Pijoan JI, Krishnan E (2014) Tophaceous gout and high level of hyperuricaemia are both associated with increased risk of mortality in patients with gout. Ann Rheum Dis 73(1):177–182. CrossRefGoogle Scholar
  24. 24.
    Headley S, Germain M, Wood R, Joubert J, Milch C, Evans E, Poindexter A, Cornelius A, Brewer B, Pescatello LS, Parker B (2014) Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial. Am J Kidney Dis 64(2):222–229. CrossRefGoogle Scholar
  25. 25.
    Quach C, Galen BT (2018) HLA-B*5801 testing to prevent allopurinol hypersensitivity syndrome: a teachable moment. JAMA Int Med 178(9):1260–1261. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • WooSeong Jeong
    • 1
  • Seung-Jae Joo
    • 2
  • Jinsoek Kim
    • 1
  • Jae-Geun Lee
    • 2
  • Joon Hyouk Choi
    • 2
    Email author
  1. 1.Division of Rheumatology, Department of Internal Medicine, Jeju National University HospitalJeju National University School of MedicineJejuSouth Korea
  2. 2.Division of Cardiology, Department of Internal Medicine, Jeju National University HospitalJeju National University School of MedicineJejuSouth Korea

Personalised recommendations