Uric acid level in advanced age of patients with rheumatoid arthritis

Rheumatoid Arthritis is a systemic autoimmune disorder that primarily targets the synovium of diarthrodial joints resulting in inflammation, erosion of periarticular surfaces. Though the etiology and pathogenesis of Rheumatoid arthritis remain unresolved, the reactive oxygen species (ROS) have been implicated to play an important role in this process (Quinonez-Flores et al. , 2016) Free radicals are the molecules containing one or more unpaired electrons in the outermost atomic or molecular orbital’s and capable of exciting independently. Generation of free radicals attack the nearest stable molecule by stealing it’s outermost electrons by which molecule then loses its electron and becomes a free radical itself, beginning a chain reaction cascade resulting in damage to the cells results in tissue damage (Sailaja Rao et al. , 2011) This will further acceleration the incidence in the patient with Rheumatoid Arthritis. As Rheumatoid arthritis is associated with an increase in oxidative stress, which is defined as an increased load of free radicals generated during cellular metabolism. Considerable evidence implicates oxidative stress in the pathophysiology of many complications. As uric acid, is a powerful exogenous scavenger of free radicals when compared to vitamin C in the blood plasma (Sautin & Johnson, 2008) Though high uric acid level may leads to various complication including Gout, the present study was aimed to explore the uric acid level and incident of oxidative stress in the patient with Rheumatoid arthritis.

MATERIALS AND METHODS

Study was carried out at Sri Lakshmi Narayana Institute of Medical Sciences, Hospital Pondicherry, India, Affiliated to Bharath Institute of Higher Education and research, Chennai. An informed verbal consent was taken from the patients before conducting the study. The institutional ethical clearance was also obtained.

Inclusion Criteria

Patients with rheumatoid arthritis who are all suffering from active disease at the time of investigation, complaining of morning stiffness, synovial swellings and increased sedimentation rate are included in this study Exclusion Criteria

The individuals having clinical history of Diabetes

Mellitus, Cardio Vascular Disease, various Inflammatory diseases and those who are not willing to participate were excluded in this study.

Parameters

The healthy individuals (Control) and rheumatoid arthritis patients were subjected to the following investigations, rheumatoid Factor, Erythrocyte Sedimentation Rate and Uric Acid levels.

Statistical analysis

Statistical analysis was carried using Students‘t’ test.

RESULTS

DISCUSSION

Free radicals have been implicated in the pathogenesis of numerous diseases like diabetes mellitus, cancer, rheumatoid arthritis, and also in aging. Uric acid plays an important protective role in humans by providing protection against oxidative stress provoked ageing and cancer. Uric Acid is an oxidizable substrate for haemprotein and hydrogen peroxide which able to able to protect the oxidative damage by acting as an electron donor and further chelate metal ions to converting them into poorly reactive forms to enable them to catalyse the free radical reactions.

Table 1 Rheumatoid Arthritis complication

Uric acid is a strong exogenous antioxidant protects the Red blood cells for the oxidative damage, in the present study significant elevation in the Erythrocyte Sedimentation Rate was observed with concomitant decease in the Uric acid levels in artherities patients (Simavlı et al., 2010). Further correlation that was observed in this study between the serum MDA level and blood ESR and between the serum MDA and CRP levels in patients with Rheumatoid Arthritis (Silva et al., 2010) This may be due the depletion in the uric acid levels as it react with reactive oxygen species result in oxidation products like allantoin, hence uric acid is an important tool in the assessment of oxidative stress in humans. Further Uric Acid is ionized to urate, which has limited solubility in water and excess production leads to crystallization and accumulated in joints results in arthritis. Further in the present study rheumatoid arthritis was found more common in females than males and most patients fall in the age group of 50-60 years. The prevalence of Rheumatoid Arthritis increases with age and the sex difference was explored in this study.

CONFLICTS OF INTEREST

All authors have declared that they do not have any conflict of interest for publishing this research.