Clin Rheumatol. 2026 Jun 6. doi: 10.1007/s10067-026-08177-w. Online ahead of print.
ABSTRACT
BACKGROUND: Gout is increasingly recognized as a systemic metabolic and inflammatory disorder. The urate paradox-where uric acid shifts from a plasma antioxidant to an intracellular pro-oxidant-remains a clinical challenge in managing systemic complications.
OBJECTIVE: This study evaluates the association between systemic oxidative stress imbalance and high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammatory burden in gouty patients.
METHODS: A case-control study was conducted on 200 participants (100 gouty patients and 100 healthy controls) in Yemen. Biomarkers including malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione (GSH), and hs-CRP were quantified. Multivariate linear regression was used to assess the independent predictive value of MDA for hs-CRP.
RESULTS: Gouty patients exhibited significantly elevated MDA (6.45 ± 1.55 nmol/mL) and hs-CRP (14.2 ± 5.1 mg/L) compared to controls (P < 0.001). Conversely, a profound depletion in TAC and GSH was observed. A statistically significant positive correlation (r = 0.78, P < 0.001) was observed between MDA and hs-CRP. In multivariate analysis, MDA remained a significant independent associate, explaining approximately 61% of the variance in hs-CRP levels (R2 = 0.61, P < 0.001).
CONCLUSION: Gout is characterized by a significant systemic oxidative stress imbalance which is independently associated with systemic inflammation. Clinical management should transcend urate-lowering therapy to include strategies aimed at restoring antioxidant capacity to mitigate systemic inflammatory damage. Key Points • Gouty patients exhibit a profound state of systemic redox exhaustion, characterized by depleted antioxidant defenses. • Lipid peroxidation (MDA) is strongly associated with the systemic inflammatory burden (hs-CRP) in gouty cohorts. • The robust correlation between oxidative stress and inflammatory markers suggests their potential as biomarkers for assessing disease status. • Systemic inflammation in gout appears to be closely linked to the severity of oxidative stress imbalance.
PMID:42250201 | DOI:10.1007/s10067-026-08177-w
