The prevalence of hyperuricemia and its associated risk factors in patients presenting with joint pain in Karachi

Muhammad Muzzammil, Abdul Qadir, Ayesha Mughal, Jahazeb Effendi, Muhammad Saeed Minhas, Syed Jahanzeb


Background: To determine the prevalence and association of hyperuricemia with genetic factors, dietary and alcohol consumption, metabolic syndrome, diuretic use and chronic renal disease in patients presenting with joint pain in the outpatient department (OPD) at a tertiary care hospital of Karachi, Pakistan and to establish a significant correlation between concentration of serum creatinine and triglyceride with uric acid concentration statistically.

Methods: This study was conducted on 2200 patients. The data included age, gender, occupation, genetic factors (family history), dietary and alcohol consumption, metabolic syndrome, hypertension, obesity, diuretic use and chronic renal disease. Serum uric acid concentration of 2.4-6.0 mg/dl (female) and 3.4-7.0 mg/dl (male) labelled as normal values. All participants’ serum uric acid concentration compared with serum creatinine and triglyceride concentration.

Results: Overall prevalence of 30.1% (662 patients) hyperuricemia in patients presenting with joint pain. Majority of the patients belonged to age group 30-34 and highest average uric acid value (7.7±2.01) was found to be in the age group of 65 and above. Hyperuricemia was related to increased age (56.25%), genetic factors 159 (24.01%), dietary 370 (55.89%) and alcohol consumption 33 (4.98%), metabolic syndrome (hypertension 146 (22.05%), obesity 121 (18.27%), diuretic use 215 (32.47%) and chronic renal disease 53 (8.00%). On laboratory investigations, hyperuricemia was directly related to serum creatinine and triglyceride.

Conclusions: This study emphasized the high prevalence of hyperuricemia in patients presenting with joint pain and it is directly proportional to the age. Increased serum uric acid levels with increasing age might be secondary to impaired renal function, use of diuretics, and hypertension as commonly seen among elderly patients. Early diagnosis, management of risk factors and treatment will prevent adverse effects on health.



Hyperuricemia, Prevalence, Associations, Increase age, Genetic factor, Metabolic syndrome

Full Text:



Copeman WSC. A short History of the Gout, Blerkeley, University of California Press, 1964.

Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988–1994. Am J Kidney Dis. 2002;40:37-42.

Emmerson BT, Nagel SL, Duffy DL, Martin NG. Genetic control of the renal clearance of urate: a study of twins. Ann Rheum Dis. 1992;51:375-7.

Wilk JB, Djousse L, Borecki I, Atwood LD, Hunt SC, Rich SS, et al. Segregation analysis of serum uric acid in the NHLBI Family Heart Study. Hum Genet. 2000;106:355-9.

Roddy E, Zhang W, Doherty M. The changing epidemiology of gout. Nat Clin Pract Rheumatol. 2007;3:443-9.

The United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States. Rosemont, IL: American Academy of Orthopaedic Surgeons. Chapter 4. Arthritis. 2014.

Cisternas MG, Murphy LB, Pasta DJ, Yelin EH, Helmick CG. Annual medical care expenditures among US adults with gout, 2005–2011. Arthritis Rheum. 2014;66(S10):888.

Chandratre P, Roddy E, Clarson L, Richardson J, Hider SL, Mallen CD. Health-related quality of life in gout: a systematic review. Rheumatology (Oxford). 2013;52(11): 2031-40.

Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccud F, et al, Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health. 2004;25:4-9.

Jossa F, Farinaro F, Panico S, Krogh V, Celentano E, Galasso R, et al. Serum uric acid and hypertension; the Oliveti heart study. J Hum Hypertens. 1994;8:677-81.

Taniguchi Y, Hayashi T, Tsumura K, Endo G, Fujii S, Okada K. serum uric acid and the risk for hypertension and Type 2 diabetes in Japanese men: The Osaka Health Survey. J Hypertens. 2001;19:1209-15.

Selby JV, Friedman GD, Queensberry CP. Precursors of essential hypertension; Pulmonary function , heart rate, uric acid, serum cholesterol and other serum chemistries. Am J Epidemiol. 1990;131:101-27.

Lohsoonthorn V, Dhanamun B, Williams MA. Prevalence of Hyperuricemia and Relationship with Metabolic Syndrome in Thai Adults Receiving Annual Health Exams. Arch Med Res. 2006;13:883-9.

Marion LM., Shih-Chieh L, Chang HY, Lyu L, Tsai KT, William LP. High prevalence of hyperuricemia in elderly Taiwanese. Asia Pacific J Clin Nutr. 2005;14(3):285-92 .

Gordon T, Kannel WB. Drinking and its relation to smoking, blood pressure, blood lipids, and uric acid. Framingham Study Arch Int Med. 1983;143:1366-74.

Hak AE, Choi HK. Menopause, Postmenopausal Hormone Use and Serum Uric Acid Levels in US Women—The Third National Health and Nutrition Examination Survey. Arthritis Res Ther. 2008;10:R116.

Yoo TW, Sung KC, Shin HS, Kim BJ, Kim BS, Kang JH, et al. Relationship between Serum Uric Acid Concentration and Insulin Resistance and Metabolic Syndrome. Circ J. 2005;69:928-33.

Lim JH, Kim YK, Kim YS, Na SH, Rhee MY, Lee MM. Relationship between Serum Uric Acid Levels, Metabolic Syndrome and Arterial Stiffness in Korean. Korean Circ J. 2010;40:314-20.

Lee HJ, Park HT, Cho GJ, Yi KW, Ahn KH, Shin JH, et al. Relationship between Uric Acid and Metabolic Syndrome According to Menopausal Status. Gynecol Endocrinol. 2011;27:406-11.

Leyva F, Wingrove CS, Godsland IF, Stevenson JC. The glycolytic pathway to coronary heart disease: a hypothesis. Metabolism. 1998;47(6):657-62.

Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Bonadonna RC. Carotid Atherosclerosis and Coronary Heart Disease in the Metabolic Syndrome: Prospective Data from the Bruneck Study. Diabetes Care. 2003;26:1251-7.

Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is There a Pathogenetic Role for Uric Acid in Hypertension and Cardiovascular and Renal Disease? Hypertension. 2003;41:1183-90.

Kanellis J, Kang DH. Uric Acid as a Mediator of Endothelial Dysfunction, Inflammation and Vascular Disease. Seminars Neurol. 2005;25:39-42.

Kawamoto R, Tabara Y, Kohara K, Kusunoki T, Abe M, Miki T. Serum Uric Acid is More Strongly Associated with Impaired Fasting Glucose in Women than in Men from a Community-Dwelling Population. PLoS One. 2013;8(6):e65886.

Kivity S, Kopel E, Steinlauf S, Segev S, Sidi Y, Olchovsky D. The Association between Serum Uric Acid and Diabetes Mellitus Is Stronger in Women. J Women’s Health. 2013;22:782-9.

Bhole V, Choi JW, Kim SW, de Vera M, Choi H. Serum Uric Acid Levels and the Risk of Type 2 Diabetes: A Prospective Study. Am J Med. 2010;123:957-61.

Dehghan A, van Hoek M, Sijbrands EJ, Hofman A, Witteman JC. High Serum Uric Acid as a Novel Risk Factor for Type 2 Diabetes. Diabetes Care. 2008;31:361-2.

Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE. Visceral Adiposity in as Independent Predictor of Incident Hypertention in Japanese Americans. Ann Int Med. 2004;140:992-1000.

Choi HK, De Vera MA, Krishnan E. Gout and the Risk of Type 2 Diabetes among Men with a High Cardiovascular Risk Profile. Rheumatology. 2008;47:1567-70.

Sun N, Zhang Y, Tian JL, Wang H. Relationship between uric acid and arterial stiffness in the elderly with metabolic syndrome components. Chin Med J (Engl). 2013;126(16):3097-102.

Dai X, Yuan J, Yao P, Yang B, Gui L, Zhang X. Association between Serum Uric Acid and the Metabolic Syndrome among a Middle- and Old-Age Chinese Population. Eur J Epidemiol. 2013;28:669-76.

Keenan T, Blaha MJ, Nasir K, Silverman MG, Tota-Maharaj R, Carvalho JA. Relation of Uric Acid to Serum Levels of High-Sensitivity C-Reactive Protein, Triglycerides and High-Density Lipoprotein Cholesterol and to Hepatic Steatosis. Am J Cardiol. 2012;110:1787-92.

Amin-ul-Haq, Mahmood R, Ahmad Z, Rehman J, Gilani G. Association of Serum Uric Acid with Blood Urea and Serum Creatinine. Pak J Physiol. 2010;6:46-9.

Choi HK, Mount DB, Reginato AM. Pathogenesis of Gout. Ann Int Med. 2005;143:499-516.

Grayson PC, Kim SY, LaValley M, Choi HK. Hyperuricemia and Incident Hypertension: A Systematic Review and Meta-Analysis. Arthritis Care Res. 2010;63:102-10.