Middle molecules of different fractions and middle-molecular osteoassociated hormones in gouty arthritis

O.V. Syniachenko, D.M. Fedorov, M.V. Yermolaieva, D.A. Chistiakov


Background. Gouty arthritis is the most common inflammatory disease of joints in men. In addition to disorders of purine metabolism, pro­inflammatory cytokines, matrix metalloproteinases and eicosanoids, various middle­molecular compounds (hormones, peptides, lipids) may participate in the pathogenesis of the disease, but their significance remains to be explored. The purpose of the study was to evaluate the clinical and pathogenetic significance of middle molecules (MM) of different fractions and middle­molecular osteoassociated hormones in gouty arthritis. Materials and ­methods. 105 patients with primary gout were examined, 92 % of men and 8 % of women aged 26 to 76 years (51 years on average), and women were 8 years older. The average duration of the disease was 12 years. The first sign of gout among 91 % of the patients was the joint crisis, and in the remaining cases — renal colic. The ratio of the frequency of intermittent and chronic forms of arthritis was 2 : 1, the latent type of nephropathy occurred in 66 % of cases, urolithiasis — in 34 %, and the ratio of stages I, II, III and IV of chronic kidney disease was 4 : 2 : 1 : 1 The content of the aminopeptide (AF), peptide (PF), nucleotide (NF), chromatophoric fractions (CF) and integral middle­molecular index (MMI) was investigated, as well as middle­molecular osteoassociated hormones (insulin (Ins), calcitonin (CT), osteocalcin (OC)). A spectrophotometer SF­46 (Russia), Olympus­AU640 bioanalyzer (Japan), MPT2­Lauda computer tensiometer (Germany), and PR2100­Sanofi Diagnostic Pasteur reader (France) were used. Only patients without exacerbation of arthritis were ­examined. Results. Primary gout occurs with disturbances in the metabolism of uric acid, oxypurinol, purine bases, purine metabolism enzymes and purine­associated microelements, the integral changes of which depend on the type of the joint syndrome, the presence of peripheral and bone tofi, determine bone­destructive articular lesions, while prognostic factor for the severity of arthropathy is the high blood level of purine bases. In cases of gout, serum AF concentrations increase by 15 %, PF — by 16 %, NF — by 31 %, CF — by 15 %, average fraction — by 17 % and MMI — by 10 %, which is observed in 67, 53, 64, 25, 62 and 31 % of patients, respectively. Meanwhile, the AF content is closely related to the severity of the joint syndrome, it determines the degree of joint space narrowing and subchondral sclerosis, the development of bone erosions and meniscus changes, and the MM of different fractions have correlation links with the parameters of purine metabolism (uric acid, adenine, guanine, xanthine, xanthine deaminase, adenosine deaminase, molybdenum and lead). Patients with gout were characterized by the significant increase in the concentration of Ins in the blood by 92 % and OC by 3 times combined with the decrease in the CT content by 51 %, which is respectively found in 53, 99 and 83 % of examined patients. It correlated with severity of the joint syndrome, the presence of peripheral and bone tofi. And in cases of the chronicity of arthritis, OC indicators increase, and there are close relationships of middle­molecular osteoassociated hormones with bone­destructive articular changes, parameters of purine metabolism and integral level of MM of different fractions. The indicators of Ins are of practical importance. Conclusions. The studied middle­molecular compounds are involved in clinical and pathogenetic formation of gouty arthritis and have prognostic significance.


gout; arthritis; pathogenesis; clinical picture; middle-molecular compounds


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