Hyperuricemia, disease activity, and 10-year cardiovascular risk in chronic inflammatory arthritis: a post-hoc analysis of the CARMA project

OBJECTIVES: To determine the prognostic impact of hyperuricemia on cardiovascular events and its association with inflammatory markers and disease activity in patients with chronic inflammatory arthritis (CIA). METHODS: Post-hoc analysis of a 10-year prospective cohort (2010-2022) including 1,552 patients with CIA and 349 controls from 67 Spanish hospitals. Hyperuricemia was defined as serum urate (SU) >6.8 mg/dL at baseline, and its impact on major adverse cardiovascular events (MACE) during follow-up was assessed using multivariable logistic regression. Associations of hyperuricemia and SU levels with inflammatory markers and individual (swollen joint count, tender joint count, global VAS) and composite disease activity indices (DAS28, BASDAI) were analyzed using Pearson correlation and Mann-Whitney U test. RESULTS: Hyperuricemia prevalence was 11.2% in both CIA and controls, with a mean serum urate level of 5.0 ± 2.3 in the CIA group and 5.0 ± 1.4 in controls. Hyperuricemia independently increased the risk of MACE in CIA (adjusted OR 1.87, 95% CI 1.23-2.86), particularly in axial spondyloarthritis (adjusted OR 4.02, 95% CI 1.96-8.24), but not in rheumatoid arthritis or psoriatic arthritis; SU levels were not predictive. Hyperuricemia correlated with higher hsCRP levels in axial spondyloarthritis, psoriatic arthritis, and controls, but not in rheumatoid arthritis. No associations were found with ESR or disease activity indices. CONCLUSION: Baseline hyperuricemia is an independent prognostic factor for cardiovascular events in CIA, particularly in axial spondyloarthritis, but not in non-inflammatory controls. It was also associated with higher hsCRP levels, without any effect on disease activity indices. Individualized management strategies are needed in CIA.