Abstract
Background Kaposi sarcoma is a rare vascular mesenchymal neoplasm, associated with Human Herpes Virus 8 (HHV8). Gout is a condition clinically characterized by recurrent flares of arthritis and hyperuricemia. Following our clinical impression that patients with classical Kaposi sarcoma (CKS) have a high rate of gout, we explored this in a retrospective manner. Methods All consecutive patients diagnosed with sarcoma or carcinosarcoma within a single tertiary center between 1/2012–12/2017 were identified through the pathology department database. A cohort of CKS patients was compared with the non-Kaposi sarcoma and carcinosarcoma cohort. Data were extracted from patients' electronic medical records. Patients younger than 18 and patients without clinical data available were excluded. Association between diagnosis of gout and CKS was assessed and adjusted for risk factors. Results Three hundred and sixty-one patients were eligible for this analysis, 61 were diagnosed with CKS and 300 with other types of sarcoma. We found a higher incidence of gout in CKS patients, 11/61 (18%) patients, compared with 8/300 (2.6%) with other types of sarcoma, odds ratio (OR) 8.0 (P < 0.00001). This association persisted when adjusted for age >39 years (OR = 6.7, P < 0.00001), age and male sex (OR = 4.97, P < 0.0001), and when adjusting for multiple confounding factors and medical comorbidities. Conclusions We have demonstrated a statistically significant association between gout and CKS. As risk factors for gout were accounted for, this association may be explained by HHV8 immune-related effects. This should be further explored in vitro and in population-based studies.
Highlights
Kaposi sarcoma is a rare vascular mesenchymal neoplasm, associated with Human Herpes Virus 8 (HHV8)
Following a clinical impression in our clinics that patients with classical Kaposi sarcoma (CKS) have a high rate of gout, we set out to explore this finding in a large cohort of patients with CKS compared with a control cohort of patients with other sarcomas/carcinosarcomas
61 patients were diagnosed with CKS and comprised the study group, and 300 patients with other types of sarcoma or carcinosarcoma comprised the control group
Summary
Kaposi sarcoma (KS) is an angioproliferative disorder, originating from endothelial cells, myofibroblasts, and monocyte-macrophage cells. Its incidence was found to be 20,000 times more frequent in patients with AIDS compared with the general population and 300 times more frequent compared with other immune-suppressed patient groups [8]. It is more commonly associated with HIV-1 infection than with HIV-2 infection [9]. Known risk factors for gout are renal function impairment, decreased excretion through the gastrointestinal system and urate overproduction, obesity, and alcohol consumption [15,16,17]. E prevalence of gout in the overall US adult population approaches 4% and is in the region of 6% in men and 2% in women [18]. Following a clinical impression in our clinics that patients with CKS have a high rate of gout, we set out to explore this finding in a large cohort of patients with CKS compared with a control cohort of patients with other sarcomas/carcinosarcomas
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