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<H2>Ultrasound Analysis Shows Patients With Asymptomatic Hyperuricaemia May Benefit From Therapy: Presented at EULAR
By Ed Susman
ROME -- June 22, 2010 -- Despite a lack of symptoms, individuals with hyperuricaemia may be experiencing undetected joint damage, and these patients may benefit from urate-lowering therapy, researchers said here at the 2010 Annual Meeting of the European League Against Rheumatism (EULAR).
When doctors identified subjects with elevated serum uric acid levels, they performed noninvasive ultrasound of key joints.
"Asymptomatic hyperuricaemic patients show ultrasound morphostructural changes similar to those with established gout," said Carlos Pineda, MD, Instituto Nacional de Rehabilitación, Mexico City, Mexico, during his poster presentation on June 19. "These results confirm that urate crystals are present in articular tissues before gout is clinically evident."
Of 45 patients identified as being hyperuricaemic with a serum uric acid level about 7 mg/dL, doctors found that 24 of these patients exhibited the telltale "double-contour" ultrasound signals indicating a likelihood of crystal deposits in joints. When similar tests were performed on 52 matched controls who were normouricaemic, only 1 patient exhibited the double contour sign (P < .0001).
Dr. Pineda and colleagues identified patients who were asymptomatic but exhibited hyperuricaemia on various routine tests either for other suspected illnesses or as part of a regular physical examination. If these adults had serum uric acid >7.0 mg/dL and did not have any complaints of joint pain, they were recruited for the study. Also recruited were controls who also did not express joint complaints. The average serum uric acid level in the patients deemed to be hyperuricaemic was 8.17 mg/dL.
All patients underwent ultrasound scans of the femoral cartilage and tendons in the knee and at the ankle, the Achilles tendon, and the first metatarsophalangeal joint. The researchers reported no statistical differences in appearance of osteophytes, bone erosions, or synovitis between the patients who were hyperuricaemic and those who had normal serum uric acid levels
But they did see the marked difference in patients exhibiting the double contour sign among the hyperuricaemic individuals. "Ultrasound has been shown to be superior in detecting changes in gouty arthritis than other imaging techniques," Dr. Pineda noted. "Ultrasonic characteristics of gout are already well defined. However, the findings in asymptomatic patients have not been thoroughly defined."
Dr. Pineda said the ultrasonic findings support "the use of urate-lowering therapy in asymptomatic hyperuricaemia patients."
Re: Urate crystals are present in articular tissues before gout is clinically evident
i have been looking in to gout recently a little and came across a book on natural remedies that advocates the eating of cherries (fresh or tinned makes no difference apparently) and you need to eat 25 a day on presentation of the symptoms and then as it resolves 10 a day for maintainence.
as is often the case in a health magazine a few days later it was recommended again.
neither explained what it is in cherries that can clear the pain so well or whether taking cherries on a regular basis if you have a high urate problem could actually prevent it turning to gout.
any thoughts?
Re: Urate crystals are present in articular tissues before gout is clinically evident
Sounds like wishful thinking on someones part. If there were some active component it would seem unlikley that the amount would be so presicely constant irrespective of type of cherry and its weight - even if this were true that the same dose would be effective for every case of hyperuricaemia is doubly doubtful. If you are keen to find out; why not track down the article sourse and see what the basis for it was? Keep us posted if yoiu find out.
cheers
Martin
The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918 www.winnipegfootclinic.com
Re: Urate crystals are present in articular tissues before gout is clinically evident
Interestingly the opposite seems to be possible with sustained normouricemia.
THIELE, R. G. & SCHLESINGER, N. (2010) Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatology International, 30, 495-503.
Fig. 2 Patient 2: plantar longitudinal view centered over the 1st metatarsal phalangeal joint of left and right feet. Top left MTP 1 joint and bottom, right MTP 1 joint. SuperWcial to both metatarsal heads, which appear as a hyperechoic outline, anechoic hyaline cartilage is seen. On the images on the left side, after more than 1 year of documented hyperuricemia, a thick hyperechoic, irregular band coats the cartilage (arrows). On the images on the right side, which were taken after 6.5 months of well-documented, sustained normouricemia, this layer of echogenic material has disappeared.
Cheers
Martin
The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918 www.winnipegfootclinic.com
Re: Urate crystals are present in articular tissues before gout is clinically evident
Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients.
Filippucci E, Meenagh G, Delle Sedie A, Sakellariou G, Iagnocco A, Riente L, Gutierrez M, Bombardieri S, Valesini G, Montecucco C, Grassi W. Clin Exp Rheumatol. 2011 Nov;29(6):901-905.
Quote:
OBJECTIVES:
This study aims to investigate the relationship between clinical and US findings together with the prevalence and distribution of US findings indicative of monosodium urate (MSU) crystal deposition within the foot in patients with gout.
METHODS:
A total of 50 patients with gout attending the in-patient and the out-patient clinics of the Rheumatology Departments were prospectively enrolled in this multi-centre study. Multiplanar examination of the following 15 joints was performed: talo-navicular, navicular-cuneiform (medial, intermediate and lateral), calcaneo-cuboid, medial, intermediate and lateral cuneiform-metatarsal, cuboid-4th metatarsal, cuboid-5th metatarsal and all five metatarsophalangeal (MTP) joints.
RESULTS:
The following US findings were indicative of gout: enhancement of the superficial margin of the hyaline cartilage, intra-articular tophus, and extraarticular tophus. In 46 patients, a total of 1380 foot joints were investigated. In 1309 joints that were not clinically involved, US detected signs indicative of joint inflammation in 9% (121/1309). Talo-navicular joint and the first MTP joint were the joints in which the highest number of US findings were found at mid-foot and fore-foot, respectively. At MTP joint level, dorsal scans allowed the detection of a higher number of US findings indicative of joint inflammation, and MSU crystal deposits rather than on the volar plane.
CONCLUSIONS:
This study demonstrated that US detected a higher number of inflamed foot joints than clinical examination, and that the first MTP and the talo-navicular joints were the anatomic sites with the highest prevalence of US signs of MSU crystal aggregates.
Re: Urate crystals are present in articular tissues before gout is clinically evident
Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study.
Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M. Arthritis Res Ther. 2011 Jan 17;13(1):R4.
Quote:
INTRODUCTION:
In this study, we aimed to investigate ultrasonographic (US) changes suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic individuals with hyperuricemia.
METHODS:
We conducted a cross-sectional, controlled study including US examinations of the knees and first metatarsal-phalangeal joints (first MTPJs), as well as of the tendons and enthesis of the lower limbs. Differences were estimated by χ² or unpaired t-tests as appropriate. Associations were calculated using the Spearman's correlation coefficient rank test.
RESULTS:
Fifty asymptomatic individuals with hyperuricemia and 52 normouricemic subjects were included. Hyperechoic enhancement of the superficial margin of the hyaline cartilage (double contour sign) was found in 25% of the first MTPJs from hyperuricemic individuals, in contrast to none in the control group (P < 0.0001). Similar results were found on the femoral cartilage (17% versus 0; P < 0.0001). Patellar enthesopathy (12% versus 2.9%; P = 0.01) and tophi (6% versus 0; P = 0.01) as well as Achilles enthesopathy (15% versus 1.9%; P = 0.0007) were more frequent in hyperuricemic than in normouricemic individuals. Intra-articular tophi were found in eight hyperuricemic individuals but in none of the normouricemic subjects (P = 0.003).
CONCLUSIONS:
These data demonstrate that morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically asymptomatic individuals.
Re: Urate crystals are present in articular tissues before gout is clinically evident
Ultrasonography in gout: a case-control study.
Ottaviani S, Richette P, Allard A, Ora J, Bardin T. Clin Exp Rheumatol. 2012 Apr 17
Quote:
OBJECTIVES:
To determine the sensitivity and specificity of ultrasonography for gout, and to investigate the relationship with severity of gout.
METHODS:
In this case-control study, we prospectively enrolled 53 patients with crystal-proven gout and 50 controls. Ultrasonography was performed on 10 joints for each patient (metatarsophalangeal [MTP] joints 1-2, knees, metacarpophalangeal [MCP] joints 2-3) to determine the prevalence of the double contour (DC) sign and tophi in each site.
RESULTS:
We assessed 530 joints in gouty patients and 500 in controls. Gouty patients had a mean disease duration 9.2±10.7 years and a mean of 14.7±19.8 acute attacks. Clinical exam revealed tophi in 44% of patients. Mean urate level was 656.7±145.3 μM. Inter-reader agreement between the 2 sonographers was excellent for both DC sign and tophi. The frequency of the DC sign in MTPs, knees and MCPs for gouty patients and controls was 67% vs. 2%, 57% vs. 0%, and 21% vs. 0%, respectively (all p<0.001), whereas that of tophi, only found in gouty patients, was 74%, 42% and 22%, respectively (p<0.001). The sensitivity of the DC sign was 67% for MTPs, 57% for knees and 21% for MCPs, and specificity was high (all >98%). The sensitivity of tophi was 74%, 42% and 22%, respectively, and specificity 100% for all sites. For MTPs, the DC sign, but not tophi, was significantly associated with uricemia (p<0.05) and disease duration (p=0.01).
CONCLUSIONS:
Ultrasonography has good sensitivity and specificity to diagnose gout. Sensitivity depends on disease duration, joint site and severity of the disease.
Urate crystals are present in articular tissues before gout is clinically evident
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