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Bone erosion commonly found in first MTP joint in patients with gout
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Urate deposition, synovitis and bone erosion were commonly found at the first metatarsophalangeal joint among participants with gout, according to a study of 29 participants.
Researchers identified ultrasound features of the first metatarsophalangeal (MTP) joint in 23 participants with gout, 29 participants with asymptomatic hyperuricemia and 34 controls with normouricemia who were age- and sex-matched. A musculoskeletal radiologist performed a grey-scale and power Doppler ultrasound assessment of bilateral joints for each participant. At the time of scanning, no participant had joint inflammation. Later, two musculoskeletal radiologists assessed the static images for the presence of double contour sign, tophus, erosion, effusion, synovial hypertrophy, synovitis and cartilage thickness.
Compared with controls, participants with gout (odds ratio = 3.91) and asymptomatic hyperuricemia (odds ratio = 3.81) were more likely to have a double contour sign. Those with gout were more likely to have erosion (odds ratio = 10.13) and synovitis (odds ratio = nine). In addition, these patients also had greater tophus and erosion diameters. Compared with participants who had asymptomatic hyperuricemia, those with gout were more likely to have more severe erosion and synovitis grades, as well as a less severe effusion grade.
The researchers concluded those with asymptomatic hyperuricemia lacked inflammation and structural joint changes, but had a similar rate of urate deposition.
“Features other than crystal deposition, specifically synovitis and bone erosion, may be useful in differentiating gout from asymptomatic hyperuricemia,” the researchers wrote. “These data support the concept that gout is a disease of chronic inflammation with a persistent subclinical immune response to the presence of [monosodium urate] MSU crystals within joints.”
Disclosure: One researcher, Nicola Dalbeth, MBChB, MD, FRACP, reports personal fees or grants from Takeda, Teijin, Menarini, Pfizer, AstraZeneca, Ardea, Crealta, Cymabay and Fonterra.
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