Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study

TLDR

The study aimed to assess ultrasonographic signs of gouty arthritis in cartilage, joints, and tendons of asymptomatic hyperuricemic individuals. A cross‑sectional controlled study examined knees and first MTPJs, plus lower‑limb tendons and entheses, using ultrasonography in 50 hyperuricemic and 52 normouricemic participants, with differences assessed by χ² or t‑tests and correlations by Spearman. Ultrasound detected gout‑like changes in asymptomatic hyperuricemic individuals, with double‑contour cartilage signs in 25 % of first MTPJs and 17 % of femoral cartilage, patellar enthesopathy in 12 %, Achilles enthesopathy in 15 %, and tophi in 6 % (including intra‑articular tophi in 16 %), all significantly more frequent than in normouricemic controls.

Abstract

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.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.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).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.