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Open Access Highly Accessed Research article

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

Carlos Pineda1*, Luis M Amezcua-Guerra2, Carla Solano3, Pedro Rodriguez-Henríquez4, Cristina Hernández-Díaz5, Angelica Vargas6, Fritz Hofmann5 and Marwin Gutiérrez7

Author Affiliations

1 Biomedical Research Subdirection, Instituto Nacional de Rehabilitación, Av. México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico

2 Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico

3 Department of Rheumatology, Hospital Nacional Rosales and Instituto Salvadoreño del Seguro Social, Final calle Arce 25 Av. Norte, San Salvador, El Salvador

4 Department of Rheumatology, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Sección XVI, Tlalpan, Mexico City 14080, Mexico

5 Department of Musculoskeletal Ultrasonography, Instituto Nacional de Rehabilitación, Av. México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico

6 Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico

7 Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli 52, Jesi, Ancona I-60035, Italy

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Arthritis Research & Therapy 2011, 13:R4  doi:10.1186/ar3223

Published: 17 January 2011

Abstract

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.