Gout Clinical Update, October 27, 2011

Ultrasonography allowed for the detection of articular urate deposits in 60% of gouty patients not requiring urate lowering therapy (ULT) as recommended by international recommendations, according to a study published in Clinical and Experimental Rheumatology.

Two trained ultrasonographers assessed 10 joints per patient (metatarsophalangeal [MTP] joints one-two, knees, metacarpophalangeal [MCP] joints two-three) to determine the prevalence of the double-contour (DC) sign and tophi in each site.

The researchers studied 150 joints from 15 patients (median age 56.9 years [interquartile range 31.7] years; 14 males). Interobserver agreement was good to excellent for all articular sites and the median number of acute attacks per patient was 2.0 [0.7].

“The prevalence of the DC sign in the knees and MTP joints was 46.7% and 40% respectively, whereas that of tophi was 26.7% for both sites,” the researchers wrote in the study abstract. “No urate deposits were found in MCP joints. The DC sign and tophi were found in at least one articular site in 60% and 46.7% of patients, respectively. All patients with urate levels > 600 μM (10 mg/dl) had a DC sign in at least one assessed joint. Urate levels were positively correlated with presence of the DC sign in knees (p=0.005) and MTP joints (p=0.03) but not presence of tophi.”

The Impact of Acute Gout Flares on Foot Pain and Disability

Acute gout flares can result in severe foot pain, impairment, and disability in patients, data that supports improved management of gout to prevent the consequences of poorly controlled disease, according to a new study.

The research, which was conducted by clinicians at the Health and Rehabilitation Research Institute at AUT University in Auckland, New Zealand, was published in Arthritis Care and Research.

The prospective observational study recruited 20 patients with acute gout flares from emergency departments, hospital wards, and rheumatology outpatient clinics. Patients were recruited at the time of the flare, which was the baseline visit, and then reassessed at a follow-up visit six to eight weeks after the initial assessment once the acute flare had resolved.

“The foot was affected by acute gout in 14 patients (70%). Objective measures of joint inflammation including swollen and tender joint counts and C-reactive protein significantly improved at the follow-up visit, compared with the baseline visit,” the researchers wrote in the study abstract.

“At baseline, high levels of foot pain, impairment, and disability were reported. All patient-reported outcome measures of general and foot-specific musculoskeletal function improved at the follow-up visit compared with the baseline visit. However, pain, impairment, and disability scores did not entirely normalize after resolution of the acute gout flare.”

SourcesAn Exploratory Ultrasound Study of Early Gout [Clinical and Experimental Rheumatology]Foot Pain, Impairment and Disability in Patients with Acute Gout Flares: A Prospective Observational Study [Arthritis Care and Research]