Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Gout is poorly managed in the community. Long standing poorly controlled gout can lead into progressive destructive arthropathy, decreased quality of life and increased mortality. Aims of this study is to assess the burden of subclinical synovitis in gout both in acute and intercritical phases. Subclinical synovitis may have implications for the long term outcome of patients with gout.
Methods
This pilot study included 30 participants with gout according to either ACR or EULAR criteria. Subjects with any other inflammatory joint disorders were excluded. Subjects were examined twice. One visit was during the period of acute gout and second was during the intercritical phase. The intercritical phase visit was done at least four weeks after the resolution of symptoms of acute gout. Examinations performed during each visit include tender and swollen joint count, musculoskeletal ultrasound (US) of 52 peripheral joints for gray scale synovitis and power Doppler (PD). Blood was collected for ESR, high sensitivity CRP (hs CRP) and uric acid.
Results
Median age of the subjects was 69 (IQR 52.5-74) and BMI was 26.40(IQR 23.12-29.40). Females were 7.4%. Median disease duration was 3 years (IQR 11-2). The mean interval between visits was 3.6 months (SD 2.4).
|
|
Flare visit |
Intercritical visit |
P value |
|
Number of subjects seen |
27 |
27 |
|
|
Hs CRP |
8.19 (3.57-37.45)* |
5.15 (1.39-8.46)* |
0.054 |
|
ESR |
28 (14.5-44.75)* |
13.5 (5.75-33)* |
0.031 |
|
Serum uric acid |
0.44 (0.36-0.5)* |
0.38 (0.2975-0.485)* |
0.405 |
|
Number of joints clinically involved |
1 (1-2)* |
0 (0-0)* |
0.007 |
|
Number of joints involved on US (defined as a PD score of >/= 2) |
5 (3-11)* |
4 (3-7)* |
0.139 |
|
Number of joints involved only by US and not clinically |
4 (2-9)* |
4.5 (3-7.25)* |
0.901 |
|
Most commonly involved joints by US
|
1st MTP (n=30), knee (n= 17), wrist (n=17) and 2nd MCP (n=16)
|
1st MTP (n=21), wrist (n= 17), 2nd MCP(n=17) and knee (n=14)
|
|
*Median (IQR)
Conclusion
Ultrasound demonstrates subclinical synovitis during acute and intercritical periods. Interestingly, whilst there were significantly less clinically active joints during the intercritical period (p =0.007) there was not less joints involved by US (p=0.139). Ultrasound may be important in the monitoring of inflammation in the management of gout.
Disclosure:
P. Chowalloor,
None;
P. Cheah,
None;
H. I. Keen,
None.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-synovial-inflammation-in-gout/