Running the Numbers

Abstract

### Background Asymptomatic hyperuricaemia is the most important risk factor in the development of gout, as the risk of acute arthritis rises exponentially with the serum levels of uric acid. It is a common condition, estimated at 15-20% in the general population and even though asymptomatic, approximately 20% of patients with untreated high uric acid levels develop gout over the following 5 years. Unfortunately there is not enough data available about subclinical urate crystal deposition and the joint damage that it causes. ### Objectives This study aimed to demonstrate that high levels of serum uric acid can induce changes suggestive of gout in the hyaline cartilage, joints and tendons of patients with asymptomatic hyperuricaemia. ### Method The study was a cross-sectional study on 30 patients with hyperuricaemia with no history of gout. An ultrasound examination on the knees and first methatarsophalangeal joints was performed. ### Results Synovitis was found in 7 patients (23%), 6 patients had erosions (20%), 9 patients had tophaceous material (30%) and 2 patients had DCS (6.6%). There was a slightly higher rate of findings in men than in women (8 men vs 5 women). ### Conclusion The study confirms that sustained high levels of serum uric acid can induce subclinical articular and periarticular urate deposits, synovitis and joint erosions that are detectable on ultrasound. These ultrasound findings may allow early diagnosis and treatment of gout in patients with hyperuricaemia. ### References Find all the books, read about the author, and more. See search results for this author. Are you an author? Learn about Author Central. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology, 5th ed. 2011. Doherty M. New insights into the epidemiology of gout, Rheumatology (2009) 48 (suppl 2) ii2-ii8. doi 10.1093/rheumatology/kep086. Neogi T. Asymptomatic hyperuricemia: perhaps not so benign? J Rheumatol 2008;35:734-737. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther 2011 Jan 17;13(1):R4. doi: 10.1186/ar3223. De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martín-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis 2012;71:157-158. doi:10.1136/ard.2011.154997. Puig JG, De Miguel E, Castillo MC, Rocha AL, Martinez MA, Torres RJ: Asymptomatic hyperuricemia impact of ultrasonography. \[abstract\] Nucleosides Nucleotides Nucleic Acids 2008;27:592-595. Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia \[abstract\] Ann Rheum Dis 2013;72:5 638-645. ### Disclosure of Interest None declared