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When doctors identified subjects with elevated serum uric acid levels, they performed noninvasive ultrasound of key joints.

Despite a lack of symptoms, individuals with hyperuricaemia may be experiencing undetected joint damage, and these patients may benefit from urate-lowering therapy, researchers said here at the 2010 Annual Meeting of the European League Against Rheumatism (EULAR).

When doctors identified subjects with elevated serum uric acid levels, they performed noninvasive ultrasound of key joints.

" Asymptomatic hyperuricaemic patients show ultrasound morphostructural changes similar to those with established gout," said Carlos Pineda, MD, Instituto Nacional de Rehabilitación, Mexico City, Mexico, during his poster presentation on June 19. "These results confirm that urate crystals are present in articular tissues before gout is clinically evident."

Of 45 patients identified as being hyperuricaemic with a serum uric acid level about 7 mg/dL, doctors found that 24 of these patients exhibited the telltale "double-contour" ultrasound signals indicating a likelihood of crystal deposits in joints. When similar tests were performed on 52 matched controls who were normouricaemic, only 1 patient exhibited the double contour sign (P < .0001).

Dr. Pineda and colleagues identified patients who were asymptomatic but exhibited hyperuricaemia on various routine tests either for other suspected illnesses or as part of a regular physical examination. If these adults had serum uric acid >7.0 mg/dL and did not have any complaints of joint pain, they were recruited for the study. Also recruited were controls who also did not express joint complaints. The average serum uric acid level in the patients deemed to be hyperuricaemic was 8.17 mg/dL.

All patients underwent ultrasound scans of the femoral cartilage and tendons in the knee and at the ankle, the Achilles tendon, and the first metatarsophalangeal joint. The researchers reported no statistical differences in appearance of osteophytes, bone erosions, or synovitis between the patients who were hyperuricaemic and those who had normal serum uric acid levels

But they did see the marked difference in patients exhibiting the double contour sign among the hyperuricaemic individuals. " Ultrasound has been shown to be superior in detecting changes in gouty arthritis than other imaging techniques," Dr. Pineda noted. "Ultrasonic characteristics of gout are already well defined. However, the findings in asymptomatic patients have not been thoroughly defined."

Dr. Pineda said the ultrasonic findings support "the use of urate-lowering therapy in asymptomatic hyperuricaemia patients."

Source: peer-view-media-bar