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Tendon involvement in patients with gout: an ultrasound study of prevalence

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Abstract

The objective of the present study is to evaluate, by ultrasonography (US), the prevalence in the quadriceps, patellar, and Achilles tendon involvement of gout compared to that of patients with osteoarthritis and asymptomatic marathon runners. This is a multicenter, multinational, transverse cross-sectional, and comparative study comprising 80 patients with the diagnosis of gout according to the American College of Rheumatology (ACR) criteria, compared with two control groups: 35 patients with generalized osteoarthritis according to the ACR criteria and 35 subjects who were healthy marathon runners. Demographics and clinical characteristics, such as age, gender, comorbidity, disease duration, pain at the enthesis in the knee and ankle, frequency of disease exacerbations, uric acid level more than 7.2 mg at the time of evaluation, and type of treatment, were recorded. All participants were examined by ultrasound at the quadriceps, the patellar at its proximal and distal insertion, and the Achilles tendon to detect intra-tendinous tophus or aggregates according to the OMERACT definitions. Descriptive statistics and differences between groups were analyzed by chi-square test. Sensitivity and specificity by US were calculated. The prevalence of intra-tendinous aggregates and tophi in gout was significant compared with the other groups. Both lesions were the most frequent at the distal patellar insertion, followed by the quadriceps, Achilles, and proximal patellar insertion ones. In patients with osteoarthritis (OA), intra-tendinous hyperechoic aggregates were observed in 20 % of quadriceps tendons and in 11 % of patellar tendons at its proximal insertion, while in the healthy marathon runner group, the Achilles tendon had this kind of lesion in 17 % of the subjects. Neither the OA nor the healthy marathon runners had intra-tendinous tophi. The sensitivity and specificity of US to detect tophi or aggregates were 69.6 and 92 %, respectively, tendon involvement at the lower limbs in gout is very frequent, particularly in the patellar tendon, and US possesses good sensitivity and specificity for detecting intra-tendinous tophi.

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References

  1. Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum 63:3136–41

    Article  PubMed  Google Scholar 

  2. Neogi T, Jansen TLT, Dalbeth N, Fransen J, Schumacher HR, Berebsen D et al (2015) 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Ann Rheum Dis 74:1789–98

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W et al (2008) Diagnostic imaging of gout. Comparison of high-resolution US versus conventional X-ray. Eur Radiol 18:621–30

    Article  PubMed  Google Scholar 

  4. Thiele RG, Schlesinger N (2007) Ultrasonography is a reliable, non-invasive method for diagnosing gout. Rheumatology 46:1116–21

    Article  CAS  PubMed  Google Scholar 

  5. Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W (2009) Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthr Cartil 17:178–81

    Article  CAS  PubMed  Google Scholar 

  6. Peiteado D, de Miguel E, Villalba A, Ordóñez MC, Castillo C, Martín-Mola E (2012) Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol 30:830–7

    PubMed  Google Scholar 

  7. Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P (1996) Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis 55:921–3

  8. Weniger FG, Davison SP, Risin M, Salyapongse AN, Manders EK (2003) Gouty flexor tenosynovitis of the digits: report of three cases. J Hand Surg [Am] 28:669–72

  9. Primm DD Jr, Allen JR (1983) Gouty involvement of a flexor tendon in the hand. J Hand Surg [Am] 8:863–5

  10. de Avila Fernandes E, Sandim GB, Mitraud SA, Kubota ES, Ferrari AJ, Fernandes AR (2010) Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout. Insights Imaging 1:143–8

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM (2013) Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis 72:1545–8

    Article  PubMed  Google Scholar 

  12. Chhana A, Cllon K, Dray M, Pool B, Naot D, Gamble GD et al (2014) Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis 73:1737–41

    Article  PubMed  Google Scholar 

  13. Sasaki K, Yamamoto N, Kiyosawa T, Sekido M (2012) The role of collagen arrangement change during tendon healing demonstrated by scanning electron microscopy. J Electron Microsc 61:327–34

    Article  Google Scholar 

  14. Schweyer S, Hemmerlein B, Radzun HJ, Fayyazi A (2000) Continuous recruitment, co-expression of tumour necrosis factor-alpha and matrix metalloproteinases, and apoptosis of macrophages in gout tophi. Virchows Arch 437:534–9

    Article  CAS  PubMed  Google Scholar 

  15. Levy M, Seelenfreund M, Maor P, Friei A, Lurie M (1971) Bilateral spontaneous and simultaneous rupture of the quadriceps tendon in gout. J Bone Joint Surg 53:510–3

    CAS  Google Scholar 

  16. Wurapa RK, Zelouf DS (2002) Flexor tendon rupture caused by gout: a case report. J Hand Surg [Am] 27:591–3

    Article  Google Scholar 

  17. Sainsbury DC, Hidvegi N, Blair JW (2008) Intra-tendinous gout in a repaired flexor digitorum profundus. J Hand Surg Eur Vol 33:528–9

    Article  CAS  PubMed  Google Scholar 

  18. Radice F, Monckeberg JE, Carcuro G (2011) Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration. J Foot Ankle Surg 50:751–3

    Article  PubMed  Google Scholar 

  19. Mathieu S, Pereira B, Couderc M, Soubrier M (2013) Usefulness of ultrasonography in the diagnosis of gout: a meta-analysis. Ann Rheum Dis 72:e23

    Article  CAS  PubMed  Google Scholar 

  20. Naredo E, Uson J, Jiménez-Palop M, Martínez A, Vicente E, Brito E et al (2014) Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis 73:1522–8

    Article  PubMed  Google Scholar 

  21. Chowalloor PV, Keen HI (2013) A systematic review of ultrasonography in gout and asymptomatic hyperuricemia. Ann Rheum Dis 72:638–45

    Article  PubMed  Google Scholar 

  22. Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J (2011) Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis Care Res 63:1456–62

    Article  CAS  Google Scholar 

  23. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20:895–900

    Article  CAS  PubMed  Google Scholar 

  24. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brant K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Arthritis Rheum 29:1039–49

    Article  CAS  PubMed  Google Scholar 

  25. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Gutiérrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo S et al (2015) International consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 54:1797–805

    Article  Google Scholar 

  27. Abate M, Schiavone C, Salini V, Andia I (2013) Occurrence of tendon pathologies in metabolic disorders. Rheumatology 52:599–608

    Article  CAS  PubMed  Google Scholar 

  28. Gaida JE, Alfredson L, Kiss ZS, Wilson AM, Alfredson H, Cook JL (2009) Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc 41:1194–7

    Article  CAS  PubMed  Google Scholar 

  29. Tsouli SG, Xydis V, Argyropoulou MI, Tselepis AD, Elisaf M, Kiortsis DN (2009) Regression of Achilles tendon thickness after statin treatment in patients with familial hypercholesterolemia: an ultrasonographic study. Atherosclerosis 205:151–5

    Article  CAS  PubMed  Google Scholar 

  30. Terslev L, Gutierrez M, Christensen R, Balint PV, Bruyn GA, Delle Sedie A et al (2015) Assessing elementary lesions in gout by ultrasound: results of an OMERACT patient-based agreement and reliability exercise. J Rheumatol 42:2149–54

    Article  CAS  PubMed  Google Scholar 

  31. Terslev L, Gutierrez M, Schmidt WA, Keen HI, Filippucci E, Kane D et al (2015) Ultrasound as an outcome measure in gout. A validation process by the OMERACT ultrasound working group. J Rheumatol 42:2177–81

    Article  PubMed  Google Scholar 

  32. Peiteado D, Villalba A, Martín-Mola E, de Miguel E (2015) Reduction but not disappearance of Doppler signal after two years of treatment for gout. Do we need a more intensive treatment? Clin Exp Rheumatol 33:385–90

    PubMed  Google Scholar 

  33. Wright SA, Filippucci E, Mcveigh C, Grey A, McCarron M, Grassi W et al (2007) High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis 66:859–64

    Article  PubMed  Google Scholar 

  34. Ottavianni S, Allard A, Bardin T, Richette P (2011) An exploratory ultrasound study of early gout. Clin Exp Rheumatol 29:816–21

    Google Scholar 

  35. Filippucci E, Scier CA, Delle Siede A, Iagnocco A, Riente L, Meenagh G et al (2010) Ultrasound imaging for the rheumatologist XXV. Sonographic assessment of the knee in patients with gout and calcium pyrophosphate deposition disease. Clin Exp Rheumatol 28:2–5

    CAS  PubMed  Google Scholar 

  36. Ventura-Ríos L, Navarro-Compan V, Aliste M, Alva Linares M, Areny R, Audisio M et al (2016) Is entheses ultrasound reliable? A reading Latin American exercise. Clin Rheumatol 35:1353–7

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Lucio Ventura-Ríos & Cristina Hernández-Díaz

  2. Spine Surgery Service, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico

    Guadalupe Sánchez-Bringas

  3. Research Direction, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Carlos Pineda

  4. Rheumatology Research and Musculoskeletal Ultrasound, Brown University, Providence VAMC, University Medicine Foundation/RIH, Providence, RI, USA

    Anthony Reginato

  5. Rheumatology Unit, Hospital Edgardo Rebagliati Martins, Lima, Perú

    Magaly Alva & Claudia Mora

  6. Rheumatology Unit, Facultad de Ciencias Médicas, Hospital Nacional de Clínicas, Córdoba, Argentina

    Marcelo Audisio & Guillermo Py

  7. Rheumatology Unit, Instituto Reumatológico Strusberg, Córdoba, Argentina

    Ana Bertoli

  8. Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina

    Tomas Cazenave

  9. División de Enfermedades Musculoesqueléticas y Reumáticas, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Marwin Gutiérrez

  10. Rheumatology Lima, Hospital Marino Molina Scippa ESSALUD, Lima, Peru

    Oscar Sedano

  11. Rheumatology Unit, Hospital Nacional Rosales, San Salvador, El Salvador

    Carla Solano

  12. Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain

    Eugenio de Miguel

Authors
  1. Lucio Ventura-Ríos
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  2. Guadalupe Sánchez-Bringas
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  4. Cristina Hernández-Díaz
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  5. Anthony Reginato
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  6. Magaly Alva
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  7. Marcelo Audisio
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  8. Ana Bertoli
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  9. Tomas Cazenave
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  10. Marwin Gutiérrez
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  11. Claudia Mora
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  12. Guillermo Py
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  13. Oscar Sedano
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  14. Carla Solano
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  15. Eugenio de Miguel
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Correspondence to Lucio Ventura-Ríos.

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Ventura-Ríos, L., Sánchez-Bringas, G., Pineda, C. et al. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 35, 2039–2044 (2016). https://doi.org/10.1007/s10067-016-3309-7

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  • DOI: https://doi.org/10.1007/s10067-016-3309-7

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