Premium
The burden of subclinical intra‐articular inflammation in gout
Author(s) -
Chowalloor Priya,
Raymond Warren David,
Cheah Patrick,
Keen Helen
Publication year - 2020
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13811
Subject(s) - medicine , interquartile range , gout , subclinical infection , erythrocyte sedimentation rate , visual analogue scale , c reactive protein , uric acid , gastroenterology , cohort , prospective cohort study , surgery , physical therapy , inflammation
Objective To assess the burden of subclinical intra‐articular inflammation using ultrasound in people with gout. Methods A pilot, prospective longitudinal cohort of 28 participants with gout were examined twice, once during a gout flare (n = 25) and then during an inter‐critical phase (n = 27). At each visit, a 52 joint count was done followed by ultrasound examination for detection of intra‐articular power Doppler (PD) signal. Clinically active joints were defined as tender and swollen. Data was collected on patient reported gout pain ‐ visual analog scale (VAS) (painVAS), physician global VAS (physicianVAS), Health Assessment Questionnaire (HAQ), serum uric acid, erythrocyte sedimentation rate (ESR), and high‐sensitivity C‐reactive protein (HsCRP). Results At the flare visit, participants had a median of 1 clinically active joint (interquartile range [IQR] 1‐2), and a median of 5 joints with a PD score ≥ 2 (IQR 4‐10, P < .001). At the inter‐critical visit, participants reported an median of 0 clinically active joints (IQR 0‐0), and a median of 4 joints with a PD score ≥ 2 (IQR 3‐7, P < .001). Physician VAS (5.69 vs 3.40, P < .001), painVAS (6 vs 0, P < .001), HAQ (0.75 vs 0.12, P = .032), and ESR (29 vs 13.5 mm/h, P = .02) were higher at the acute visit, but HsCRP levels were similar (8.88 vs 5.15 mg/L, P = .062). Conclusion This pilot study established the presence of subclinical intra‐articular inflammation in gout at both acute and inter‐critical phases. Despite the apparent resolution of symptoms after an acute flare, a relatively high proportion of joints had subclinical inflammation in the inter‐critical visit. The long‐term implications of untreated subclinical joint inflammation are not clear.