Correlati osteoarticolari e vascolari dell'iperuricemia asintomatica: studio ecografico

Aim: Hyperuricemia is the most important risk factor for the development of gout. Despite this strong association, the majority of patients with hyperuricemia do not develop gout. We investigate the musculoskeletal and vascular ultrasonographic changes in patients with asymptomatic hyperuricaemia.Methods: Ninety-three hyperuricemic asymptomatic patients with a sustained serum urate concentration equal to or above 7.0 mg/dl documented at least twice in the last 2 years and 93 sex- and age-matched controls were prospectively recruited. A standardised ultrasonography assay was performed to evaluate aggregates, double contourn sign, tendon calcification, erosion, tophy. Furthermore common carotid artery (CCA)-IMT was assessed with automated radiofrequency-based US.Results: Hyperechoic enhancement of the superficial margin of the hyaline cartilage (double contour sign) and hyperechoic cloudy areas was found in 13% and 11% of the first MTPJs from hyperuricemic individuals, in contrast to none in the control group (P< 0.0001). Similar results were found on the femoral cartilage (10% and 11% versus 0;P< 0.0001). Quadricipital and patellar calcification (13,4% and 9,7 versus 3,4 and 4,3%;P= 0.01) as well as knee (11,3% versus 0%;P= 0.0001) were more frequent in hyperuricemic than in normouricemic individuals. Tendinous tophi and erosion were found in 12 and 15 hyperuricemic individuals respectively but in none of the normouricemic subjects (P= 0.003). The mean CCA-IMT was significantly greater in hyperuricemic patients than in controls [843.29vs821.12 ;P= 0.035]Conclusion: These data demonstrate that morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in asymptomatic individuals. Moreover radiofrequency-based measurement of CCA-IMT is greater in hyperuricemic patients as compared with controls.