December 27, 2018
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Bone erosions detected in 44% of patients with gout

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Researchers using ultrasound were able to detect bone erosions in 44% of patients with gout, with 78.4% of erosions occurring at the first metatarsophalangeal joints, according to data published in Arthritis Care & Research.

“Few studies have focused on bone erosion in patients with gout,” Mian Wu, MD, of the Shanghai Jiao Tong University Affiliated Sixth People's Hospital, and colleagues wrote. “The sample sizes of these studies were quite small, so further clinical studies in a larger cohort of patients are warranted to confirm these findings and to explore the prevalence and distribution of bone erosion in patients with gout.”

To analyze the prevalence, distribution and factors associated with bone erosion, as detected through ultrasound, among patients with gout, Wu and colleagues conducted a retrospective cohort study of 980 participants recruited from the Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Eligibility included a history of gout based on the 2015 ACR/EULAR criteria to undergo imaging investigations. All participants completed a questionnaire at enrollment documenting age, sex, disease duration, comorbidities, medications, flare frequency, pain score and various clinical data.

 
Researchers using ultrasound were able to detect bone erosions in 44% of patients with gout, according to data.
Source: Shutterstock

All participants underwent ultrasound examinations, performed by three experienced sonographers. The researchers calculated the prevalence and distribution of bone erosion, including both clinical variables and ultrasound signs into a multivariate logistic analysis to clarify associated factors.

According to Wu and colleagues, bone erosions were found in 44% of participants, with 78.4% of all erosions detected in the first metatarsophalangeal joint. A multivariate logistic regression analysis found that age, duration of gout, the existence of tophi, ultrasound-detected synovial hypertrophy and joint effusion were independently associated with bone erosion. In addition, a tophus was the most significant factor linked to bone erosion, (OR = 4.218; 95% CI, 3.092-5.731).

The researchers also found that the risk for bone erosion increased as the number of tophi increased (P < .001). However, after stratifying the size of tophi, the odds ratios did not significantly increase (P = .206).

“This study has shown that bone erosion is a common complication of gout,” Wu and colleagues wrote. “Age, duration of gout, tophi, synovial hypertrophy and joint effusion were independently associated with bone erosion, shedding further light on the links between crystal deposition and joint damage in patients with gout. These results suggest that an early diagnosis of gout, controlling the urate level and decreasing local urate crystal deposition may be the most effective way to prevent bone erosion in patients with gout.” – by Jason Laday

Disclosure: Wu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.