Gout

Gouty changes on ultrasound common in people with type 2 diabetes


Joint pathology consistent with gout is common in people with type 2 diabetes and hyperuricemia irrespective of symptoms or a diagnosis of gout.

In a sub-study of the Fremantle Diabetes Study, 101 participants with fasting serum uric acid levels ≥ 4.2mmol/L were assessed by ultrasound for intra-articular urate deposition and inflammation in a number of joints commonly affected by gout.

Just over 40% of hyperuricemic patients self-reported a diagnosis of gout and 12.2% said they used allopurinol.

However the ultrasound showed 59.4% of participants had aggregates in their joints, 27.7% had the double contour sign and 19.7% had evidence of at least one tophus.

“There was no statistically significant difference between the prevalence of these features of crystal deposition in those with asymptomatic hyperuricemia (ASH) versus participants with gout,” the study said.

“As asymptomatic crystal deposition is a predictor of the future development of gout, and since the associated joint inflammation may contribute to the development of cardiovascular disease, these data have potential clinical implications.”

More than a third (36%) of participants also had evidence of joint inflammation – mostly in the wrist or first metatarsophalangeal joint – as defined by a power Doppler signal ≥2.

There was no association between the presence of self-reported ischemic heart disease and either joint abnormality on ultrasound or inflammatory changes.

The study noted the low treatment rate for patients diagnosed with gout suggested poor adherence to gout management guidelines.

“Although urate lowering treatment (ULT) for ASH remains controversial, it is possible that intra-articular crystal deposition and/or inflammation on ultrasound may identify a sub-set of individuals in whom lifestyle changes and pharmacotherapy attenuate cardiovascular disease as well as preventing gout.”

The findings are published in Journal of Diabetes and Its Complications.

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