The burden of subclinical intra-articular inflammation in gout

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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.

Original languageEnglish
Pages (from-to)661-668
Number of pages8
JournalInternational Journal of Rheumatic Diseases
Issue number5
Publication statusPublished - 1 May 2020


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