Background Hyperuricemia has been associated with the development of hypertension, metabolic syndrome, diabetes mellitus and represents a well recognized risk factor for cardiovascular disease.
Objectives To determine ultrasonographic (US) changes suggestive of gouty arthritis in the joints and the hyaline cartilage from hypertensive patients with hyperuricemia asymptomatic for gouty arthritis.
Methods We performed a cross-sectional, controlled study including US examinations of the first metatarsal-phalangeal joints (first MTPJs) and knees of hypertensive patients hospitalized for monitoring. 72 hypertensive patients with hyperuricemia asymptomatic for gouty arthritis and 68 normouricemic hypertensive patients were included. Ultrasound morphostructural changes followed were: the double contour sign determined by the hyperechoic enhancement of the condrosynovial margin of the hyaline cartilage and the intraarticular tophi, using a MyLab25 Gold scanner (Esaote, Italy), with a multifrequency linear array transducer (10-18MHz).
Results The double contour sign was found in 43% of the first MTPJs from hyperuricemic hypertensive patients, in contrast to only 6% control group of normouricemic hypertensive patients (p < 0.0001), as well as on the femoral cartilage (25% versus 3%; p < 0.001). Intra-articular tophaceus material was detected in 16 hyperuricemic patients but in none of the normouricemic ones (p < 0.001).
Conclusions These findings demonstrate that ultrasound detected morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in hypertensive patients clinically asymptomatic for gouty arthritis, increasing the risk of subsequent development of the articular disease, with activation of inflammation and thus creating a vicious cycle of increasing the risk for cardiovascular disease. Monitoring morphostructural changes suggestive of gouty arthritis in this hypertensive population and lowering serum uric acid levels might be beneficial in reducing the risk of further complications from both cardiovascular and arthritis point of view.
References C. Pineda et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Research & Therapy 2011, 13:R4 doi:10.1186/ar3223
Disclosure of Interest None Declared