Matthew Carroll1,2, Nicola Dalbeth1,2, Bruce Allen1,2, Sarah Stewart1,2, Tony House1,2, Mark Boocock1,2, Christopher Frampton1,2, Keith Rome3,4. 1. From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. 2. M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology. 3. From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. krome@aut.ac.nz. 4. M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology. krome@aut.ac.nz.
Abstract
OBJECTIVE: To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). METHODS: Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. RESULTS: The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p < 0.01). Intratendinous hyperechoic spots (p < 0.01) and intratendinous power Doppler signal (p < 0.01) were more frequent in participants with gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both gout participants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p < 0.01), but between-zone differences were not observed for other features. CONCLUSION: US features of urate deposition, tophus, and vascularization are present throughout the AT in patients with tophaceous gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.
OBJECTIVE: To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). METHODS: Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. RESULTS: The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p < 0.01). Intratendinous hyperechoic spots (p < 0.01) and intratendinous power Doppler signal (p < 0.01) were more frequent in participants with gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both goutparticipants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p < 0.01), but between-zone differences were not observed for other features. CONCLUSION: US features of urate deposition, tophus, and vascularization are present throughout the AT in patients with tophaceous gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.
Authors: Lucio Ventura-Ríos; Tomas Cazenave; Cristina Hernández-Díaz; Selma Gallegos-Nava; Citlallyc Gómez-Ruiz; Marcos Rosemffet; Karina Silva-Luna; Pedro Rodríguez-Henríquez; Janitzia Vázquez-Mellado; Julio Casasola-Vargas; Esteban Cruz-Arenas; Eugenio M de Miguel Journal: Front Med (Lausanne) Date: 2022-05-24