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Urate crystals are present in articular tissues before gout is clinically evident

Discussion in 'General Issues and Discussion Forum' started by Mart, Jul 6, 2010.

  1. Mart

    Mart Well-Known Member


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    <H2>Ultrasound Analysis Shows Patients With Asymptomatic Hyperuricaemia May Benefit From Therapy: Presented at EULAR

    • By Ed Susman

      ROME -- June 22, 2010 -- Despite a lack of symptoms, individuals with hyperuricaemia may be experiencing undetected joint damage, and these patients may benefit from urate-lowering therapy, researchers said here at the 2010 Annual Meeting of the European League Against Rheumatism (EULAR).

      When doctors identified subjects with elevated serum uric acid levels, they performed noninvasive ultrasound of key joints.

      "Asymptomatic hyperuricaemic patients show ultrasound morphostructural changes similar to those with established gout," said Carlos Pineda, MD, Instituto Nacional de Rehabilitación, Mexico City, Mexico, during his poster presentation on June 19. "These results confirm that urate crystals are present in articular tissues before gout is clinically evident."

      Of 45 patients identified as being hyperuricaemic with a serum uric acid level about 7 mg/dL, doctors found that 24 of these patients exhibited the telltale "double-contour" ultrasound signals indicating a likelihood of crystal deposits in joints. When similar tests were performed on 52 matched controls who were normouricaemic, only 1 patient exhibited the double contour sign (P < .0001).

      Dr. Pineda and colleagues identified patients who were asymptomatic but exhibited hyperuricaemia on various routine tests either for other suspected illnesses or as part of a regular physical examination. If these adults had serum uric acid >7.0 mg/dL and did not have any complaints of joint pain, they were recruited for the study. Also recruited were controls who also did not express joint complaints. The average serum uric acid level in the patients deemed to be hyperuricaemic was 8.17 mg/dL.

      All patients underwent ultrasound scans of the femoral cartilage and tendons in the knee and at the ankle, the Achilles tendon, and the first metatarsophalangeal joint. The researchers reported no statistical differences in appearance of osteophytes, bone erosions, or synovitis between the patients who were hyperuricaemic and those who had normal serum uric acid levels

      But they did see the marked difference in patients exhibiting the double contour sign among the hyperuricaemic individuals. "Ultrasound has been shown to be superior in detecting changes in gouty arthritis than other imaging techniques," Dr. Pineda noted. "Ultrasonic characteristics of gout are already well defined. However, the findings in asymptomatic patients have not been thoroughly defined."

      Dr. Pineda said the ultrasonic findings support "the use of urate-lowering therapy in asymptomatic hyperuricaemia patients."

      [Presentation title: Asymptomatic Hyperuricemia: Ultrasonographic Findings. Abstract SAT0384]
    </H2>
     
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  3. twinkletoes

    twinkletoes Member

    i have been looking in to gout recently a little and came across a book on natural remedies that advocates the eating of cherries (fresh or tinned makes no difference apparently) and you need to eat 25 a day on presentation of the symptoms and then as it resolves 10 a day for maintainence.
    as is often the case in a health magazine a few days later it was recommended again.
    neither explained what it is in cherries that can clear the pain so well or whether taking cherries on a regular basis if you have a high urate problem could actually prevent it turning to gout.
    any thoughts?
     
  4. Mart

    Mart Well-Known Member

    Sounds like wishful thinking on someones part. If there were some active component it would seem unlikley that the amount would be so presicely constant irrespective of type of cherry and its weight - even if this were true that the same dose would be effective for every case of hyperuricaemia is doubly doubtful. If you are keen to find out; why not track down the article sourse and see what the basis for it was? Keep us posted if yoiu find out.

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  5. Mart

    Mart Well-Known Member

    Interestingly the opposite seems to be possible with sustained normouricemia.

    THIELE, R. G. & SCHLESINGER, N. (2010) Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatology International, 30, 495-503.

    double contour sign.jpg


    Fig. 2 Patient 2: plantar longitudinal view centered over the 1st metatarsal phalangeal joint of left and right feet. Top left MTP 1 joint and bottom, right MTP 1 joint. SuperWcial to both metatarsal heads, which appear as a hyperechoic outline, anechoic hyaline cartilage is seen. On the images on the left side, after more than 1 year of documented hyperuricemia, a thick hyperechoic, irregular band coats the cartilage (arrows). On the images on the right side, which were taken after 6.5 months of well-documented, sustained normouricemia, this layer of echogenic material has disappeared.



    Cheers

    Martin



    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
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    NewsBot The Admin that posts the news.

    Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients.
    Filippucci E, Meenagh G, Delle Sedie A, Sakellariou G, Iagnocco A, Riente L, Gutierrez M, Bombardieri S, Valesini G, Montecucco C, Grassi W.
    Clin Exp Rheumatol. 2011 Nov;29(6):901-905.
     
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    NewsBot The Admin that posts the news.

    Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study.
    Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M.
    Arthritis Res Ther. 2011 Jan 17;13(1):R4.
     
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    NewsBot The Admin that posts the news.

    Ultrasonography in gout: a case-control study.
    Ottaviani S, Richette P, Allard A, Ora J, Bardin T.
    Clin Exp Rheumatol. 2012 Apr 17
     
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