Hyperuricaemia with deposition: latest evidence and therapeutic approach

Abstract

This article reviews recent evidence on urate deposition and the opportunity for a therapeutic approach. We reviewed Pubmed 2013-2015 literature using the search terms 'deposition' with 'hyperuricaemia', 'gout', 'ultrasonography', 'DECT' (dual-energy computed tomography), 'radiography', 'CT'(computed tomography), 'MRI' (magnetic resonance imaging), or 'cardiovascular', in addition to a digital bibliographic library compiled by the authors with 2072 papers on hyperuricaemia and gout. Relevant papers on the topic were selected. Recent evidence, mostly based on imaging studies, showed a continuum from hyperuricaemia to deposition and clinical manifestations. Chronic inflammation and structural damage may be present even in asymptomatic patients with crystal-proved deposition. The impact of early intervention in patients with asymptomatic deposition either on vascular outcomes or further structural joint damage has not been demonstrated yet. In conclusion, a worldwide definition of gout is still lacking, stages from hyperuricaemia to clinical gout not being definitively defined. Although there is increasing interest on the impact of early deposits on joint damage and cardiovascular outcomes, robust evidence is still lacking to fully support interventions.

Keywords: deposition; dual-energy computed tomography; gout; gout suppressant; hyperuricaemia; ultrasonography.

Figure 1.

(a) Magnetic resonance imaging of the knee showing no deposition or structural damage at the first presentation of gout. (b) The patient underwent arthroscopy due to suspected infection, with urate deposits showing on the cartilage surface. (c) Synovial biopsy showing areas with chronic, foreign body-like granulomas. (reproduced from Perez-Ruiz et al. [2015] with permission).

Figure 2.

Ultrasonography of the knee (a) and finger pad (b) showing hyperechoic areas (tophi) with a power-Doppler signal in a patient with systemic lupus erythematosus treated with corticosteroids. No previous flare, but unspecific arthralgia was retrieved from careful anamnesis. The patient was fully asymptomatic after 6 months of intensive urate-lowering therapy. (reproduced from Perez-Ruiz et al. [2015] with permission).