BackgroundGout is the most common inflammatory arthropathy¹. It is related to elevated uric acid levels and often associated with bone loss². Furthermore, chronic inflammation has been associated with fragility fractures despite normal bone mass by dual-energy X-ray absorptiometry (DXA). However, the evaluation of bone microstructure in patients with tophaceous gout and its association with bone mineral density (BMD) has not been studied yet.ObjectivesThe present study aimed to investigate the correlation between densitometric parameters and bone microstructure using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with tophaceous gout.MethodsEleven male tophaceous gout (Figure 1) patients were enrolled in this cross-sectional study. Patients using drugs that can affect bone metabolism (e.g bisphosphonates, teriparatide and denosumab), corticosteroid use for more than 3 months and those with end-stage chronic kidney disease were excluded. Demographics and clinicals data were obtained through interviews and medical records. Laboratory tests were performed using standard automated methods. DXA was performed to evaluate the BMD. HR-pQCT at the distal radius and tibia was performed to assess trabecular and cortical volumetric BMD (Tb.vBMD= trabecular volumetric BMD; Ct.vBMD= cortical volumetric BMD), microstructure (Tb.N= trabecular number, Tb.Th= trabecular thickness, Tb.Sp= trabecular separation, Ct.Th= cortical thickness, Co.Po= cortical porosity) and strength (S= stiffness, F.Load= failure load) bone parameters. Pearson’s correlation (r) tests were performed.ResultsDemographic data are described in Table 1. Uric acid levels were negatively correlated with HR-pQCT microstructure data, such as Ct.Th tibia (r= -0.720, p= 0.029) and S tibia (r= -0.810, p= 0.008) as well as DXA data, such as lumbar spine BMD (r= -0.685, p=0.02).On the other hand, it was found a positive correlation between BMD of total hip and Tb.N tibia (r= 0.743, p= 0.035), Ct.Th tibia (r= 0.902, p= 0.005) and S tibia (r= 0.938, p= 0,001).ConclusionThe results of this study showed that uric acid levels were negatively correlated with tibia bone microarchitecture parameters. However, total hip BMD was positively correlated with these tibia bone microstructure data.References[1]Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010;12(6):223. doi: 10.1186/ar3199. Epub 2010 Dec 21. PMID: 21205285; PMCID: PMC3046529.[2]Braun T, Schett G. Pathways for bone loss in inflammatory disease. Curr Osteoporos Rep. 2012 Jun;10(2):101-8. doi: 10.1007/s11914-012-0104-5. PMID: 22527726.Table 1.Clinical and demographic characteristics of patients.Tophaceous Gout (n = 11)Age (years)62.5 ± 11.5BMI31.1 ± 7.9Number of tophi8.0 ± 10.5Years of disease16.4 ± 7.6Calcium (mg/dL)9.4 ± 0.3Vitamin D (ng/mL)26.2 ± 8.3HDL (mg/dl)39.6 ± 10.4LDL (mg/dl)112.2 ± 45.0Triglycerides (mg/dl)235.1 ± 117.0ESR (mm/h)21 ± 39CRP (mg/L)5.3 ± 6.1Nephrolithiasis(4) 36.4Diabetes(5) 45.5Hypertension(8) 72.7Gout crises in the last 3 years(7) 63.6Results are expressed in mean ± SD (standard deviation), or n (%).ESR: erythrocyte sedimentation rate; CRP: c-reactive protein; LDL: low-density lipoprotein; HDL: High-density lipoprotein; BMI: Body mass index.Figure 1.AcknowledgementsWe would like to thank Professor Rosa Maria Rodrigues Pereira, MD, PhD (in memoriam) for the inspiration and organization of this paper.Disclosure of InterestsNone Declared.
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