Differences in Achilles tendon stiffness in people with gout.

Abstract

Background Chronic gout is associated with weaker foot/leg muscles, altered gait patterns and on-going foot pain. Inflammation associated with gout may change tissue elasticity and ultrasound imaging (US) utilising shear wave elastography (SWE) offers a non-invasive method of quantifying these changes in tendon stiffness and SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with chronic gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along a longitudinal section of the mid-point of the Achilles tendon bilaterally. Prior to data collection, intra-observer error was good (0.75). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results: A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 (95% CI (0.38 to 1.7) p=0.003 and left Achilles mdiff = 0.7 (95% CI 0.09 to 1.32) p=0.025. Conclusion: Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

Predictive Ability of Achilles Tendon Elastography for Frailty in Older Adults

“…Although several studies have implicated the change of AT stiffness in various populations, including individuals with gout [24], hypothyroidism [25], DM [26], and cardiovascular disease [27], the signi cance of AT-SWE persists even after adjusting for CVD, DM, HT, hypothyroidism treatment, and the number of medicines used in different models of regression analyses. These results therefore strengthen our hypothesis by showing that the association between AT and frailty is independent of common parameters shared with low AT stiffness, such as gait speed decline, and the multimorbidity associated with frailty.…”

“…Reduced tendon stiffness increases the metabolic cost of walking and decreases walking speed, impacting independence and quality of life in older adults [14]. On the other hand, frailty is commonly associated with sarcopenia [24] and sarcopenia may potentially lead to alterations in biomechanical stress on the AT. Thus, with a two-way relationship, frailty itself can contribute to changes in the AT, and changes in the AT can also contribute to frailty.…”