AB0927 HIGHER ULTRASOUND BURDEN WITH MONOSODIUM URATE CRYSTALS IN THE JOINTS IS CONNECTED TO MORE PRONOUNCED ARTERIOSCLEROTIC VASCULAR ALTERATIONS
Authors: R. Gancheva, T. Kundurzhiev, Z. Kolarov, A. Koundurdjiev
Journal: Annals of the Rheumatic Diseases (2020)

Background: The severity of gout and the presence of subcutaneous tophi increase the risk of cardiovascular death. In patients (pts) in the spectrum of gout and in subjects who have inflammatory arthritis with accompanying asymptomatic hyperuricemia, data whether ultrasound (US) burden with monosodium urate (MSU) crystals in the joints is associated with higher cardiovascular risk are contradictory. Objectives: To establish the relationship between US MSU crystal deposits in the joints with diastolic heart function and carotid arteries alterations in gout pts, individuals with asymptomatic hyperuricemia and no sign of inflammatory arthritis and psoriatic arthritis pts with asymptomatic hyperuricemia. Methods: The study is cross-sectional. A total of 121 consecutive pts were included, divided into 85 pts with gout - 63 males and 22 females aged 57.7±14.1 years, 27 subjects with asymptomatic hyperuricemia and no sign of inflammatory arthritis - 13 males and 14 females aged 53.4±17.2 years, and 9 psoriatic arthritis individuals with asymptomatic hyperuricemia - 2 males and 7 females aged 61.2±14.4 years. Pts underwent two-dimensional echocardiography, US examination of the common carotid arteries and US of the joints of the hands, elbows, knees, ankles and feet. The echocardiography was conducted with 2.5 MHz transducer phased array working with pulse Doppler frequency of 2.5 MHz. Parameters of the transmitral blood flow were measured: the ratio between maximal early and late flow velocities (E/A ratio) and deceleration time (DT). With tissue Doppler imaging, early diastolic mitral annular velocity (eˊ) was obtained. We judged for left ventricular filling pressure by determining E/eˊ ratio. Using US of the common carotid arteries done with 10 MHz linear transducer working with pulse Doppler frequency of 5 MHz were measured: intima-media thickness (IMT), common carotid artery resistive index (CCARI) and the presence of atherosclerotic plaques was recorded. US of the joints was performed with a high-frequency, linear transducer, 4-15 MHz. The existence of double contour sign, intra-tendinous MSU aggregates, snow storm, tophi, tophi with erosions, or a combination of these US features was assessed. Data were analyzed by Chi-Square, Mann-Whitney, Kruskal Wallis, t-test and ANOVA. Results: In the three groups there was no difference in the mean values of E/A ratio (p=0.591), DT (p=0.498), eˊ (p=0.662), E/eˊ ratio (p=0.754), IMT (p=0.260), CCARI (p=0.089) and in the frequency of heterogeneous or homogeneous carotid arteries plaques (p=0.595). Among pts with and without evidence of MSU crystals in the joints the means of E/A ratio (p=0.452), DT (p=0.367), eˊ (p=0.218), E/eˊ ratio (p=0.230), IMT (p=0.165), CCARI (p=0.097) and the frequency of heterogeneous or homogeneous plaques (p=0.830) were comparable. The distribution of MSU crystal deposits in two or more joints was the highest in gout pts (56.5%) compared to pts with asymptomatic hyperuricemia (11.1%) and individuals with psoriatic arthritis (22.2%), (p&lt;0.001). Pts with MSU crystal deposits in two or more joints compared to those with crystal deposits in one joint and pts without MSU crystals had the highest CCARI (mean±SD; 0.72±0.05 vs 0.69±0.07 vs 0.68±0.07, p=0.019), the longest DT (mean±SD; 236±50.99 msec vs 208.09±34.30 msec vs 216±55.43 msec, p=0.026) and had a tendency of lowest eˊ (mean±SD; 10.33±3.96 cm/s vs 12.03±3.83 cm/s vs 11.99±3.98 cm/s, p=0.077), but the values of E/A ratio (p=0.119), E/eˊ ratio (p=0.107), IMT (p=0.151) and the distribution of atherosclerotic plaques (p=0.920) were equal. Conclusion: Pts with higher US MSU burden have more pronounced left ventricular diastolic dysfunction and greater vascular stiffness. The changes in their vessels are mainly of the arteriosclerotic type. Disclosure of Interests: None declared