Tendon involvement in the feet of patients with gout: a dual-energy CT study

Dalbeth, Nicola; Kalluru, Ramanamma; Aati, Opetaia; Horne, Anne; Doyle, Anthony; McQueen, Fiona

doi:10.1136/annrheumdis-2012-202786

Cited by 118 publications

(83 citation statements)

References 16 publications

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“…Contrary to our hypothesis, our results indicate that the dorsiflexors of the ankle are not affected by strength deficits to the same extent as the plantarflexors of the ankle in people with gout. This finding may be related to the pattern of crystal deposition and patient symptoms reported in the foot and ankle, in which anterior ankle structures, including the tibialis anterior tendon are less frequently involved compared with the posterior ankle and Achilles tendon [6,8]. Our results are consistent with previous studies investigating the ankle in other chronic inflammatory arthritic conditions [27] in which neural…”

Section: Discussionsupporting

confidence: 91%

“…Previous research has observed tophaceous deposition in the Achilles, peroneal and the tibialis posterior muscle tendons in people with gout [6,8]. Tendons have important functional roles, both in generating and absorbing mechanical work during ambulation [19].…”

Section: Discussionmentioning

confidence: 99%

“…The structures of the foot and ankle are frequently affected in people with gout [4,5]. Furthermore, imaging studies have demonstrated particular patterns of foot involvement in gout in which the most common sites for MSU deposition are the first metatarsophalangeal joint, ankle joint and tendons surrounding the ankle including the peroneal and Achilles tendons [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Stewart

Mawston

Davidtz

et al. 2016

Clinical Biomechanics

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Foot and ankle muscle strength in people with gout: a two-arm cross-sectional study, Clinical Biomechanics (2015Biomechanics ( ), doi: 10.1016Biomechanics ( /j.clinbiomech.2015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT ABSTRACTBackground Foot and ankle structures are the most commonly affected in people with gout.However, the effect of gout on foot and ankle muscle strength is not well understood. The primary aim of this study was to determine whether differences exist in foot and ankle muscle strength for ankle plantarflexion, dorsiflexion, inversion and eversion between people with gout and age-and sex-matched controls. The secondary aim was to determine whether foot and ankle muscle strength was correlated with foot pain and disability.Methods Peak isokinetic concentric muscle torque was measured for ankle plantarflexion, dorsiflexion, eversion and inversion in 20 participants with gout and 20 matched controls at two testing velocities (30°/s and 120°/s) using a Biodex dynamometer. Foot pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI).Findings Participants with gout demonstrated reduced muscle strength at both the 30°/s and 120°/s testing velocities for plantarflexion, inversion and eversion (p<0.05). People with gout also displayed a reduced plantarflexion-to-dorsiflexion strength ratio at both 30 o /s and 120 o /s (p<0.05). Foot pain and disability was higher in people with gout (p<0.0001) and MFPDI scores were inversely correlated with plantarflexion and inversion muscle strength at the 30°/s testing velocity, and plantarflexion, inversion and eversion muscle strength at the 120°/s testing velocity (all p<0.05).Interpretation People with gout have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls. Foot and ankle strength reductions are strongly associated with increased foot pain and disability in people with gout.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Stewart

Mawston

Davidtz

et al. 2016

Clinical Biomechanics

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“…Gout is a chronic disease of monosodium urate (MSU) crystal deposition, with a predilection for peripheral sites in the lower limbs [1,2]. The presence of MSU crystals initiate local inflammation resulting in self-limiting flares of acute gouty arthritis.…”

Section: Introductionmentioning

confidence: 99%

Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study

et al. 2016

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Please cite this article as: Stewart S, Morpeth T, Dalbeth N, Vandal AC, Carroll M, Davidtz L, Mawston G, Otter S, Rome K, Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: a two-arm cross sectional study, Gait and Posture (2015), http://dx.doi.org/10.1016/j.gaitpost. 2015.11.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Method Gait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age-and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure.Results At the self-selected speed, gout participants demonstrated increased step time (p=0.017), and stance time (p=0.012), and reduced velocity (p=0.031) and cadence (p=0.013). At the fast speed, gout participants demonstrated increased step time (p=0.007), swing time (p=0.005) and stance time (p=0.019) and reduced velocity (p=0.036) and cadence (p=0.009). For participants with gout, step length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); stride length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); and velocity was correlated with total MFPDI (r=-0.60, p=0.011), function (r=-0.63, p=0.007) and work/leisure (r=-0.53, p=0.030). ConclusionGait patterns exhibited by people with gout are different from controls during both selfselected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.

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“…5 However, unless urate lowering therapy (ULT) is started and continued long-term to reduce the serum urate below saturation concentrations, patients can develop progressive disease, with recurrent A qualitative study to explore health professionals' experience of treating gout: understanding perceived barriers to effective gout management ORIGINAL SCIENTIFIC PAPER ORIGINAL RESEARCH attacks, gouty tophi, joint damage, and limitation of quality of life. 6,7 There are low national rates of continuous allopurinol prescription and serum urate monitoring in NZ. 8 To date no qualitative data exist on the perspective of NZ health professionals as to why gout treatment remains suboptimal.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study to explore health professionals’ experience of treating gout: understanding perceived barriers to effective gout management

Humphrey

Hulme²,

Dalbeth

et al. 2016

J Prim Health Care

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IntroductIon: The management of gout is challenging and mainly occurs in primary care. This study aims to explore the experience of treating gout among primary care clinicians and understand the perceived barriers to effective therapy.Methods: Fourteen health professionals from primary care practices in South Auckland were recruited. Each participated in a semi-structured interview exploring their experience of treating and managing gout patients were analysed thematically.FIndIngs: Participants described the large burden of gout in their communities and the importance of the clinician-patient relationship in gout management. Four themes summarise the perceived barriers to effective urate lowering therapy (ULT); unique gout factors, eg its intermittent nature and potential for stigmatisation; systemic barriers to optimal treatment, or barriers that emerge from working within a certain organisation; uncertainty about ownership, or who should carry responsibility for overcoming barriers to optimal treatment; and cultural barriers to optimal treatment. conclusIon: Clinicians in primary practice perceive gout management to be mainly acute rather than preventive care. Patients may be stigmatised and management difficult particularly when diet is emphasised over ULT. Practice nurses are a group potentially available and willing to assist in educating patients. These findings may be helpful in planning for and improving healthcare in gout.

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Tendon involvement in the feet of patients with gout: a dual-energy CT study

Abstract: Tendons are commonly affected by MSU crystal deposition in patients with tophaceous gout. The patterns of MSU crystal deposition suggest that biomechanical strain or other local factors may contribute to deposition of MSU crystals.

Cited by 118 publications

References 16 publications

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study

A qualitative study to explore health professionals’ experience of treating gout: understanding perceived barriers to effective gout management

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