Clinical correlation between serum uric acid level and tophus involmente of tendon: a descriptive study


  • Susheel Soni Department of Orthopaedic, IMCHRC, Indore, Madhya Pradesh
  • Deepak Mantri Department of Orthopaedic, MGMMC, Indore, Madhya Pradesh
  • Penosh Agrawal Consultant Radiologist, MHOW Indore, Madhya Pradesh



Tophus, Uric acid, Tendon, Ultrasound


Background: Clinical correlation between serum uric acid level and tophus involvement of tendon.

Methods: This is a non randomised multicetric prospective study carried out from December 2015 to May 2018. This is a descriptive study comprising 108 patients with diagnosis of gout according to the American College of Rheumatology (ACR) criteria. US examination included the quadriceps tendons, the patellar Tendon, peroneus tendon and the Achilles tendon. All tendons were evaluated bilaterally according to the EULAR guidelines for performing US in rheumatology.

Results: We included the patients aged between 20-60 year. In this study male patients was 86 (79.63% ) and 22 (20.37%) patient were female. In this study 108 patients with serum uric acid level between 5.5 -9.0 mg/dl with age from 20 yr to 60 yr were studied. Uric acid level between 7 - 9 mg/dl found in 68.48% and it was in age between 30–45 yr of age. 73 patiens (67.59%) had pain at enthesis for at least once before inclusion in the study. Intra-tendinous tophi and hyperechoic aggregates were the most frequent lesions at the tendon in US examinations. In our study Patellar tendon is the most frequently involved tendon followed by quadriceps, Achilles and peroneus tendon.

Conclusions: Tophius involvement of tendon in the lower limbs in gout is very frequent, particularly at the patellar tendon, Quadriceps tendon and Achilles tendon.


Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population. National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63:3136–41.

Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factor. Nat Rev Rheumatol. 2015;11(11):649-62.

Badulescu M. Macovei L. Rezus E. Acute gout attack with normal serum uric acid levels. Rev Med chir soc Nat Iasi. 2014;118(4);946-5.

Neogi T, Jansen TLT, Dalbeth N, Fransen J, Schumacher HR, Berebsen D, et al. 2015 gout classification criteria: an American College of Rheumatology/ European League Against Rheumatism Collaborative Initiative. Ann Rheum Dis. 2015;74:1789–98.

Filippucci E, RiverosMG, Georgescu D, Salaffi F, GrassiW. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthr Cartil. 2009;17:178–81.

Thiele RG, Schlesinger N. Ultrasonography is a reliable, non-invasive method for diagnosing gout. Rheumatology. 2007;46:1116–21.

Filippucci E, RiverosMG, Georgescu D, Salaffi F, GrassiW. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthr Cartil. 2009;17:178–81.

Peiteado D, de Miguel E, Villalba A, Ordóñez MC, Castillo C Martín-Mola E. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol. 2012;30:830–7.

Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis. 1996;55:921–3.

Weniger FG, Davison SP, Risin M, Salyapongse AN, Manders EK. Gouty flexor tenosynovitis of the digits: report of three cases. J Hand Surg [Am]. 2003;28:669–72.

Primm DD Jr, Allen JR. Gouty involvement of a flexor tendon in the hand. J Hand Surg [Am]. 1983;8:863–5.

de Avila Fernandes E, Sandim GB, Mitraud SA, Kubota ES, Ferrari AJ, Fernandes AR. Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout. Insights Imaging. 2010;1:143–8.

Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM. Tendon involvement in the feet of patients with gout: a dualenergy CT study. Ann Rheum Dis. 2013;72:1545–8.

Chhana A, Cllon K, Dray M, Pool B, Naot D, Gamble GD, et al. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis. 2014; 73:1737–41.

Sasaki K, Yamamoto N, Kiyosawa T, Sekido M. The role of collagen arrangement change during tendon healing demonstrated by scanning electron microscopy. J Electron Microsc. 2012;61:327–34.

Schweyer S, Hemmerlein B, Radzun HJ, Fayyazi A. Continuous recruitment, co-expression of tumour necrosis factoralpha andmatrix metalloproteinases, and apoptosis of macrophages in gout tophi. Virchows Arch. 2000;437:534–9.

Levy M, Seelenfreund M, Maor P, Friei A, Lurie M. Bilateral spontaneous and simultaneous rupture of the quadriceps tendon in gout. J Bone Joint Surg. 1971;53:510–3.

Wurapa RK, Zelouf DS. Flexor tendon rupture caused by gout: a case report. J Hand Surg [Am]. 2002;27:591–3.

Sainsbury DC, Hidvegi N, Blair JW. Intra-tendinous gout in a repaired flexor digitorum profundus. J Hand Surg Eur. 2008;33:528–9.

Radice F, Monckeberg JE, Carcuro G. Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration. J Foot Ankle Surg. 2011;50:751–3.

Mathieu S, Pereira B, Couderc M, Soubrier M. Usefulness of ultrasonography in the diagnosis of gout: a meta-analysis. Ann Rheum Dis. 2013;72:e23.

Naredo E, Uson J, Jiménez-Palop M, Martínez A, Vicente E, Brito E, et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis. 2014;73:1522–8.

Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricemia. Ann Rheum Dis. 2013;72:638–45.

Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis Care Res. 2011;63:1456–62.

Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20:895–900.

Backhaus M, Burmester GR, Gerber T, Grassi W, Machol KP, Swen WA et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001; 60:641–9.

Gutiérrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo S et al. International consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford). 2015;54:1797–805.

Terslev L, GutierrezM, Christensen R, Balint PV, Bruyn GA, Delle Sedie A et al. Assessing elementary lesions in gout by ultrasound: results of an OMERACT patient-based agreement and reliability exercise. J Rheumatol. 2015; 42:2149–54.

Terslev L, Gutierrez M, SchmidtWA, Keen HI, Filippucci E, Kane D et al. Ultrasound as an outcome measure in gout. A validation process by the OMERACT ultrasound working group. J Rheumatol. 2015;42:2177–81.






Original Research Articles