Bone Erosions and Systemic Bone Loss on HR-pQCT in Men With Tophaceous Gout

Aims

Gout, a prevalent inflammatory arthropathy, predominantly affects males and arises from persistent hyperuricemia, resulting in monosodium urate crystal deposition. Hyperuricemia is associated with comorbidities, exacerbating patient morbidity. Conflicting literature exists regarding uric acid's impact on bone mineral density (BMD), with potential proinflammatory effects in gout patients. Localized bone destruction (erosions) is a hallmark of gout, necessitating early detection due to its predictive role in musculoskeletal disability.

Methods

This cross-sectional study included 26 tophaceous gout patients. Clinical and densitometric parameters were assessed, and high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for bone microarchitecture evaluation, as well as bone erosions in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. A healthy control group of 52 age and BMI-matched individuals was included.

Results

Despite normal areal bone mineral density (BMD), tophaceous gout patients exhibited impaired HR-pQCT parameters, including lower cortical volumetric BMD (Ct.vBMD) and higher cortical porosity at the distal radius. Similar trends were observed at the tibia. Bone erosions were prevalent (96%), with distribution across MCP and PIP joints. Patients with ≥ 4 erosions displayed increased tophi prevalence and longer uricosuric use. Erosions correlated with compromised microarchitecture, emphasizing their association with disease activity.

Conclusion

Despite normal BMD, tophaceous gout patients manifest systemic bone loss, with bone microarchitectural deterioration and localized bone erosions, underscoring the need for detailed clinical approaches to prevent musculoskeletal disabilities, including fragility fractures, in this population.