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JCR: Journal of Clinical Rheumatology:
doi: 10.1097/RHU.0b013e3181ffe28a
Concise Reports

Asymptomatic Gout in a Male With Meniscus Injury

Checa, Angel MD

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From the Division of Rheumatology, Drexel University College of Medicine, Philadelphia, PA.

Correspondence: Angel Checa, MD, Division of Rheumatology, Drexel University College of Medicine, 219 N Broad St, Philadelphia, PA 19107. E-mail: checaag@yahoo.com

Modern diagnostic imaging modalities such as ultrasonography, which has an increasing use in rheumatology, might clarify ancient concerns about asymptomatic hyperuricemia.

A 51-year-old man with a history of metabolic syndrome and hyperuricemia over the last five years was seen in the arthroscopic unit for pain and swelling in the right knee after a twisting trauma playing sports. A sonogram of the knee showed a hyperechoic track in "double-contour" characteristic of gout and thinning of the hyaline cartilage (Fig. A). At arthroscopy, there was a transverse tear of the lateral meniscus and chalky deposits easily detachable during arthroscopic probing on fraying condyles and femoral trochlea (Fig. B). There were also chalky deposits in the synovium (Fig. C). The diagnosis of gout was corroborated by polarizing microscopy of fluid obtained by arthroscopic washout. Excellent outcome followed an arthroscopic meniscectomy and treatment for gout.

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This is an illustrative case of asymptomatic gout probably contributing to secondary damage of the cartilage. Characteristic intra-articular deposits of monosodium urate have also been detected in other patients who underwent arthroscopy for a mechanical condition or injury of the knee.1,2 In a recent case series of patients with asymptomatic hyperuricemia assessed by ultrasound, urate deposits were detected in around one third in the joint or periarticularly.3

Ultrasonography might be a helpful tool in screening patients with asymptomatic hyperuricemia. This imaging modality is inexpensive and noninvasive. Prior studies have suggested that ultrasound has a similar sensitivity to that of MRI when used to identify tophaceous deposits and may even identify gout when MRI cannot.4 Nonetheless, additional investigations are needed to characterize groups at greatest risk among patients with hyperuricemia and to establish which joints to scan.

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REFERENCES

1. Yu KH. Intrarticular tophi in a joint without a previous gout attack. J Rheumatol. 2003;30(8):1868-1870.

2. Baker JF, Synnott KA. Gout revealed on arthroscopy after minor trauma. Arthritis Rheum. 2010;62(7):2126.

3. Puig JG, de Miguel E, Castillo MC, et al. Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids. 2008;27(6):592-595.

4. Thiele RG, Anandarajah AP, Tabechian D, et al. Comparing ultrasonography, MRI, conventional radiography, high-resolution CT and 3D rendering in patients with crystal proven gout. Arthritis Rheum. 2008;58:S466.

© 2010 Lippincott Williams & Wilkins, Inc.

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