Gancheva R.¹, Kundurdjiev A.², Ivanova M.¹, Kundurzhiev T.³ and Kolarov Z.¹
¹Clinic of Rheumatology, University Hospital St. Iv. Rilski, ²Clinic of Nephrology, University Hospital St. Iv.Rilski, ³Faculty of Public Health, Medical University, Sofia, Bulgaria
Background: Gout is related with cardiovascular (CV) events. Whether tophi are associated with more severe target organ damage is still unknown.
Objectives: To determine parameters of the heart and carotid arteries and to establish whether pathological alterations are more pronounced in the presence of tophi. Methods: 132 gout patients (pts) were examined cross-sectionally and were divided into two groups: 78 gouty arthritis without tophi, 63 males and 15 females aged 56.46±12.38 and 54 gouty tophi, 53 males and 1 female aged 58.83±11.46. Pts underwent a complex multimodal ultrasonography done by one investigator, who was blinded to clinical data. The following parameters were measured: left atrium (LA), aortic (Ao) root, E/Em – an indicator of left ventricular filling pressure, intima-media thickness (IMT), common carotid artery resistive index (CCARI) and prevalence of atherosclerotic plaques. The cutoff for LA was >42mm and for Ao root >40mm in males and >38mm in females. Data were analyzed by Kolmogorov-Smirnov, t-test, x² tests and binary logistic regression.
Results: Between the groups there was no significant difference in the distribution of smoking (p=0.942), diabetes mellitus (p=0.630), arterial hypertension (p=0.814), previous CV event (p=0.094), dyslipidemia (p=0.638), obesity (p=0.452) and in the percent of pts who were treated with diuretics (p=0.640) and statins (p=0.096). In contrast, chronic kidney failure was more common in gouty tophi (p=0.007). Although there was no great difference in serum uric acid (p=0.078) and in the percent of pts with flare (p=0.067), gouty tophi were with higher CRP (p=0.002), lower Hb (p=0.001) and albumin (p<0.001). Comparing gouty tophi to gout without no difference was established in Ao root (mean±SD; 37.94±4.41 vs 37.72±4.76mm, p=0.786), IMT (p=0.093), E/Em (mean±SD; 7.38±2.62 vs 6.79±2.63, p=0.214) and in the prevalence of plaques (p=0.479). However, gouty tophi were with larger LA (mean±SD; 40.84±5.93 vs 37.96±4.90mm, p=0.003) and higher CCARI (mean±SD; 0.73±0.04 vs 0.70±0.05, p=0.001). Tophi increased the risk of LA enlargement with an OR=2.466 (95% CI; 1.135-5.355, p=0.023), but they did not modify the risk of having enlarged Ao root.
Conclusions: Tophi were independently associated with LA enlargement and in pts with tophi carotid arteries were stiffer, which led us to suggest that chronic inflammation contributes for the pathological changes.
Keywords: gouty tophi, target organ damage, left atrium