Stewart Sarah, Dalbeth Nicola, Vandal Alain C, Rome Keith
Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand.
Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand ; Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand.
J Foot Ankle Res. 2015 Aug 18;8:41. doi: 10.1186/s13047-015-0091-8. eCollection 2015.
This study aimed to identify patient-reported outcomes and clinician-assessed characteristics of the first metatarsophalangeal joint (1MTPJ) in people with gout and with asymptomatic hyperuricaemia by comparing them to normouricaemic controls.
Twenty four people with gout (without current symptoms of acute arthritis), 29 with asymptomatic hyperuricaemia and 34 age- and sex-matched controls participated in this cross-sectional observational study. Patient-reported outcomes included 1MTPJ pain, foot pain and disability, body pain, lower limb function, activity limitation and overall wellbeing. Clinician-assessed characteristics of the 1MTPJ included range of motion (ROM), plantar- and dorsi-flexion force, foot posture, temperature and hallux valgus severity.
Compared to controls, participants with gout reported greater 1MTPJ pain (p = 0.014), greater foot pain and disability (p < 0.001), increased odds of having disabling foot pain (odds ratio (OR) 13.4, p < 0.001), decreased lower limb function for daily living (p = 0.002) and recreational (p < 0.001) activities, increased activity limitation (p = 0.002), reduced overall wellbeing (p = 0.034), reduced ROM (p < 0.001), reduced plantarflexion force (p = 0.012), increased 1MTPJ plantar (p = 0.004), dorsal (p = 0.003) and medial (p = 0.004) temperature and had increased odds of having more severe hallux valgus (OR 0.3 p = 0.041). Compared to controls, participants with asymptomatic hyperuricaemia had increased odds of having disabling foot pain (OR 4.2, p = 0.013), increased activity limitation (p = 0.033), decreased lower limb function for daily living (p = 0.026) and recreational (p = 0.010) activities, increased 1MTPJ plantarflexion force (p = 0.004) and a more pronated foot type (p = 0.036).
People with gout demonstrate 1MTPJ-specific changes indicative of subclinical inflammation, even in the absence of acute arthritis. People with asymptomatic hyperuricaemia, who exhibit no features or symptoms of gout, also report high levels of foot- and lower limb-related pain and disability.
本研究旨在通过将痛风患者和无症状高尿酸血症患者与尿酸正常的对照组进行比较，确定患者报告的第一跖趾关节（1MTPJ）结局以及临床医生评估的特征。
24名痛风患者（无急性关节炎当前症状）、29名无症状高尿酸血症患者以及34名年龄和性别匹配的对照者参与了这项横断面观察性研究。患者报告的结局包括1MTPJ疼痛、足部疼痛和残疾、身体疼痛、下肢功能、活动受限和总体健康状况。临床医生评估的1MTPJ特征包括活动范围（ROM）、跖屈和背屈力、足部姿势、温度以及拇外翻严重程度。
与对照组相比，痛风患者报告的1MTPJ疼痛更严重（p = 0.014）、足部疼痛和残疾更严重（p < 0.001）、出现致残性足部疼痛的几率增加（优势比（OR）13.4，p < 0.001）、日常生活（p = 0.002）和娱乐（p < 0.001）活动的下肢功能下降、活动受限增加（p = 0.002）、总体健康状况下降（p = 0.034）、ROM降低（p < 0.001）、跖屈力降低（p = 0.012）、1MTPJ跖侧（p = 0.004）、背侧（p = 0.003）和内侧（p = 0.004）温度升高，且拇外翻更严重的几率增加（OR 0.3，p = 0.041）。与对照组相比，无症状高尿酸血症患者出现致残性足部疼痛的几率增加（OR 4.2，p = 0.013）、活动受限增加（p = 0.033）、日常生活（p = 0.026）和娱乐（p = 0.010）活动的下肢功能下降、1MTPJ跖屈力增加（p = 0.004）以及足型更旋前（p = 0.036）。
痛风患者表现出1MTPJ特异性变化，提示存在亚临床炎症，即使在无急性关节炎的情况下也是如此。无症状高尿酸血症患者虽无痛风的特征或症状，但也报告了高水平的足部和下肢相关疼痛及残疾。
