Short communicationAnkle joint function during walking in tophaceous gout: A biomechanical gait analysis study
Introduction
Gout is a common form of inflammatory arthritis in adults and is a chronic disease of urate crystal deposition in articular and peri-articular structures [1]. Clinically, gout is characterised by painful flares of acute monoarthritis interspersed with asymptomatic periods and can progress to a chronic arthritis with tophus formation [2]. Tophaceous gout, characterised by deposition of monosodium urate crystals (MSU) is associated with pain, inflammation, joint deformity and/or joint destruction, bone erosions and alteration to tendon and ligament structure and function [3], [4]. Dual-energy computed tomography has shown that the foot and ankle contain the largest volume of MSU crystal deposition with between 37% and 68% of people with gout demonstrating some degree of crystal deposition within joints and soft tissue structures of the foot and ankle [5], [6], [7], [8]. Stewart [9] reported that people with gout were found to have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls using isokinetic dynamometry. Despite the importance of lower limb and foot muscle strength requirements in major daily life activities, including walking, there is limited knowledge of kinematic or kinetic characteristics of ankle function in people with gout. The aim of the study was to determine the kinematic and kinetic characteristics of the ankle joint in people with tophaceous gout in comparison with age-and sex-matched control participants.
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Methods
Participants with tophaceous gout were recruited from a rheumatology clinic at the Auckland District Health Board, Auckland, New Zealand. Participants were eligible for study inclusion if they were: classified with gout according to the 1977 American Rheumatism Association criteria [10]; aged >18 years old; able to walk 10 m without assistive devices; and had at least one subcutaneous tophus determined by clinical examination at the time of data collection. Tophi were defined as palpable
Results
Twenty-four tophaceous gout and 24 controls participated in the study. The majority of participants with gout were middle-aged males of European ethnicity (Table 1). Participants with tophaceous gout had a mean (SD) serum urate level of 0.37 (0.11) mmol/l and disease duration of 17.4 (11.9) years. Table 2 illustrates peak ankle joint angular velocity was significantly decreased in participants with gout (P < 0.01). No differences were found for ankle ROM in either the sagittal (P = 0.43) or
Discussion
Three dimensional gait analysis has improved our understanding of foot and ankle function in people with inflammatory arthritic conditions such as rheumatoid arthritis but has not been reported in gout. We found no differences in ankle ROM, peak force and peak plantar flexor moments and ankle plantarflexor concentric work were similar between the groups. The findings are contrary to previous work that reported people with gout have significantly reduced plantarflexion, eversion and inversion
Conclusions
Three dimensional gait analysis demonstrated that ankle joint function does not change in people with gout. People with gout demonstrated a reduced peak ankle joint angular velocity which may reflect gait-limiting factors and adaptations from the high levels of foot pain, impairment and disability experienced by this population.
Conflict of interest
We confirm that each individual named as author meets Gait & Posture criteria for authorship. All authors were involved in drafting the report or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. The manuscript has not been submitted or is not simultaneously being submitted elsewhere.
Author’s contributions
All authors made substantial contributions to conception and design of the study, undertook all clinical data collection, contributed to analysis and interpretation of data and to writing the manuscript. All authors were involved in drafting of the manuscript or revising it critically for important intellectual content. All authors read and approved the final manuscript.
Funding
Financial support for the study was provided by Arthritis New Zealand. N. Dalbeth has received consulting fees, speaker fees or grants from the following companies: Takeda, Menarini, Pfizer, Crealta, Cymabay, Fonterra, Ardea Biosciences and AstraZeneca, outside the submitted work. The other authors declare no competing interests.
Acknowledgements
We confirm that each individual named as author meets Gait & Posture criteria for authorship. All authors were involved in drafting the report or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. The manuscript has not been submitted or is not simultaneously being submitted elsewhere. This work was supported by Arthritis New Zealand.
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