ABS0177 FOOT AND ANKLE INVOLVEMENT IN GOUT: CLINICAL, RADIOLOGICAL, AND FUNCTIONAL OUTCOMES FROM A FIVE-YEAR STUDY IN A TERTIARY HOSPITAL IN SOUTHERN TUNISIA

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Background: Gout is a disease characterized by the deposition of monosodium urate monohydrate (MSU) crystals, leading to acute and chronic inflammation, which can result in structural and functional damage to joints and surrounding tissues. Foot and ankle involvement in gout is common and significantly impacts patients' quality of life due to debilitating pain, structural damage, and functional impairment. Objectives: This study aimed to assess the prevalence, clinical and radiological aspects, functional impact, and therapeutic approaches to foot and ankle involvement in gout. Methods: We conducted a cross-sectional descriptive study on gout patients with foot involvement over five years (2019–2023) at the Rheumatology Department of Hedi Chaker University Hospital, Sfax, Tunisia. We included adult patients aged over 16 years and diagnosed with gout according to the 2015 American College of Rheumatology (ACR). Data were collected through detailed clinical examinations and radiographic imaging, and the Foot Function Index (FFI) was used to assess functional impact. Results: Among 200 gout patients, with a mean age of 71 years (range: 37–92) and a male predominance (sex ratio: 2.47). Hypertension was present in 52% of cases, and 31.5% were on diuretics. In our study, 73 (36.5%) had foot pain and the mean pain intensity was 6.4/10 on the Visual Analog Scale. Most cases were oligo-articular (55%), and the first metatarsophalangeal joint was the most commonly affected site (28.7%). Hyperuricemia was noted in 91.7% of cases, with a mean serum uric acid level of 567 µmol/L. Standard foot radiographs were normal in 28.7% of cases, although radiographic anomalies included joint space narrowing (19%), periarticular geodes (31.5%), and osteophytes (20.5%). Ultrasound examinations of the foot and ankle, performed in 21 patients, revealed early signs of gout in 52% of cases (n=11), such as intra-articular effusion in the talocrural joint (42%; n=9) and double-contour signs (23.8%; n=5). The FFI score was calculated in 85% of patients (n=62) and averaged 53.3%. The mean subscale scores for ‘Pain,' ‘Function,' and ‘Activity Limitation' were 60%, 56%, and 44%, respectively. During acute gout attacks, all patients benefited from rest and joint icing. For long-term management, lifestyle and dietary recommendations were provided to reduce purine intake. Allopurinol was prescribed as the first-line urate-lowering therapy in 84.9% of cases, with gradually increasing doses, initiated after acute attacks and combined with colchicine at the start. For foot static disorders, orthopedic insoles were prescribed to one patient with grade III high-arched foot. Analgesic physiotherapy for the foot and ankle was indicated in 10% of patients with secondary osteoarthritis due to recurrent gout attacks. Short-term outcomes were favorable in all cases, with resolution of acute gout attacks. Long-term, recurrent acute joint attacks were noted in 13.6% of cases, due to discontinuation of long-term therapy in 10.9% or dietary deviations in 2.7%. Conclusion: Our findings emphasize the high prevalence and significant impact of foot and ankle involvement in gout. Ultrasound proved valuable for early detection, even in asymptomatic stages. Regular assessment, early diagnosis, and appropriate management are essential to improve patient outcomes and quality of life. REFERENCES: NIL . Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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