Management of Ankle Gout Arthritis by Arthroscopic Debridement and Drug Therapy

Ankle arthroscopic debridement is a safe method for the treatment of ankle gout arthritis, and when combined with conservative drug therapy may improve clinical efficacy, lower recurrence rate, and shorten hospital stays, according to study results published in Journal of Clinical Rheumatology.

Previous studies have suggested that removal of monosodium urate crystals in the anterior and posterior ankle may provide better results in patients with ankle gouty arthritis. The objective of the current study was to determine the clinical feasibility, efficacy, and cost economics of combination therapy with arthroscopic debridement and conservative drug treatment compared with drug treatment alone.

The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hind foot score was used for the assessment of preoperative and postoperative ankle-hind foot pain and function of patients in both groups. Furthermore, the effective rate, based on symptoms and joint function, recurrence rate, length of hospital stay, complications, and cost economics were compared between the groups at 48 hours postoperatively, on discharge, and at 1 year.

The study cohort included 56 patients with acute ankle gout arthritis hospitalized from January 2017 to August 2019, including 32 patients (23 men; mean age, 48.5±9.7 years) who received arthroscopic debridement in a special floating position and drug therapy (observation group), and 24 patients (17 men; mean age, 50.2±11.2 years) who received conservative drug treatment alone (control group).

While the AOFAS score on admission was similar in the observation and the control group (60.31 and 64.54, respectively; P =.550), the score was significantly higher in the observation vs control group at 48 hours postoperatively (80.73 vs 71.09, respectively; P =.000), on discharge (87.73 vs 77.71, respectively; P =.000), and at 1 year postoperatively (85.92 vs 76.36, respectively; P =.000).

At the time of discharge, the total effective rate was higher in the observation vs control group, but the difference was not statistically significant (93.75% vs 83.33%, respectively; P =.212). Recurrence rate was also noted to be lower in the observation vs control group, but the difference was not statistically significant (15.63% vs 25%; P =.382). The length of hospital stay was significantly shorter in the observation vs control group (4.92 vs 8.90 days, respectively; P =.000) and the mean hospitalization cost was significantly higher in the observation vs control group (¥8981.2 vs ¥3558.3, respectively; P =.000).

The study had several limitations, including the relatively small sample size, short follow-up time, and potential selection bias as the treatment method was chosen by the patients.

“Ankle gout arthritis can be systematically and safely managed with an ankle arthroscopic technique in a special floating position. In addition, compared with conservative drug therapy alone, ankle arthroscopic debridement combined with conservative drug therapy improved clinical efficacy, lowered the recurrence rate, and shortened the length of hospitalization,” the researchers concluded.

Reference

Tang B, Zeng X, Fan C. Significantly better efficacy for acute ankle gouty arthritis through arthroscopic debridement compared with simple drug therapy: a longitudinal study with 1-year follow-up. J Clin Rheumatol. Published online December 11, 2020. doi:10.1097/RHU.0000000000001608