The first metatarsophalangeal joint in gout: a systematic review and meta-analysis

Abstract

Background

The aim of this review was to qualitatively synthesise studies that have investigated characteristics of the first metatarsophalangeal joint (1 ^st MTP) in gout and to undertake a meta-analysis to estimate the average prevalence of acute 1 ^st MTP arthritis across studies in people with gout.

Methods

Studies published in English were included if they involved participants who had a diagnosis of gout and presented original findings relating to the following outcome measures associated with the 1 ^st MTP: epidemiology; clinical features; structural and functional characteristics; and microscopic and imaging features.

Results

Forty-five studies were included in the qualitative synthesis. 1 ^st MTP pain was a prominent feature in people with gout. People with 1 ^st MTP gout reported walking- and general-disability. Structural and functional characteristics of 1 ^st MTP gout included hallux valgus, osteoarthritis, and restricted joint motion. Successful crystal aspiration ranged from 81 to 91 % and positive crystal identification via microscopy ranged from 83 to 93 % in patients with a history of 1 ^st MTP gout. Imaging features were common at the 1 ^st MTP including the double contour sign, tophi and erosions. Eleven studies involving 2,325 participants were included in the meta-analysis, providing an estimate of the average prevalence of acute 1 ^st MTP arthritis across studies of 73 % (95 % prediction interval 40–92 %; range 48–97 %; I ² = 93 %).

Conclusions

1 ^st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability. Gout affects the structure and function of the 1 ^st MTP. Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1 ^st MTP in people with gout.