High resolution ultrasonography of the 1st metatarsal phalangeal joint in gout: A controlled study

Stephen A Wright ^1*, Emilio Filippucci ², Claire McVeigh ¹, Arthur Grey ¹, Maura McCarron ¹, Walter Grassi ², Gary D Wright ¹ and Allister J Taggart ¹

¹ Musgrave Park Hospital, United Kingdom
² Universita Politecnia delle Marche, Italy

^* To whom correspondence should be addressed. E-mail: drsawright{at}yahoo.co.uk.

Accepted 16 December 2006

Abstract

Objective: To compare high resolution ultrasound (HRUS) with conventional radiography in the detection of erosions in the 1st MTPJs of patients with gout and to identify characteristic sonographic features of gout.

Methods: HRUS examination of the 1st MTP joints of both feet was performed by two independent sonographers. The presence of joint and soft-tissue pathology was recorded. Feet x-ray were performed on the same day and reported by the same radiologist.

Results: 39 male patients with gout and 22 aged- matched control subjects (14 with an inflammatory arthropathy and 8 disease free) were studied. The agreement between erosion on HRUS and x-ray was poor, ê = 0.229 (non-weighted), with McNemar’s test significant (p<0.0001) indicating a large number of x-ray false negatives. 22 MTPJs in gout patients had never been subject to a clinical attack of acute gout. In these MTPJs there were 10 erosions detected by HRUS and 3 erosions on x-ray. HRUS features significantly more prevalent in the gout patients were hard and soft tophi (p<0.01), and the double contour sign (p<0.01).

Conclusions: These data show that HRUS may assist with the management of gout in two ways. First, to aid with diagnosis by identifying the sonographic features that may be representative of the disease. Second, to allow the early detection of erosive joint damage and/or tophaceous deposits even in clinically silent joints.

Keywords: gout, ultrasound

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