Background The musculoskeletal high resolution ultrasonography (HRU) is useful in the gout diagnosis, the assessment of UMS deposits extension and following up the response to urate lowering therapy.Therefore we consider that the HRU should be part of the initial evaluation and follow-up of these patients.
Objectives The aim of our study is to describe the presence of most specific sonography features in real life patients with gout and determine its role in the diagnosis, follow up and therapeutic response.
Methods The musculoskeletal HRU specific features; Tophus, Crystal deposits (double contour sign), and Erosions were obtained in 60 outpatients with Gout (ACR criteria 1977) between January 2009 and November 2011. Data were collected for our academic program developed since 2007 by the Colombian Rheumatology Association and the School of Medicine la Sabana University with the advisory of the Spanish Society of Rheumatology (SER). The ultrasonographic examinations were performed in symptomatic joints by rheumatologists in training with advisory of a rheumatologist and radiologist with experience in musculoskeletal ultrasonography. EULAR protocols were followed and a high quality HRU system (GE Medical Systems Logiq P5/8-13MHz linear probe) was used.
Results In a descriptive study of 60 male patients with Gout, (mean age 56.06 years ±10.19, mean disease duration 14.13 years ±8.81, mean serum urate 8.17 mgr/dl ±1.41, mean episodes of acute arthritis in last year 2.80±2.56) musculoskeletal ultrasound features were studied. Only eight patients had a proven gout diagnosis by synovial fluid analysis, serum urate (SU) levels previous sonographic study were available in 52 patients (86.66%) and only thirteen patients (21.66%) had received urate-lowering medication. A total of 131 joints were analyzed (1° MTP 74, Knee 24, Ankle 8, MCP 8, Wrist 3, Elbow 3 others 11). Ultrasound specific findings seen in these joints were the following: crystal deposits in 93/131 joints (70.99%), tophus in 70/131 joints (53.43%) and erosions in 41/131 joints (31.29%). We found tophus by HRU in 53 patients (88.33%), crystal deposits in 57 patients (95%) and erosions in 37 patients (61.66%). In 59 patients were started hypouricaemic treatments. In two patients who received eighteen months of permanent allopurinol treatment, a third HRU of control did no detect “sentinel” crystal deposit and tophus. We found palpable tophus in 27 patients (45%) and thirty patients without tophus in clinical examination were detected tophus by HRU.
Conclusions Musculoskeletal HRU is an important tool in the diagnosis and follow up of patients with gout. The HRU is more sensitive than clinical examination to detect tophus, allowing the reclassification of the disease, start the acid uric lowering therapy earlier and monitor treatment response.
Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W et al. High-resolution ultrasonography of the first metatarsalphalangeal joint in gout: a controlled study. Ann Rheum Dis 2007; 66:859-864.
Perez-Ruiz F, Dalbeth N, Urresola A, De Miguel E, Schlesinger N. Imaging of gout: findings and utility. Arthritis Research & Therapy 2009, 11:232 (17 June 2009)
Disclosure of Interest None Declared