Background Ultrasound (US) has gained considerable interest among Rheumatologists in the assessment of patients with gout due to its usefulness in both clinical practice and research activity. While a solid and still growing body of evidence supports its use in daily rheumatological practice, operator dependency and the long learning curve represent the main limitations.
Objectives To describe the learning curve of Rheumatologists with limited experience in US attending an intensive disease-oriented training programme focusing on the skills required to obtain and interpret US signs of monosodium urate (MSU) crystal deposits at joint and periarticular tissues.
Methods Three investigators participated in a seven-days training programme, carried out on 12 male patients with gout. The agreement between the expert and the beginners was calculated in 4 sessions on eight patients with gout The US assessment was performed at the following anatomic sites: second and third metacarpophalangeal (MCP) joints; knee, tibiotalar and first metatarsophalangeal (MTP) joints; second and third finger flexors; quadriceps and patellar posterior tibialis; peroneus longus and brevis, and Achilles tendons. The presence or absence of synovial fluid/synovial hypertrophy, double contour sign, intra- or periarticular and intratendinous tophi, bursitis, bone erosions was recorded.
Results A total of 12 patients with gout (all males) were included. Eight patients were scanned directly by all of the investigators during the four sessions of the US evaluation, whereas four patients were scanned during hands-on and practical sessions by the expert sonographer. A total of 416 anatomical sites (for each patient: 10 joints, four finger flexor tendons, two quadriceps tendons, two patellar tendons, two posterior tibialis tendons, four peroneous tendons, and two Achilles tendons) were studied. Both κ values and overall agreement percentages of qualitative assessments of US gout findings showed, at the end of exercise, moderate to excellent agreement, while in the first session, poor/fair agreement was obtained (Beginner 1 (κ values at I and IV session)= synovitis 0.334–0.875 double contour sign 0.184–0.762, intra- or periarticular intratendinous tophi 0.226-709, bursitis 0.429-0.673, bone erosions 0.210-0.810. Beginner 2 (κ values at I and IV session)= synovitis 0.310-0.769 double contour sign 0.133-0.709, intra- or periarticular intratendinous tophi 0.211-0.840, bursitis 0.429-0.818, bone erosions 0.364-0.909). Beginners’ examinations at the end of the training session including sensitivity, specificity, and feasibility of the beginners were also improved.
Conclusions After 1 week of the disease-oriented training programme, Rheumatologists with limited experience in US were satisfactorily able to detect and interpretthe mainUS signs indicative of MSU crystal deposits at different tissues in patients with gout.
Disclosure of Interest None Declared