Background Imaging may be useful for monitoring the response to therapy. Within the OMERACT proposal for the core set domains for outcome measures in chronic gout, serum urate levels, recurrence of gouty flares, tophus regression, and joint damage imaging have been included, among other proposed issues.
Objectives To perform a systematic literature review of the utility of magnetic resonance imaging (MRI) and ultrasound (US) on assessment of treatment response in patients with gout.
Methods MEDLINE, EMBASE, the Cochrane Library (up February 2012), and abstracts presented at the 2010 and 2011 meetings of the American College of Rheumatology and European League Against Rheumatism, were searched for treatment studies of any duration and therapeutic options, examining the ability of MRI/US to assess the treatment response in gouty patients. Metaanalyses, systematic reviews, randomized clinical trials, cohort studies and validation studies were included. Quality was appraised using validated scales.
Results There were only 3 US published studies in the literature that analyzed the US utility on assessment of response to treatment in patients with gout. All of them were prospective case studies with a little number of patients and they were reviewed in detailed. A total of 36 patients with gout were examined with US. All of them had a baseline serum urate > 6 mg/dl. US features of gout (double contour sign, hyperechoic spots in synovial fluid, hyperechoic cloudy areas, tophus diameter and volume) achieved significant reduction in patients who reached the aim of uricemia ≤ 6mg/dl in all the studies, however, patients in whom levels did not dropped below 6 mg/dl, US features of gout did not change. Other parameters evaluated in one study included ESR, CRP, number of tender (TRN), number of swollen joints, and pain score (SP). All of them decreased with the uricemia reduction, but only TRN and SP were statistically significant.
No data were found about the MRI value on treatment response assessment in patients with gout.
Conclusions The improvement in ultrasound features shows concurrent validity with the uric acid reduction. According to the published evidence, US can be a useful tool for monitoring the treatment of gout arthropathy patients, although more research is needed. The value of MRI on treatment response assessment in patients with gout, remains to be determined.
Disclosure of Interest None Declared
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