Background The role of ultrasonography (US) in diagnosis of gout is not clearly established .
Objectives The detection of monosodium urate (MSU) crystals depositions in pts with asymptomatic hyperuricemia (ASHU) and in pts with gout by US examination for early diagnostics of gout.
Methods The study included 84 pts with either ASHU (n=34), or gout (n=50), 72 males and 12 females. The diagnosis corresponded all pts with gout to the criteria developed by S.L. Wallace, and were subjected to joint puncture (1st metatarsophalangeal joint (MTPJ), knee, elbow, ankle) with further synovial fluid analysis under polarized microscopy. Mean age of gout pts was 48,1±12,6 y., disease duration <1 years was established in 12 out of 50 pts (24%); mean age of ASHU pts was 47,21±11,57 y., with mean level of uric acid – 473,71±73,7μmol/l. All pts were subjected to 1st MTPJ US examination with linear 7–17 MHz multi-frequency ultrasonic transducer. Statistica 10.0 package and Biostatistics were used for statistical processing of data. P values <0.05 were considered statistically significant.
Results Based on US examination data the “double contour” (DC) sign in the 1st MTPJ was found in 36 (72%) out of 50 gout pts, intra-articular or soft tissue gouty tophi – in 27 (54%) pts, both signs – in 24 (48%) pts. MSU were found in 45 (90%) gout pts by synovial fluid analysis. 1st MTPJ arthritis was established in past medical history in 41 gout pts. In subjects with disease duration <1 years DC sign was found more frequently as compared to pts with disease duration ≥1 years, respectively in 30 (79%), and 6 (50%) (p=0,045), same refers to the presence of US tophus signs: in 22 (58%), and 5 (42%) pts (p=0,33) respectively; one of the two signs - in 36 (95%), and 6 (50%) pts, respectively (p=0,0002). In 4 out of 50 gout pts with only one attack of arthritis in past medical history the DC sign was found in 1 patient, as well as intra-articular or soft tissue tophus - also in 1 patient. The US DC sign in ASHU subgroup was found in 12 (35%) pts, US tophus sign – in 5 (15%) pts, both sings – in 2 (6%) pts. In 17 pts with UA level >420 μmol/l and ≤480 μmol/l the US DC sign was found in 4 (24%) pts. In 12 pts with UA level >480 μmol/l and ≤540 μmol/l the DC sign was found in 5 (42%) pts, and both signs – US DC and US tophus were present in 2 (17%) pts. Elevated uric acid levels >540 μmol/l were detected in 5 pts, the US DC sign was found in 3 out of them, while both signs – in 2 pts. Energy Doppler scanning identified synovitis in 15 (44%) out of 34 ASHU pts.
Conclusions Serum UA levels may predefine US detection of MSU deposition in ASHU pts and in 44% of cases US signs of MSU depositions are combined with subtle signs of inflammation, detected with energy Doppler scanning. Detection rates of US gout signs grow in parallel with disease duration.
International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Gutierrez M., Schmidt W.A, Thiele R.G, Keen H.I., Kaeley G.S., Naredo E, Iagnocco A., Bruyn G.A., Balint P.V. et al. Oxford Journals Rheumatology. Volume 54, Issue 10. Pp. 1797–1805
Disclosure of Interest None declared
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