Background In some cases differential diagnosis between yearly gouty arthritis and other types of arthritis is very difficult. In 2015 the sonographic detection of urate crystal deposits in hyaline cartilage as a new criterion was included in set of classification criteria of gout . But diagnostic value of that ultrasound marker in first month of disease is underinvestigated.
Objectives To investigate sensitivity and specificity of sonographic detection of gouty hyperechoic deposits in hyaline cartilage in patients with gout in comparison with other signs of gout in debut of arthritis.
Methods The 104 patients with yearly arthritis (duration of symptoms less than 6 month) was examined by clinical, laboratory, X-Ray and ultrasonography. After investigation the following diagnoses were made: Gout in 32 patients, Osteoarthritis in 28 patients, Rheumatoid arthritis in 28 patients, Psoriatic arthritis in 16 patients. Ultrasound investigation of affected joints was performed in all subjects by linear probe 18 MHz. Urate crystal deposits were seen on the surface of the hyaline cartilage as a hyperechoic thin line or dots on the cartilage, wich sometimes imitate double contour of bones [2, 3]. Sensitivity and specificity of ultrasound sign were compared with subcutaneous tophi, bone cysts (X-Ray sign) and hyperuricemia.
Results The urate crystal deposits in gyalinic cartilage of at least one of affected joints were revealed in 28 of 32 (87,5%) patients with Gout, in 3 of 28 (10,7%) patients with Osteoarthritis and 1of 16 (6,3%) patients with Psoriatic arthritis. Comparative data of sensitivity and specificity of crystal deposits, bone cysts, subcutaneous tophi and hyperuricemia are represented in table below.
Conclusions Ultrasound detection of urate crystal deposits in hyaline cartilage in patients with gout in yearly stage has a high sensitivity and comparable level of specificity with other diagnostic markers of Gout.
Neogi T et al. Gout classification criteria: an American College of Rheumatology European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–1798.
Filippucci E., Di Geso L, Grassi W. Tips and tricks to recognize microcrystalline arthritis. Rheumatology 2012;51(7):18–21.
Naredo E et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis. 2014;73(10):1522–1528.
Disclosure of Interest None declared