Background The first metatarsophangeal (MTP) joint is most commonly involved joint in acute gout. The gout is often diagnosed by clinical findings, not arthrocentesis, especially in the first MTP joint. Various non-invasive methods to diagnose gout have developed until now. High-resolution ultrasonography has recently been raised as a promising new imaging modality for gout. We intended to find out characteristic sonographic features of acute gouty arthritis involving the first MTP joint, and evaluated the efficacy and safety of ultrasound-guided intraarticular steroid injection.
Objectives The aims of this study are first, to identify the characteristic sonographic findings of acute gouty arthritis affecting the first MTP joint in comparison to non-affected MTP joint, and second, to evaluate the efficacy and safety of ultrasound-guided intraarticular steroid injection to the first MTP joint.
Methods We enrolled 20 patients with acute gouty arthritis involving the first MTP joint unilaterally, performed a sonographic evaluation for both (affected and non-affected) first MTP joints, and compared the sonographic features of affected joint with non-affected one. Ultrasound-guided intraarticular steroid (triamcinolone 10mg and 2% lidocaine 1ml) was injected to the affected first MTP joint in 16 patients. Visual analogue scales (VAS) for pain, general disability, walking disability were assessed at baseline, 24 hrs, 48 hrs, and 7 days after injection.
Results Bone erosion, joint effusion, synovial hypertrophy, double contour sign in ultrasonography were not significantly different in both (affected and non-affected) first MTP joints, but more tophus-like lesion was present (p<0.01), and higher power doppler signal was observed in affected joint (p=0.037). The reduction of mean VAS scores in pain, general disability, walking disability were 49.9 mm (±27.0), 33.7 mm (±26.3), 39.4 mm (±27.1), respectively, at 48hrs after ultrasound-guided intraarticular steroid injection. There were no serious adverse events.
Conclusions More prevalent tophus-like lesion and higher power doppler signal in high-resolution ultrasonography are characteristic features of acute gout compared to non-affected joint. Ultrasound-guided intraarticular steroid injection to the first MTP joint is an effective and safe therapeutic option.
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Disclosure of Interest None Declared
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