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Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout?
  1. Esperanza Naredo1,2,
  2. Jacqueline Uson3,
  3. Mercedes Jiménez-Palop4,
  4. Agustín Martínez5,
  5. Esther Vicente6,
  6. Elia Brito7,
  7. Ana Rodríguez7,
  8. Francisco Javier Cornejo8,
  9. Santos Castañeda6,
  10. María Jesús Martínez3,
  11. Jesús Sanz4,
  12. Ingrid Möller9,
  13. Enrique Batlle-Gualda10,
  14. Jesús Garrido11,
  15. Eliseo Pascual5
  1. 1Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain
  2. 2Department of Rheumatology, Hospìtal Universitario Severo Ochoa, Madrid, Spain
  3. 3Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain
  4. 4Department of Rheumatology, Hospital Puerta de Hierro, Madrid, Spain
  5. 5Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain
  6. 6Department of Rheumatology, Hospital de la Princesa, IIS-Princesa, Madrid, Spain
  7. 7Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
  8. 8C.S. Mendiguchia Carriche, Leganés, Madrid
  9. 9Department of Rheumatology, Instituto Poal, Barcelona, Spain
  10. 10Department of Rheumatology, Hospital Clínico de San Juan, Alicante, Spain
  11. 11Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain
  1. Correspondence to Dr Esperanza Naredo, Department of Rheumatology, Hospital General Universitario Gregorio Marañón Doctor Alvarez Sierra 4, 4° A, 28033 Madrid, Spain; enaredo{at}


Objective The primary objective of this prospective case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)-detected abnormalities in the upper and lower limbs in gout. The secondary objective was to test the concurrent validity of US abnormalities using as gold standard the microscopic demonstration of monosodium urate (MSU) crystals.

Methods Ninety-one men with gout and 42 age-matched controls were prospectively recruited. All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints, six bursae, eight tendons, 20 tendon compartments, four ligaments, and 18 articular cartilages by experts in US blinded to the patients’ group. Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals. Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise.

Results The assessment of one joint (ie, radiocarpal joint) for hyperechoic aggregates (HAGs), two tendons (ie, patellar tendon and triceps tendon) for HAGs and three articular cartilages (ie, first metatarsal, talar and second metacarpal/femoral) for double contour sign showed the best balance between sensitivity and specificity (84.6% and 83.3%, respectively). Intraobserver reliability was good (mean κ 0.75) and interobserver reliability was moderate (κ 0.52). The aspirated material from HAGs was positive for MSU crystals in 77.6% of patients with gout and negative in all controls.

Conclusions Our results suggest that US bilateral assessment of one joint, three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity.

  • Ultrasonography
  • Gout
  • Arthritis

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