Additive value for ultrasonographic signal in a screening algorithm for patients presenting with acute mono-/oligoarthritis in whom gout is suspected

Abstract

Crystal arthritides such as gout can be detected by ultrasonography (US). This study reveals the performance of joint US (double contour sign (DCS), tophus (T), hyperechoic spots cq. "snow storm" (SS)) for diagnosing gout and calcium pyrophosphate dihydrate crystal deposition disease (CPPD) in patients with acute mono- or oligoarthritis (MOA). The gold standard is the presence of monosodium urate (MSU)/CPPD crystals. Fifty-four Dutch patients had an acute MOA. US was performed on the following six joints maximum: the arthritic joint, the contra lateral side, metatarsophalangeal (MTP)-1, and knees bilaterally in case of arthritis in one of these joints. In case of wrist/PIP/MCP-arthritis, the knees and MTP-1 were scanned. These were examined for DCS, T, SS, and intercartilage rim (CPPD). Synovial fluid was aspirated from the affected joint for MSU proof. Twenty-six of the 54 (48 %) patients with MOA had MSU-proven gout. Sensitivity of DCS and any US abnormality (DCS, T, SS) was 77 and 96 %, respectively. The positive likelihood ratio (LR+) for DCS and any ultrasonographic abnormality (USabn) was 3.08 and 2.99, respectively, and the LR- was 0.31 and 0.06, respectively. In MSU-proven gout patients where the affected joint is not MTP-1, MTP-1 still showed USabn in 42 % of the patients. None of the CPPD patients had an intercartilage rim. In dedicated hands, ultrasonography deserves a place early in a screening algorithm of MOA patients, particularly if specificity is high enough to make punctures abundant or when microscopy is not available. In 86 % of the MSU-proven gout patients, the DCS is not present in another joint other than the affected or MTP-1 joint.

The place of musculoskeletal ultrasonography in gout diagnosis

“…In these cases US examination of the joint could simplify the diagnosis process. This fact was demonstrated by Lamers-Karnebeek et al [59] in patients with monoarthrithis in which 48% of patients had MSU crystals-proven gout. In this cases sensitivity of DC sign and any US abnormality (DC sign, tophi, or snowstorm appearance of the joint effusion) was 77 and 96 %, respectively.…”

“…The place of the US in patients suspected of gout must be clearly defined [59] due to the high numbers of patients presented with monoarthritis. The research agenda concerning the use of US in gouty patients is still busy despite of the recent achievements in this pathology.…”

Pacientų, Kuriems Nustatytas Sukėlėjas, Atlikus 7 Lytiškai Plintančių Infekcijų Molekulinį Tyrimą, Rezultatų Analizė

“…Frequent periarticular involvement is described in previous ultrasounds [6], also DECT studies: DECT helped to diagnose gout in 11 out of 30 patients with undifferentiated arthritis/ tendinitis/enthesitis who had a negative synovial fluid-polarising microscopy from their initial diagnostic evaluation; periarticular involvement was shown on DECT in these cases [24]. Another reason of disagreement between clinical symptoms and US in the knee area found in our study might be low sensitivity of US regarding T in suprapatellar and parapatellar joint recesses.…”

Is ultrasound changing the way we understand rheumatology? Including ultrasound examination in the classification criteria of polymyalgia rheumatica and gout.

“…Recent reports suggest that US [47] and DECT [48] may allow accurate identification of some patients with gout. Due to low costs and affordability, as well as easy access to US machines, inclusion of US in these criteria will be an essential step forward in advancing the research agenda for gout management [49][50][51].…”