Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study: Table 1

Brief Report: Monosodium Urate Monohydrate Crystal Deposits Are Common in Asymptomatic Sons of Patients With Gout: The Sons of Gout Study

“…This study demonstrates that the sons of patients with gout have a higher prevalence of hyperuricemia 11, uric acid underexcretion 8, and asymptomatic MSU crystal deposition than observed in previous studies in which participants were preselected according to their serum urate level 4, 5, 6. The results also raise the possibility that MSU crystal deposition occurs initially in the first MTP joints and in tendons before appearing in other joints such as the ankle and the knee.…”

“…The heritability of serum urate and urinary uric acid excretion is estimated to be ~60% and 60–87%, respectively 2, while the heritability of gout is lower at 17.0% and 35.1% in Taiwanese women and men, respectively 3, and was estimated to range between 0% and 58% in a study from the US 1. As 14.5–25% of people with high serum urate levels have asymptomatic MSU crystal deposition 4, 5, 6, studies that use a symptomatic disease phenotype may underestimate the heritability of MSU crystal deposition.…”

Is the Double Contour Sign Specific for Gout? Or Only for Crystal Arthritis?

“…It seems likely that this finding in asymptomatic hyperuricemia represents true subclinical MSU crystal deposition, because the DC sign was observed at much lower frequency in normouricemic controls (0-5%) in the same studies 7,8 . Further, another study of 26 asymptomatic individuals with hyperuricemia, of whom 9 had urate crystals documented from joint fluid, DC, or hyperechoic cloudy area, had a positive predictive value of 82%, sensitivity of 100%, and specificity of 88% 9 .…”

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

“…A recent systematic literature review, as part of the 3e Initiative on Diagnosis and Management of Gout, highlighted dual energy computerized tomography (DECT) and ultrasound (US) as promising imaging tools that have shown markedly better performance than clinical findings, although further testing is warranted 6 . In comparison to DECT, US appears to be more feasible because it is patient-friendly, safe and non-invasive, free of ionizing radiation, allows multiple target assessment in real time, and may aid the aspiration process for relevant material for microscopy 7 . Several published studies have highlighted the ability of US to detect crystal deposits and have addressed its possible role in very early diagnosis, based on their US findings indicative of gout in patients with asymptomatic hyperuricemia 7,8,9 .…”