Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise

Cazenave, Tomás; Martire, María Victoria; Gutiérrez, Marwin; Waimann, Christian A.; Pineda, Carlos; Rosa, Javier; Ruta, Santiago; Sedano-Santiago, Oscar; Bertoli, Ana M.; Audisio, Marcelo; Hernández‐Díaz, Cristina; Ventura‐Ríos, Lucio; Quintero, Maritza; Miguel, Eugenio de; Alvarez-Del-Castillo-Araujo, Ana Laura; Abril, Andy; Ayala-Ledesma, Eliana Natalí; Alarcon-Isidro, Edith; Santiago, María Lida; Pera, Mariana; Urquiola, Cecilia; Gil, Gustavo Rodriguez; Rivera, Lina María Saldarriaga; Cefferino, Cesar; Benegas, Mariana; Cortés, Mario Enrique Díaz; Bravo, Maximiliano; Peiteado, Diana; Estrella, Natalia; Micas, Roser Areny; Muñoz, Jorge Saavedra; Toyo, Rodolfo Del Carmen Arape; Elkin, M. S. Gálvez; Spindler, Walter; Sandobal, Clarisa; Marín, Josefina; Ochtrop, Manuella Lima Gomes; Ayala, Ricardo Pavao; Catay, Erika; Py, Guillermo Enrique; Aguilar, Gabriel Hector; Colina, Yvonne Yona Rengel; Airoldi, C.; Mora-Trujillo, Claudia; Kohan, María Paula; Eguez, Lorena Evelin Urioste; Castillo-Gallego, Concepción; Díaz-Coto, José Francisco; Tate, Patricio; Saucedo, Carla; Vega-Hinojosa, Oscar; Troitiño, Cristian; Marengo, María Florencia; Marcaida, Priscila Maria; Monjo, I.; Muñoz-Louis, Roberto; Solano, Carla; Castillo, Felix Reinaldo Fernandez; Graf, César; Guinsburg, Mara; Cruz, Margarida; Ortiz, David Alejandro Navarta; Linares, Magaly Alva; Rosemffet, Marcos

doi:10.1007/s00296-018-4220-0

Cited by 18 publications

(7 citation statements)

References 18 publications

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“…Aplio i900 color ultrasonic diagnostic apparatus (probe frequency 5-18 MHz) was used for US examination. According to the international consensus of the standardized definition of US gout lesion published by OMERACT (Outcome Measures in Rheumatology), US Gout Task Force was employed [6,12], and MSU crystal deposition in joints was diagnosed based on DCS, hyperechoic aggregates (HAG), and tophi. Synovial hypertrophy, synovitis, and bone erosion were considered joint damage.…”

Section: Us Assessmentmentioning

confidence: 99%

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Cao

Zhao

Xie

et al. 2021

Journal of Immunology Research

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Objective. To evaluate monosodium urate (MSU) crystal deposition and related lesions in the joints of patients with gout and hyperuricemia (HUA) using ultrasound. To explore the association between ultrasound findings and clinical features in gout and HUA. Methods. A total of 202 patients with gout and 43 asymptomatic patients with HUA were included. The clinical data and ultrasonic assessment results were collected and statistically analyzed. Results. Deposition of MSU crystals was found in 25.58% (11/43) of patients with asymptomatic HUA and 76.24% (154/202) of patients with gout. Of the 1,082 joints from patients with gout examined, 33.09% (358/1082) displayed MSU crystal deposition. In the joints with MSU crystal deposition, 77.37% (277/358) had a history of attacks. Among the joints of gouty arthritis, double contour sign (DCS), hyperechoic aggregate (HAG), and tophi were found in 32.65% (159/487), 7.80% (38/487), and 24.64% (120/487) of the joints, respectively. DCS and tophi, but not HAG, increasingly appeared with the extension of gout duration. In patients with more than 15 years of gout history, DCS, Tophi, and HAG were found in 48.18%, 40.00%, and 6.36% of US assessed joints, respectively. In patients with gout, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. The synovial lesion was related to HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of patients with gout and 4.65% (2/43) of HUA patients, indicating that nephrolithiasis occurred in more patients with gout than in patients with HUA. Conclusion. HAG is an early performance of MSU crystal deposition in joints of gout and HUA. Both DCS and tophi are risk factors for bone erosion. Early urate-lowering therapy (ULT) should be considered in patients with gout, DCS, or tophi.

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Section: Us Assessmentmentioning

confidence: 99%

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Cao

Zhao

Xie

et al. 2021

Journal of Immunology Research

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“…Finally, the inter-reading concordance was excellent. The performance of inter-reader exercise has a great influence to improve reliability and our group has carried out this type of exercise periodically ( 38 , 39 ). The other study has shown excellent inter-observer agreement for quantitative data ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Entheseal Involvement in Spondyloarthritis (SpA) and Gout: An Ultrasound Comparative Study

et al. 2022

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ObjectiveTo compare the assessment of entheses in subjects with spondyloarthritis (SpA) with patients with gout by the Madrid Sonographic Enthesis Index (MASEI).MethodThis cross-sectional study includes videos of entheses evaluated by ultrasound (US) of 30 patients with SpA diagnosed according to the ASAS criteria and 30 patients with gout established by the presence of monosodium urate crystals. Entheses were evaluated for MASEI in 2 Institutes located in two different countries. Demographic and clinical data were registered. Total MASEI score, MASEI-inflammatory, and MASEI-chronic damage were analyzed. Comparisons between groups were obtained by chi-square test and Student's t-test. An inter-reading US reliability was realized.ResultsPatients with gout were older and had significantly more comorbidities than those with SpA. The total MASEI score was not significantly different among diseases (p = 0.07). MASEI-inflammatory was significantly more prevalent at the Achilles tendon in SpA, while the proximal patellar tendon was in gout. Power Doppler was higher in SpA compared to gout (p = 0.005). MASEI-chronic damage related to calcification/enthesophytes predominated in gout (p = 0.043), while calcaneal erosions did in SpA (p = 0.008). The inter-reader concordance was excellent (0.93, CI 95% 0.87–0.96, p = 0.001).ConclusionsSpA and gout similarly involve entheses according to MASE, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon scanned.

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“…The US technique was found to be superior to conventional radiographs in evaluating small bone changes [37] . According to experienced sonographers, the inter-and intraobserver reliability of bone erosion on US ranged from good to excellent [38] . However, a longitudinal analysis of bone erosions in response to treatment in gouty patients by US is lacking.…”

Section: Bone Erosionmentioning

confidence: 99%

High-resolution ultrasound evaluation in the follow-up of treat to target urate-lowering therapy in gout: an observational study

Zhang

Zhao

et al. 2020

Preprint

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Background: The monitoring of treat-to-target (T2T) urate-lowering therapy (ULT) for gout is crucial for the assessing treatment response. However, evidence is lacking about clinical remission on ultrasound (US). The aim of this study was to observe the changes in three outcome domains (urate deposition, joint inflammation and bone erosion) in patients with ULT within 1 year, evaluate the effect of target treatment and analyse the relationships between clinical factors and US features. Methods: The elementary lesions of the bilateral knee, ankle and first metatarsophalangeal joints were evaluated by US before and after 3,6 and 12months of treatment. Urate deposition was assessed by the maximum long and short axis diameters of the tophi and dichotomous data of the double-contour (DC) sign and aggregates. After each follow-up, the most obvious lesions were selected for repeated observation. The effective clearance rates of these three signs in different time groups were compared. A Global OMERACT–EULAR Synovitis Score (GLOESS) was calculated for these three paired joints to observe the remission and recurrence of inflammation. Bone destruction was scored at each time point. The correlation between serum uric acid (sUA) levels and tophi size changes was analysed. Results: This cohort contained 79 patients. The long and short axis diameters of tophi showed a different descending tendency. The decrease of sUA levels correlated with the decrease of long axis values, but not with the short. For tophi, there was no significant difference in the clearance rate between different time groups, while for DC sign and aggregates, significant differences were found by paired comparison. The GLOESS was significantly lower after 6 months of therapy. Bone erosion had not been improved after 1 year of ULT.Conclusion: The decrease in sUA levels was not completely parallel to the decrease in tophi size. ULT with different intensities should be formulated according to different crystal deposition conditions under US assessment. Subclinical inflammation was gradually controlled after 6 months of therapy and can be sensitively observed by US. Joint damage was relatively stable within 12 months of ULT.

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Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise

Cited by 18 publications

References 18 publications

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Entheseal Involvement in Spondyloarthritis (SpA) and Gout: An Ultrasound Comparative Study

High-resolution ultrasound evaluation in the follow-up of treat to target urate-lowering therapy in gout: an observational study

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