Sonographic estimation of monosodium urate burden predicts the fulfillment of the 2016 remission criteria for gout: a 12-month study

Cipolletta, Edoardo; Battista, Jacopo Di; Carlo, Marco Di; Matteo, Andrea Di; Salaffi, Fausto; Grassi, Walter; Filippucci, Emilio

doi:10.1186/s13075-021-02568-x

Cited by 18 publications

(18 citation statements)

References 52 publications

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“…Ultrasound in gout has mainly been advocated for diagnosis ( 45 ), though some recent papers have proven an interesting role in monitoring the disease, such as checking the reduction of deposits during ULT ( 46 ), and predicting the occurrence of flares after discontinuation of colchicine ( 47 ) or the achievement of remission criteria in the following 12 months ( 48 ). Furthermore, ultrasound could also be of interest for establishing cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

2021

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Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis.Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0–3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression.Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2–3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.50) and a positive PD signal (OR 1.67; 95% CI 1.09–2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association.Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.

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Section: Discussionmentioning

confidence: 99%

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

2021

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“…Patients with gout meeting the 2015 ACR/EULAR classification criteria and patients with a crystal-proven diagnosis of CPPD were consecutively recruited from among those participating in three US imaging studies. [8][9][10] These criteria were selected as the current and internationally recognised criteria for classifying patients as having gout or CPPD disease. Patients with mixed crystal arthritis were excluded from all studies.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…US assessments were carried out according to the 2017 EULAR standardised procedures for US imaging in rheumatology 11 by a rheumatologist blinded to patients' diagnosis. [8][9][10] The hyaline cartilage of the scanned joints was explored to detect US findings indicative of crystal deposits (ie, DC sign and CPP deposits within the cartilage layer), 1 12 paying particular attention to differentiate the DC sign from the cartilage interface sign, which is visible only when the outer margin of the hyaline cartilage is perpendicularly insonated by the US beam and usually is thinner than the DC sign and the bony cortex (figure 1). Furthermore, once a DC sign was identified, its dynamic behaviour during joint movement was evaluated while holding the probe steady (ie, movement of the DC sign together with the hyaline cartilage and the subchondral bone, indicating crystals attached on the cartilage surface or in the opposite direction, indicating crystals in the joint capsule Crystal arthropathies Crystal arthropathies Crystal arthropathies or ligaments) (online supplemental video S1 and online supplemental video S2).…”

Section: Us Assessmentmentioning

confidence: 99%

Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease

et al. 2023

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ObjectiveTo test whether the double contour (DC) sign has a different dynamic behaviour in gout and calcium pyrophosphate deposition (CPPD) and whether the dynamic assessment of the DC sign increases its accuracy in gout diagnosis.MethodsThis cross-sectional analysis included patients with gout meeting the 2015 ACR/EULAR classification criteria and patients with crystal-proven diagnosis of CPPD. Hyaline cartilages were explored by ultrasound (US) to detect the DC sign (ie, abnormal hyperechoic band over the superficial margin of hyaline cartilages) and its dynamic behaviour during joint movement was evaluated ((ie, movement of the DC sign together with subchondral bone (DC sign), or in the opposite direction (pseudo DC sign)).ResultsEighty-one patients with gout and 84 patients with CPPD underwent US assessment. Among them, 47 patients with gout and 9 patients with CPPD had evidence of the DC sign. During dynamic assessment, in all 47/47 patients with gout there was a DC sign. Conversely, in 7/9 (77.8%) patients with CPPD, there was a pseudo DC sign (p<0.01).The presence of DC sign during static assessment had a sensitivity, specificity and accuracy of 58.0% (95% CI 46.5% to 68.9%), 89.3% (95% CI 80.6% to 95.0%) and 73.9% (95% CI 66.5% to 80.5%) for gout, respectively. The dynamic evaluation improved the DC sign’s diagnostic performance (p=0.01) as the specificity (97.6% (95% CI 91.7% to 99.7%)) and the accuracy (78.2% (95% CI 71.1% to 84.2%)) increased without loss in sensitivity.ConclusionThe dynamic US assessment of the DC sign may help to differentiate the DC sign due to MSU crystals from the pseudo DC sign seen in CPPD, as they move in opposite directions.

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“…US can show resolution of urate deposits in patients on urate-lowering therapy with greater decrease of US tophus size and resolution of double-contour cartilage sign occurring in patients with lower serum urate levels than in those patients with higher serum urate levels [ 123 ]. It has been shown that the MSU crystal burden on US can predict fulfilling remission criteria for gout: the lower the baseline MSU burden estimated by US, the higher the chance to fulfil the remission criteria at 12 months, with the double-contour cartilage sign being the most useful measure [ 124 ]. Christiansen et al showed that US can detect decreases in urate crystal deposition (double contour sign, tophi, aggregates and erosions) in patients on successful urate-lowering therapy [ 125 ].…”

Section: Imaging Of Treatment Responsementioning

confidence: 99%

Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

Weaver

Vina

Munk

et al. 2021

JCM

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Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.

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Sonographic estimation of monosodium urate burden predicts the fulfillment of the 2016 remission criteria for gout: a 12-month study

Cited by 18 publications

References 52 publications

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease

Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

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