The Role of Ultrasound Semi‐Quantitative Scoring in the Diagnosis and Assessment of Gout and Hyperuricemia

Abstract

ObjectivesTo develop an ultrasound semi‐quantitative scoring system for the diagnosis and evaluation of gout and hyperuricemia.MethodsThis study included 348 male patients: 81 patients with asymptomatic hyperuricemia, 182 patients with gout, and 85 patients with other arthritis. Clinical data were collected, ultrasound was detected, gout activity score was calculated to assess disease activity, and statistical analysis was performed.ResultsMonosodium urate crystal deposition and subclinical arthritis were detected in 17 patients with asymptomatic hyperuricemia, with lesions concentrated in the metatarsophalangeal joint, ankle and peroneus‐longus and brevis at rate of 91.8%. Gout was significantly higher than non‐gouty arthritis in crystal scores (sum scores of double contour, aggregates, and tophi), but not in inflammation scores (sum scores of synovial hypertrophy, power Doppler [PD] activity, and tenosynovitis) and bone erosion. The optimal cut‐off score for the diagnosis of gout by the crystal score was 2. The sensitivity, specificity, and AUC were 95.4%, 97.1%, and .965, respectively. Gout flare had higher inflammation scores than intercritical gout, while bone erosion scores were lower than intercritical gout. The active gout patients had higher ultrasound scores of tophi, bone erosion, and PD activity than the remission group (P < .001). The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the identification with high disease activity gout by ultrasound semi‐quantitative composite score were 76.2%, 84.2%, and .812, respectively.ConclusionUltrasound helps early identification of patients at risk in asymptomatic hyperuricemia. Ultrasound semi‐quantitative scoring allows for more objective and accurate assessment of gout lesions, correlates with disease activity, and helps in the diagnosis and assessment of gout.

Time to redefine hyperuricemia? The serum uric acid cut-off level for precipitation might be lower: a pilot study

“…Several studies have reported the prevalence of subclinical US lesions related to crystal deposition in hyperuricemic individuals [ 20 , 21 , 22 , 23 ]. In a 2011 study, Pineda et al observed features of DCS at the metatarsophalangeal joint in 25% of asymptomatic subjects with hyperuricemia and they also describe other types of lesions, such as tophi and enthesophytes, but with smaller prevalence [ 20 ].…”

“…In a 2011 study, Pineda et al observed features of DCS at the metatarsophalangeal joint in 25% of asymptomatic subjects with hyperuricemia and they also describe other types of lesions, such as tophi and enthesophytes, but with smaller prevalence [ 20 ]. Similarly, in a 2021 study, Cao et al described the prevalence of monosodium urate (MSU) crystals in 25% of patients with asymptomatic hyperuricemia [ 22 ], while in very recent study in 2023, Shao & Wang reported a less frequent occurrence of crystal deposition lesions, which were visible in only 17 individuals out of a group of 81 asymptomatic subjects with hyperuricemia [ 23 ]. Common sites at which subclinical crystal depositions occurred include the metatarsophalangeal joint, ankles, and peroneus tendons [ 23 ].…”

“…Similarly, in a 2021 study, Cao et al described the prevalence of monosodium urate (MSU) crystals in 25% of patients with asymptomatic hyperuricemia [ 22 ], while in very recent study in 2023, Shao & Wang reported a less frequent occurrence of crystal deposition lesions, which were visible in only 17 individuals out of a group of 81 asymptomatic subjects with hyperuricemia [ 23 ]. Common sites at which subclinical crystal depositions occurred include the metatarsophalangeal joint, ankles, and peroneus tendons [ 23 ].…”