Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study

Pascart, Tristan; Grandjean, Agathe; Norberciak, Laurène; Ducoulombier, Vincent; Motte, Marguerite; Luraschi, H.; Vandecandelaere, M.; Godart, Catherine; Houvenagel, É.; Namane, Nasser; Budzik, Jean-François

doi:10.1186/s13075-017-1381-2

Cited by 51 publications

(32 citation statements)

References 32 publications

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“…However, it is not widely available, and in addition to being expensive and involving some radiation exposure, its use is often restricted to secondary and tertiary care centres. Its diagnostic performance, with MSU crystal identification as reference test, seems comparable to US, with a potential superiority for MSU crystal deposition detection in direct comparison with US 77–80. As observed with US, sensitivity for the diagnosis of gout is influenced by the duration of the disease, being lower in the early stage of the disease 40 48–50.…”

Section: Discussionmentioning

confidence: 89%

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

et al. 2019

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Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

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Section: Discussionmentioning

confidence: 89%

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

et al. 2019

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“…Rapidly obtaining SU levels below the dissolution threshold of MSU was associated with an OR of 1.42 of incident flares in the febuxostat trials and could be related to the mobilization of the MSU burden [ 13 ]. Prevalence of the US DC sign provides a different assessment of MSU burden than the one provided with DECT [ 14 ] and does not seem to predict the risk of flares. Flare prophylaxis is known to imperfectly prevent gout flares during ULT initiation [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…This prospective observational study included consecutive patients with a diagnosis of gout according to the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2015 criteria [ 17 ]. They were recruited to undergo quantification of urate deposition of the knees and feet using US and DECT [ 14 , 20 ] and were subsequently followed in outpatient visits. The study was approved by the institutional review board of the Lille Catholic Hospitals and all participants provided informed consent before inclusion into the study.…”

Section: Methodsmentioning

confidence: 99%

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Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study

et al. 2018

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BackgroundPredicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares.MethodsThis prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated.ResultsOverall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm3 increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15–4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm3 (specificity 61%, sensitivity 77%).ConclusionsThis is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1714-9) contains supplementary material, which is available to authorized users.

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“…In the past, reports already con rmed that high serum uric acid increased the burden of monosodium urate (MSU) deposits. [20,21] Previous studies reported that MSU deposits would lead to structural damage in corresponding organs where the MSU deposits were found. A nephrological research found that high SUA led to uric acid super saturated in the urine, and supersaturation in the urine increased monosodium urate (MSU) deposits in the kidney formed uric acid stones.…”

Section: Smooth Curve Ttingmentioning

confidence: 99%

High serum uric acid concentration is a risk factor for radiographic spondyloarthritis: a cross-sectional study

Lai¹,

Zhang²,

Zhang³

et al. 2020

Preprint

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Background: Cardiovascular disease is a kind of comorbidity of spondyloarthritis (SpA). Hyperuricaemia is a risk factor of cardiovascular disease. Previous SpA study concerning cardiovascular disease and hyperuricaemia found that hyperuricaemia is more prevalent in radiographic SpA. Thus, we evaluated the association of serum uric acid (SUA) concentration and radiographic SpA. Methods: We made use of data from a cross-sectional study in Chinese Shenzhen Second People’s Hospital from 2016 to 2018, which included 202 SpA patients diagnosed by rheumatologists. This study detected the prevalence of comorbidities and risk factors of SpA patients. Using data from this study, we evaluated the association between radiographic images of SpA and SUA concentration. We compared the SUA concentration between radiographic SpA group and non-radiographic SpA group, with logistic regression models. Stratified and interaction analyses were also performed to further confirm the consistence of the relationship. Multiple imputation was used to deal with missing data.Results: This research studied 202 SpA patients’ data including their SUA, sacroiliac images, and other relevant laboratory data. Elevated SUA concentration was found to be associated independently with the increased risk of radiographic SpA after adjusted for confounders. The risk for developing radiographic SpA increased 13% [adjusted odds ratio (OR) = 1·13, 95% confidence interval (CI):(1·05, 1·22), p=0·0014] for per 10umol/L SUA increased. Stratified analyses, interaction analyses and multiple imputation analyses also confirmed the consistence of the association.Conclusions: Based on this Chinese population cross-sectional study, we identify that elevated SUA concentration is a risk factor for developing radiographic SpA.

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Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study

Cited by 51 publications

References 32 publications

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study

High serum uric acid concentration is a risk factor for radiographic spondyloarthritis: a cross-sectional study

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