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Peral-Garrido ML, Gómez-Sabater S, Caño R, Bermúdez-García A, Lozano T, Sánchez-Ortiga R, Perdiguero M, Caro-Martínez E, Ruiz-García C, Francés R, Pascual E, Andrés M. Prevalence of crystal deposits in asymptomatic hyperuricemia according to different scanning definitions: A comparative study. Semin Arthritis Rheum 2024; 68:152470. [PMID: 38924926 DOI: 10.1016/j.semarthrit.2024.152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/24/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND/AIM The appropriate sonographic protocol for assessing urate crystal deposits in asymptomatic hyperuricemia (AH) is undefined, as well as how the choice would impact on deposit rates and accompanying sonographic, clinical and laboratory features. METHODS Patients with AH (serum urate ≥7 mg/dL) underwent musculoskeletal ultrasound of 10 locations for OMERACT elementary gout lesions (double contour [DC] signs, tophi, aggregates). Different definitions for AH with deposits were applied, varying according to deposits (any deposits; only DC and/or tophi); gradation (any grade; only grade 2-3 deposits), location (10 locations; 4-joint scheme including knees and 1MTPs; >1 location with deposits), or pre-defined definitions (DC sign in femoral condyles/1MTP and/or tophi in 1MTP). We evaluated crystal deposits rates and compared between other sonographic features, clinical and laboratory variables. RESULTS Seventy-seven participants with AH showed a median 1 location (IQR 0-2) with tophi, 1 (IQR 1-2) with aggregates, and 0 locations (IQR 0-1) with DC sign. The deposition rate ranged from 23.4% (in >1 location with grade 2-3 DC or tophi) to 87.0% (in any deposit in all 10 locations). Accompanying inflammation - assessed by a positive power-Doppler (PD) signal - and erosions were found in 19.5% and 28.4% of participants, respectively. Positive PD signal was better discriminated by criteria requiring grade 2-3 or >1 location with lesions. Erosions and the different clinical and laboratory variables were similar among protocols. CONCLUSION Rates of sonographic deposition in AH varied dramatically among studied protocols, while some could discriminate accompanying inflammation, all highlighting the need for a validated, consensus-based definition.
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Affiliation(s)
- María-Luisa Peral-Garrido
- Vinalopó University Hospital, Elche, Spain; University Miguel Hernández de Elche (UMH), Alicante, Spain
| | - Silvia Gómez-Sabater
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Rocío Caño
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Alejandra Bermúdez-García
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Teresa Lozano
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Cardiology Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Ruth Sánchez-Ortiga
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Endocrinology and Nutrition Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Miguel Perdiguero
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Nephrology Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Elena Caro-Martínez
- Internal Medicine Service, Sant Vicent del Raspeig Hospital-HACLE, San Vicente del Raspeig, Spain
| | | | - Rubén Francés
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBEREHD), Spain
| | - Eliseo Pascual
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Alicante Healthcare and Biomedical Research Institute (ISABIAL), Alicante, Spain
| | - Mariano Andrés
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Alicante Healthcare and Biomedical Research Institute (ISABIAL), Alicante, Spain.
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Jiang T, Weng Q, Zhang Y, Zhang W, Doherty M, Sarmanova A, Yang Z, Yang T, Li J, Liu K, Wang Y, Obotiba AD, Zeng C, Lei G, Wei J. Association Between Hyperuricemia and Ultrasound-Detected Hand Synovitis. Arthritis Care Res (Hoboken) 2024. [PMID: 38570913 DOI: 10.1002/acr.25342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Although hand synovitis is prevalent in the older population, the etiology remains unclear. Hyperuricemia, a modifiable metabolic disorder, may serve as an underlying mechanism of hand synovitis, but little is known about their relationship. We assessed the association between hyperuricemia and hand synovitis in a large population-based sample. METHODS We performed a cross-sectional study in Longshan County, Hunan Province, China. Hyperuricemia was defined as a serum urate level >420 μmol/L in men and >360 μmol/L in women. Ultrasound examinations were performed on both hands of 4,080 participants, and both gray-scale synovitis and the Power Doppler signal (PDS) were assessed using semiquantitative scores (grades 0-3). We evaluated the association of hyperuricemia with hand gray-scale synovitis (grade ≥2) and PDS (grade ≥1), respectively, adjusting for age, sex, and body mass index. RESULTS All required assessments for analysis were available for 3,286 participants. The prevalence of hand gray-scale synovitis was higher among participants with hyperuricemia (30.0%) than those with normouricemia (23.3%), with an adjusted odds ratio (aOR) of 1.28 (95% confidence interval [CI] 1.00-1.62). Participants with hyperuricemia also had a higher prevalence of PDS (aOR 2.36; 95% CI 1.15-4.81). Furthermore, hyperuricemia positively associated, both at the hand and joint levels, with the presence of gray-scale synovitis (aOR 1.27; 95% CI 1.00-1.60 and adjusted prevalence ratio [aPR] 1.26; 95% CI 1.10-1.44, respectively) and PDS (aOR 2.35; 95% CI 1.15-4.79 and aPR 2.34; 95% CI 1.28-4.30, respectively). CONCLUSION This population-based study provides more evidence for a positive association between hyperuricemia and prevalent hand synovitis.
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Affiliation(s)
- Ting Jiang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Qianlin Weng
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Weiya Zhang
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | - Michael Doherty
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | | | - Zidan Yang
- Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Yang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Jiatian Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Ke Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Wang
- Xiangya Hospital, Central South University, Changsha, China
| | | | - Chao Zeng
- Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Xiangya Hospital, Central South University, and Xiangya School of Public Health, Central South University, Changsha, China
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Yang K, Li J, Tao L. Purine metabolism in the development of osteoporosis. Biomed Pharmacother 2022; 155:113784. [DOI: 10.1016/j.biopha.2022.113784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
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Molyneux P, Bowen C, Ellis R, Rome K, Jackson A, Carroll M. Ultrasound Imaging Acquisition Procedures for Evaluating the First Metatarsophalangeal Joint: A Scoping Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:397-405. [PMID: 34969521 DOI: 10.1016/j.ultrasmedbio.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
The aim of this scoping review was to investigate ultrasound imaging (USI) acquisition procedures and guidelines used to assess the first metatarsophalangeal joint (MTPJ). MEDLINE, CINAHL, AMED and SPORTDiscus were systematically searched in May 2021. Studies were included if they used grey-scale USI or power Doppler and reported a USI procedure to assess the first MTPJ. Screening and data extraction were performed by two independent assessors. The scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR). A total of 403 citations were identified for screening, with 36 articles included in the final analysis. There was wide variation in USI acquisition procedures used to evaluate the first MTPJ. Inconsistencies in reporting may be attributable to the number of elements the USI acquisition procedure encompasses, which include the model of the USI device, the type of transducer, USI modalities and settings, patient position, transducer orientation, surfaces scanned and the scanning technique used. The review found inconsistencies against international guidelines and limited implementation of consensus-based recommendations to guide image acquisition. Current guidelines require further refinement of anatomical reference points to establish a standardised USI acquisition procedure, subsequently improving interpretability and reproducibility between USI studies that evaluate the first MTPJ.
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Affiliation(s)
- Prue Molyneux
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand.
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, UK
| | - Richard Ellis
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Keith Rome
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Aaron Jackson
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Matthew Carroll
- School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand
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Xu N, Han X, Zhang Y, Huang X, Zhu W, Shen M, Zhang W, Jialin C, Wei M, Qiu Z, Zeng X. Clinical features of gout in adult patients with type Ia glycogen storage disease: a single-centre retrospective study and a review of literature. Arthritis Res Ther 2022; 24:58. [PMID: 35219330 PMCID: PMC8881853 DOI: 10.1186/s13075-021-02706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to explore the clinical features of gout in adult patients with glycogen storage disease type Ia (GSD Ia). Methods Ninety-five adult patients with GSD Ia admitted to Peking Union Medical College Hospital were retrospectively analysed. A clinical diagnosis of GSD Ia was confirmed in all patients through gene sequencing. All patients had hyperuricaemia; 31 patients complicated with gout were enrolled, and 64 adult GSD Ia patients with asymptomatic hyperuricaemia were selected as a control group during the same period. Clinical characteristics were analysed and compared between the two groups. Results Thirty-one of the 95 patients had complications of gout (median age, 25 years; 11 (35.5%) females). All 31 patients had hepatomegaly, abnormal liver function, fasting hypoglycaemia, hyperuricaemia, hyperlipaemia, and hyperlacticaemia. A protuberant abdomen, growth retardation, recurrent epistaxis, and diarrhoea were the most common clinical manifestations. Among these 31 patients, 10 patients (32.3%) had gout as the presenting manifestation and were diagnosed with GSD Ia at a median time of 5 years (range, 1–14) after the first gout flare. The median age of gout onset was 18 years (range, 10–29). Fifteen of the 31 GSD Ia-related gout patients were complicated with gouty tophi, which has an average incidence time of 2 years after the first gouty flare. The mean value of the maximum serum uric acid (SUA) was 800.5 μmol/L (range, 468–1068). The incidence of gout in adult GSD Ia patients was significantly associated with the initial age of regular treatment with raw corn starch, the proportion of urate-lowering therapy initiated during the asymptomatic hyperuricaemic stage, maximum SUA level, and mean cholesterol level. Conclusions Determination of GSD Ia should be performed for young-onset gout patients with an early occurrence of gouty tophi, especially in patients with hepatomegaly, recurrent hypoglycaemia, or growth retardation. Early detection and long-term regulatory management of hyperuricaemia, in addition to early raw corn starch and lifestyle intervention, should be emphasized for GSD Ia patients in order to maintain good metabolic control. Trial registration Retrospectively registered.
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Affiliation(s)
- Na Xu
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Xinxin Han
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Yun Zhang
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Xiaoming Huang
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Weiguo Zhu
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Min Shen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chen Jialin
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China
| | - Min Wei
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhengqing Qiu
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xuejun Zeng
- Department of family medicine & Division of General Internal Medicine, Department of medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, China.
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Gutiérrez M, Sandoval H, Bertolazzi C, Soto-Fajardo C, Gastelum RMT, Reginato AM, Clavijo-Cornejo D. Update of the current role of ultrasound in asymptomatic hyperuricemia. A systematic literature review. Joint Bone Spine 2021; 89:105335. [PMID: 34954078 DOI: 10.1016/j.jbspin.2021.105335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
Ultrasound (US) is a recognized imaging modality for the assessment of gout. Recently it is being explored for its potential role in the evaluation of subjects with asymptomatic hyperuricemia (AH). Preliminary reports demonstrated the presence of monosodium urate (MSU)-crystal deposits including aggregates, double contour sign and/or tophi in both intra-articular and periarticular tissues of AH individuals. Although these results are exciting, the value and potential application of US in AH remain to be clearly delineated. In this systematic literature review, we aim to summarise the recent publications regarding the role of US in the assessment of AH. We analyzed possible application of US in the daily clinical practice and its future clinical and research potential in the evaluation of AH individuals.
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Affiliation(s)
- Marwin Gutiérrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Center of Excellence in Rheumatology, Mexico City, Mexico
| | - Hugo Sandoval
- Sociomedical Research Unit, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Chiara Bertolazzi
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Carina Soto-Fajardo
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | | | - Anthony M Reginato
- Division of Rheumatology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Denise Clavijo-Cornejo
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico.
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Anjum ZI, Bacha R, Manzoor I, Gilani SA. Reliability of knee joint sonography in the evaluation of gouty arthritis. J Ultrason 2021; 21:e300-e305. [PMID: 34970441 PMCID: PMC8678699 DOI: 10.15557/jou.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine the reliability of knee joint sonography in the evaluation of gouty arthritis. Methodology: A search of Google Scholar, PubMed, NCBI, MEDLINE, and Medscape databases, from 1988 up to 2020. The key search terms used were knee joint; knee joint ultrasound; gout; gouty arthritis, knee joint pain; sensitivity; specificity. The reviewer independently screened the titles and abstracts of the relevant articles and full-text downloads to determine whether the inclusion or exclusion criteria were met. Results: In total, 103 articles were identified through the database search. In addition, 11 articles were identified through other sources. Then, screening was performed, and 9 articles were removed due to duplication. Further screening was done for 105 articles, and 27 articles were excluded due to insufficient information. Seventy-eight full-text articles were assessed for eligibility. A total of 13 full-text articles were excluded due to research performed on animals, as the study had been designed as a review of only human studies. Sixty-three studies were included that had a qualitative synthesis. Conclusion: The knee is a weight-bearing joint and may be affected by a myriad of different pathological conditions, therefore a proper diagnosis is of prime importance for a proper management plan. Ultrasound is a non-invasive, radiation-free, and readily available modality that has high sensitivity and specificity in the evaluation of gouty arthritis.
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Xu G, Lin J, Liang J, Yang Y, Ye Z, Zhu G, Cao H. Entheseal involvement of the lower extremities in gout: an ultrasonographic descriptive observational study. Clin Rheumatol 2021; 40:4649-4657. [PMID: 34156566 DOI: 10.1007/s10067-021-05826-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/06/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to explore the prevalence and distribution of lower extremity entheseal abnormities by musculoskeletal ultrasound (US) in a cohort of gout patients, taking spondyloarthritis (SpA) patients and asymptomatic hyperuricemia (HUA) patients as controls. METHOD One hundred participants with gout, fifty patients with SpA, and twenty-nine patients with asymptomatic HUA were recruited. US was used to assess the bilateral quadriceps, patellar and Achilles tendons, and plantar fascia entheses according to the Outcome Measures in Rheumatology (OMERACT) definitions. RESULTS The US examination revealed the presence of one or more abnormalities in at least one enthesis in 45 out of 100 subjects (45.0%) and 152 out of 1000 entheses (15.2%) in the gout patients. Among the affected entheses, the patellar insertion of the quadriceps tendon was the most commonly involved area (38.0% in the gout patients versus 48.0% in the SpA patients with at least one pathological US finding, p = 0.241). There were no significant group differences in entheseal power Doppler (PD) signals, bone erosion, or enthesophytes. The patients with lower limb entheseal involvement in the gout group had an older age, longer disease duration, higher percentage of chronic tophaceous gout, and higher levels of inflammatory biomarkers of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Multivariate logistic regression analysis revealed that age (OR = 1.052, p = 0.001) and the ESR (OR = 1.023, p = 0.028) were correlated with lower limb enthesopathy in gout patients. In the subgroup analysis of gout patients without active inflammation, age (OR = 1.119, p = 0.001) and serum uric acid (UA, OR = 1.012, p = 0.002) were correlated with lower limb enthesopathy in gout. CONCLUSION Lower extremity entheseal involvement might be neglected but should be considered as an important element in the evaluation of gout patients. Enthesopathy most frequently involves in the patellar insertion of the quadriceps tendon and is characterized by entheseal hypoechogenicity and/or thickening. Key Points • Lower extremity enthesopathy might be neglected as an important element in gout. • Enthesopathy is most frequently involved in the patellar insertion of the quadriceps tendon in gout. • Age and ESR are correlated with lower limb enthesopathy in gout patients.
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Affiliation(s)
- Guanhua Xu
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Road Qingchun, Hangzhou, 310003, Zhejiang Province, China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Road Qingchun, Hangzhou, 310003, Zhejiang Province, China
| | - Junyu Liang
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Road Qingchun, Hangzhou, 310003, Zhejiang Province, China
| | - Yang Yang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Zi Ye
- The First People's Hospital of Linhai, Linhai, China
| | - Guohui Zhu
- The First People's Hospital of Linhai, Linhai, China
| | - Heng Cao
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Road Qingchun, Hangzhou, 310003, Zhejiang Province, China.
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Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia. J Immunol Res 2021; 2021:5550626. [PMID: 33884273 PMCID: PMC8041551 DOI: 10.1155/2021/5550626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
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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Silva JL, Santos-Faria D, Cerqueira M, Sousa-Neves J, Peixoto D, Teixeira F. Ultrasound features in patients with gout: A comparative analysis with matched controls. REUMATOLOGIA CLINICA 2021; 17:242-243. [PMID: 31515059 DOI: 10.1016/j.reuma.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/19/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Joana Leite Silva
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal.
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | | | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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Min HK, Cho H, Park SH. Pilot study: asymptomatic hyperuricemia patients with obesity and nonalcoholic fatty liver disease have increased risk of double contour sign. Korean J Intern Med 2020; 35:1517-1523. [PMID: 31181878 PMCID: PMC7652642 DOI: 10.3904/kjim.2018.448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/19/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Double contour sign (DCS) is a representative ultrasonographic finding in gout. DCS is evidence of monosodium urate deposit in gouty arthritis and has been identified in some patients with asymptomatic hyperuricemia. However, the specific characteristics of asymptomatic hyperuricemia in patients with DCS have not yet been revealed. METHODS We enrolled patients with incidentally found hyperuricemia. Baseline characteristics were compared between asymptomatic hyperuricemia patients with and without DCS. Logistic regression analysis was performed to determine associated factors for DCS in patients with asymptomatic hyperuricemia. RESULTS A total of 62 patients with asymptomatic hyperuricemia were enrolled, and 22 of the patients showed DCS. The metatarsophalangeal were the most commonly affected joints, and differences between asymptomatic hyperuricemia patients with and without DCS were seen in aspects of class II obesity and nonalcoholic fatty liver disease (NAFLD). Multivariate logistic regression analysis demonstrated that class II obesity and NAFLD significantly increased the risk of DCS in asymptomatic hyperuricemia patients (odds ratio [OR], 6.58, p = 0.022; OR, 5.21, p = 0.020, respectively). CONCLUSION Asymptomatic hyperuricemia patients with class II obesity and NAFLD had increased risk of DCS. Determining the presence of crystal deposition, such as DCS, among patients with asymptomatic hyperuricemia might help determine whether early pharmacologic intervention is needed, especially with severe obesity or NAFLD.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hyonjoung Cho
- Division of Rheumatology, Department of Internal Medicine, The Armed Forces Capital Hospital, Armed Forces Medical Command, Seongnam, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Sung-Hwan Park, M.D. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6011 Fax: +82-2-599-3589 E-mail:
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12
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Aslam F, England BR, Cannella A, Sharp V, Kao L, Arnason J, Albayda J, Bakewell C, Sanghvi S, Fairchild R, Torralba KD, Evangelisto A, DeMarco PJ, Bethina N, Kissin EY. Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis. Ann Rheum Dis 2020; 79:908-913. [PMID: 32213497 DOI: 10.1136/annrheumdis-2020-216927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility. METHODS Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC. RESULTS We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L. CONCLUSIONS A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.
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Affiliation(s)
- Fawad Aslam
- Rheumatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bryant R England
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Rheumatology, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Amy Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Veronika Sharp
- Division of Rheumatology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Lily Kao
- Division of Rheumatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jon Arnason
- Division of Rheumatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine Bakewell
- Division of Rheumatology, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Shruti Sanghvi
- Division of Rheumatology, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Robert Fairchild
- Division of Rheumatology, Stanford University, Stanford, California, USA
| | - Karina D Torralba
- Division of Rheumatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Amy Evangelisto
- Division of Rheumatology, Arthritis, Rheumatic & Back Disease Associates, Voorhees, New Jersey, USA
| | - Paul J DeMarco
- Center for Rheumatology and Bone Research, Arthritis and Rheumatism Associates, Wheaton, Maryland, USA.,Rheumatology, Georgetown University School of Medicine, Washington, DC, USA
| | - Narandra Bethina
- Division of Rheumatology, University of Vermont, Burlington, Vermont, USA
| | - Eugene Y Kissin
- Rheumatology, Boston University Medical Center, Boston, Massachusetts, USA
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13
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Management of Patients with Asymptomatic Hyperuriсemia – to Treat or not to Treat? Fam Med 2019. [DOI: 10.30841/2307-5112.5-6.2019.193365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford) 2019; 58:27-44. [PMID: 29547895 DOI: 10.1093/rheumatology/key002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 02/06/2023] Open
Abstract
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.
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Affiliation(s)
- Tristan Pascart
- EA 4490, Lille University, Lille, France.,Service de Rhumatologie, Hôpital Saint-Philibert, Lomme, France
| | - Frédéric Lioté
- UFR de Médecine, University of Paris Diderot, USPC, France.,INSERM, UMR 1132 Bioscar (Centre Viggo Petersen), France.,Service de Rhumatologie (Centre Viggo Petersen), Pôle Appareil Locomoteur, Hôpital Lariboisière (AP-HP), Paris, France
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15
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Löffler C, Sattler H, Löffler U, Krämer BK, Bergner R. Size matters: observations regarding the sonographic double contour sign in different joint sizes in acute gouty arthritis. Z Rheumatol 2019. [PMID: 29536155 DOI: 10.1007/s00393-018-0425-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In distinguishing urate arthritis (UA) from non-crystal-related arthritides, joint sonography including the detection of the double contour sign (DCS) and hypervascularization using power Doppler ultrasound (PDUS) is an important step in the diagnostic process. But are these sonographic features equally reliable in every accessible joint under real-life conditions? METHODS We retrospectively analyzed 362 patients with acute arthritis and evaluated the DCS and the degree of PDUS hypervascularization in patients with gout and in those with arthritis other than urate arthritis (non-UA). We classified all joints into the groups small, medium, and large. Sensitivities, specificities, positive and negative predictive values (PPV/NPV), and a binary regression model were calculated. We also evaluated the influence of serum uric acid levels (SUA) on the presence of a DCS in each joint category. RESULTS Sensitivity of the DCS in gout was 72.5% in the entire cohort, 66.0% in large, 78.8% in medium, and 72.3% in small joints. In wrist joints the DCS sensitivity maxed at 83.3%, with a specificity of 81.8%. The lowest rates of DCS sensitivity were found in gout patients with elbow joint involvement (42.9%). In all joints except metatarsophalangeal joint 1 (MTP-1), the incidence of a DCS increased by the increment of SUA levels above 7.5 mg/dl (p < 0.001). PDUS signals were most commonly found in medium and small joints and were only scarce in large joints, independent of the underlying diagnosis. CONCLUSIONS In our study we detected different rates of accuracy regarding DCS and PDUS in patients with acute arthritis. The best results were seen in medium-size joints, especially wrists.
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Affiliation(s)
- C Löffler
- Department of Nephrology, Endocrinology, Rheumatology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - H Sattler
- Department of Oncology, Rheumatology, Nephrology, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Germany
| | - U Löffler
- Psychotherapy Clinic, Institute of Psychology, University of Heidelberg, Hauptstr. 49-51, 69117, Heidelberg, Germany
| | - B K Krämer
- Department of Nephrology, Endocrinology, Rheumatology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Bergner
- Department of Oncology, Rheumatology, Nephrology, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Germany
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16
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
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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17
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Stewart S, Maxwell H, Dalbeth N. Prevalence and discrimination of OMERACT-defined elementary ultrasound lesions of gout in people with asymptomatic hyperuricaemia: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 49:62-73. [PMID: 30709689 DOI: 10.1016/j.semarthrit.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/05/2018] [Accepted: 01/08/2019] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Ultrasound lesions of gout have been described in people with asymptomatic hyperuricemia. However, the anatomical sites and ultrasound lesions most frequently involved in asymptomatic hyperuricemia have not yet been established. This systematic review and meta-analysis aimed to determine the prevalence of the Outcome Measures in Rheumatology (OMERACT) elementary ultrasound lesions of gout (double contour, aggregates, tophus, erosion) at various sites in people with asymptomatic hyperuricemia and to determine which sites and lesions discriminate from people with normouricemia. METHODS A systematic search of electronic databases, conference abstracts and reference lists was undertaken. Studies were included if they used ultrasound to image people with asymptomatic hyperuricemia and reported ≥1 OMERACT-defined lesion of gout. Meta-analyses were undertaken for the pooled prevalence of site-specific lesions in people with asymptomatic hyperuricemia, and the pooled odds ratios of these lesions compared to people with normouricemia. RESULTS Twenty studies were included. The most common site scanned was the first metatarsophalangeal joint (1MTP) (n = 17 studies) and the most common lesion reported, the double contour (n = 18). Meta-analyses of pooled prevalence showed 1MTP double contour was the most frequent finding in people with asymptomatic hyperuricemia (0.31, 95% confidence interval (CI) 0.20-0.42), followed by femoral condyle double contour (0.16, 95%CI 0.08-0.24) and 1MTP tophus (0.16, 95%CI 0.03-0.29). The highest pooled odds ratios for asymptomatic hyperuricemia vs. normouricemia were 6.98 (95%CI 3.14-15.57) for 1MTP double contour, 13.67 (95%CI 5.42-34.49) for femoral condyle double contour and 6.10 (95%CI 1.55-24.04) for 1MTP tophus. CONCLUSION In people with asymptomatic hyperuricemia, scanning of the 1MTP and femoral condyle for double contour, plus the 1MTP for tophus, has the highest prevalence and discrimination compared to those with normouricemia.
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Affiliation(s)
- Sarah Stewart
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Hannah Maxwell
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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18
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Abstract
The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available.
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Affiliation(s)
- Gérard Chalès
- Faculté de Médecine de Rennes, 2, avenue du professeur Léon-Bernard, 35000 Rennes, France.
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19
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Puetz J. Nano-evidence for joint microbleeds in hemophilia patients. J Thromb Haemost 2018; 16:1914-1917. [PMID: 30007042 DOI: 10.1111/jth.14242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
The concept of joint microbleeding in hemophilia patients was first proposed over 10 years ago. This was based on unexpected abnormalities found in medical imaging studies of asymptomatic joints. Since then, there have been no published studies confirming the presence of joint microbleeds. This critique will review the evidence for and against joint microbleeding in hemophilia patients and the potential implications.
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Affiliation(s)
- J Puetz
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA
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20
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Naredo E, Medina JP, Pérez-Baos S, Mediero A, Herrero-Beaumont G, Largo R. Validation of Musculoskeletal Ultrasound in the Assessment of Experimental Gout Synovitis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1516-1524. [PMID: 29703511 DOI: 10.1016/j.ultrasmedbio.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 06/08/2023]
Abstract
The objective of this study was to validate musculoskeletal ultrasound (US) in a rabbit model of acute gout. Acute gout was induced by intra-articular injection of monosodium urate (MSU) crystals in 10 rabbits; the 3 controls received vehicle. Rabbit knees were assessed by B-mode and power Doppler (PD) US 24 and 72 h after injections. After 72 h, all rabbits were euthanized. US discriminated between the MSU-injected and control groups with respect to the different inflammatory findings at both at 24 and 72 h and for MSU crystal-related findings after 24 h of injection. US synovial thickening, intra-synovial power Doppler signal and global joint distension significantly correlated with the synovial global histopathological score (r = 0.47, p = 0.0188), tissue vascularization measured by CD31 immunohistochemical-positive staining (r = 0.46, p = 0.0172) and tissue levels of interleukin-1β (r = 0.53, p = 0.0078), respectively. US is a valid method for assessment of synovial inflammation in experimental gouty arthritis in rabbits.
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Affiliation(s)
- Esperanza Naredo
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Juan Pablo Medina
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Sandra Pérez-Baos
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Aranzazu Mediero
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain.
| | - Raquel Largo
- Bone and Joint Research Unit, Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
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21
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Dalbeth N, Doyle AJ. Imaging tools to measure treatment response in gout. Rheumatology (Oxford) 2018; 57:i27-i34. [PMID: 29272513 DOI: 10.1093/rheumatology/kex445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/13/2022] Open
Abstract
Imaging tests are in clinical use for diagnosis, assessment of disease severity and as a marker of treatment response in people with gout. Various imaging tests have differing properties for assessing the three key disease domains in gout: urate deposition (including tophus burden), joint inflammation and structural joint damage. Dual-energy CT allows measurement of urate deposition and bone damage, and ultrasonography allows assessment of all three domains. Scoring systems have been described that allow radiological quantification of disease severity and these scoring systems may play a role in assessing the response to treatment in gout. This article reviews the properties of imaging tests, describes the available scoring systems for quantification of disease severity and discusses the challenges and controversies regarding the use of imaging tools to measure treatment response in gout.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
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22
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Keen HI, Davis WA, Latkovic E, Drinkwater JJ, Nossent J, Davis TME. Ultrasonographic assessment of joint pathology in type 2 diabetes and hyperuricemia: The Fremantle Diabetes Study Phase II. J Diabetes Complications 2018; 32:400-405. [PMID: 29483015 DOI: 10.1016/j.jdiacomp.2017.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 12/27/2022]
Abstract
AIMS The prevalence and consequences (articular and extra-articular) of hyperuricemia in type 2 diabetes, especially when asymptomatic (ASH), are incompletely understood. The aim of this study was to use ultrasonography to assess pathology associated with monosodium urate deposition in the joints of well-characterized hyperuricemic patients with type 2 diabetes. METHODS A subset of 101 participants (mean age 70.4 years, 59.8% males, median diabetes duration 14.6 years) with hyperuricemia (fasting serum uric acid ≥0.42 mmol/L) from the community-based observational Fremantle Diabetes Study Phase II were assessed by ultrasound for signs of intra-articular urate deposition and inflammation in 14 joints at increased risk of involvement in patients with gout. RESULTS Most participants had evidence of crystal deposition comprising aggregates (59.4%), tophi (19.8%) or a double contour sign (27.7%), and 37% had a power Doppler signal indicative of inflammation in at least one joint. There was no difference between the prevalence of these abnormalities in those with ASH (n = 60) versus participants with a history of gout (n = 41; P ≥ 0.15). There was no association between a history of ischemic heart disease (reported by 17.8% of participants) and either any abnormality on joint ultrasound or inflammatory changes assessed by power Doppler (P ≥ 0.41). CONCLUSIONS Joint inflammation and/or urate deposition were present in the majority of community-based patients with type 2 diabetes and hyperuricemia regardless of whether there was a history of gout. Given the potential consequences of chronic inflammation for joint damage and extra-articular complications such as cardiovascular disease, these data have potential clinical implications.
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Affiliation(s)
- Helen I Keen
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Wendy A Davis
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Erin Latkovic
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jocelyn J Drinkwater
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Johannes Nossent
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Timothy M E Davis
- Medical School, University of Western Australia, Crawley, Western Australia, Australia.
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23
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Wang P, Smith SE, Garg R, Lu F, Wohlfahrt A, Campos A, Vanni K, Yu Z, Solomon DH, Kim SC. Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT. RMD Open 2018; 4:e000593. [PMID: 29556417 PMCID: PMC5856918 DOI: 10.1136/rmdopen-2017-000593] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives Dual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT. Methods We conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan. Results The mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits. Conclusions Fifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined.
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Affiliation(s)
- Penny Wang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajesh Garg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fengxin Lu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa Wohlfahrt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anarosa Campos
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Vanni
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhi Yu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung C Kim
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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24
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Abstract
Acute gout arthritis flares contribute dominantly to gout-specific impaired health-related quality of life, representing a progressively increasing public health problem. Flares can be complex and expensive to treat, partly due to the frequent comorbidities. Unmet needs in gout management are more pressing given the markedly increasing gout flare hospital admission rates. In addition, chronic gouty arthritis can cause joint damage and functional impairment. This review addresses new knowledge on the basis for the marked, inherent variability of responses to deposited urate crystals, including the unpredictable and self-limited aspects of many gout flares. Specific topics reviewed include how innate immunity and two-signal inflammasome activation intersect with diet, metabolism, nutritional biosensing, the microbiome, and the phagocyte cytoskeleton and cell fate. The paper discusses the roles of endogenous constitutive regulators of inflammation, including certain nutritional biosensors, and emerging genetic and epigenetic factors. Recent advances in the basis of variability in responses to urate crystals in gout provide information about inflammatory arthritis, and have identified potential new targets and strategies for anti-inflammatory prevention and treatment of gouty arthritis.
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Affiliation(s)
- Robert Terkeltaub
- VA San Diego Healthcare System, 111K, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. .,Department of Medicine, University of California San Diego, San Diego, CA, USA.
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25
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Carroll M, Dalbeth N, Allen B, Stewart S, House T, Boocock M, Frampton C, Rome K. Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls. J Rheumatol 2017; 44:1487-1492. [PMID: 28765249 DOI: 10.3899/jrheum.170203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). METHODS Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. RESULTS The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p < 0.01). Intratendinous hyperechoic spots (p < 0.01) and intratendinous power Doppler signal (p < 0.01) were more frequent in participants with gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both gout participants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p < 0.01), but between-zone differences were not observed for other features. CONCLUSION US features of urate deposition, tophus, and vascularization are present throughout the AT in patients with tophaceous gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.
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Affiliation(s)
- Matthew Carroll
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Nicola Dalbeth
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Bruce Allen
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Sarah Stewart
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Tony House
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Mark Boocock
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Christopher Frampton
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology
| | - Keith Rome
- From the Health and Rehabilitation Research Institute, Auckland University of Technology; Faculty of Medical and Health Sciences, The University of Auckland; Department of Rheumatology, Auckland District Health Board; Horizon Radiology Ltd., Auckland University of Technology North Shore Campus, Auckland; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. .,M. Carroll, PhD, MSc, BHSc, Health and Rehabilitation Research Institute, Auckland University of Technology; N. Dalbeth, MBChB, MD, FRACP, Faculty of Medical and Health Sciences, The University of Auckland, and Department of Rheumatology, Auckland District Health Board; B. Allen, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; S. Stewart, PhD, BHSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; T. House, MBChB, FRANZCR, Horizon Radiology Ltd., Auckland University of Technology North Shore Campus; M. Boocock, PhD, MSc, BA (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology; C. Frampton, PhD, BSc (Hons), Department of Medicine, University of Otago, Christchurch; K. Rome, PhD, MSc, BSc (Hons), Health and Rehabilitation Research Institute, Auckland University of Technology.
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26
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Aslam F, Michet C. My Treatment Approach to Gout. Mayo Clin Proc 2017; 92:1234-1247. [PMID: 28778257 DOI: 10.1016/j.mayocp.2017.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/27/2022]
Abstract
Gout is the most common form of inflammatory arthritis in the United States. Nevertheless, gout remains misunderstood, misdiagnosed, underdiagnosed, and undertreated. Several new recommendation and guideline documents regarding the management of gout have been published in the past few years. New diagnostic modalities, such as ultrasound and dual-energy computed tomography, are now available. Newer treatment options exist, and older agents and their interactions are now better understood. This review addresses these recent diagnostic and therapeutic developments and describes our management protocol with the aim of providing the clinician with a pragmatic approach to gout management.
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Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
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27
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Stewart S, Dalbeth N, Vandal AC, Allen B, Miranda R, Rome K. Are ultrasound features at the first metatarsophalangeal joint associated with clinically-assessed pain and function? A study of people with gout, asymptomatic hyperuricaemia and normouricaemia. J Foot Ankle Res 2017; 10:22. [PMID: 28539973 PMCID: PMC5441079 DOI: 10.1186/s13047-017-0203-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/15/2017] [Indexed: 01/05/2023] Open
Abstract
Background The first metatatarsophalangeal joint (1st MTP joint) is a common location for sonographic evidence of urate deposition in people with gout and asymptomatic hyperuricaemia. However, it is unclear whether these are related to clinically-assessed pain and function. This study aimed to determine the association between ultrasound features and clinical characteristics of the 1st MTP joint in people with gout, asymptomatic hyperuricaemia and age- and sex-matched normouricaemic individuals. Methods Twenty-three people with gout, 29 with asymptomatic hyperuricaemia and 34 with normouricaemia participated in a cross-sectional study. No participant had clinical evidence of acute inflammatory arthritis at the time of assessment. Four sonographic features at the 1st MTP joint were analysed: double contour sign, tophus, bone erosion and synovitis. Clinical characteristics included in the analysis were 1st MTP joint pain, overall foot pain and disability, 1st MTP joint temperature, 1st MTP joint range of motion and gait velocity. Statistical analyses adjusted for the diagnostic group of the participant. Results After accounting for the diagnostic group, double contour sign was associated with higher foot pain and disability scores (P < 0.001). Ultrasound tophus was associated with higher foot pain and disability scores (P < 0.001), increased temperature (P = 0.005), and reduced walking velocity (P = 0.001). No associations were observed between ultrasound synovitis or erosion and the clinical characteristics. Conclusions Ultrasound features of urate crystal deposition, rather than soft tissue inflammation or bone erosion, are associated with clinical measures of foot-related functional impairment and disability even in the absence of clinical evidence of current acute inflammatory arthritis. This association persisted regardless of the diagnosis of the participant as having gout or asymptomatic hyperuricaemia.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand.,Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand.,Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640 New Zealand
| | - Bruce Allen
- Horizon Radiology, Auckland University of Technology North Shore Campus, AA Building, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Rhian Miranda
- Auckland City Hospital Radiology, Auckland District Health Board, P.O Box 92189, Auckland, New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
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28
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Imaging of gout: New tools and biomarkers? Best Pract Res Clin Rheumatol 2016; 30:638-652. [PMID: 27931959 DOI: 10.1016/j.berh.2016.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 12/27/2022]
Abstract
While joint aspiration and crystal identification by polarizing microscopy remain the gold standard for diagnosing tophaceous gout, agreement among medical and ancillary health personnel examining synovial fluid using polarizing microscopy for the detection of monosodium urate (MSU) crystals appears to be poor. Imaging modalities, including conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), and dual-energy computed tomography (DECT), have been found to provide information on the deposition of MSU crystals in tissues, and the consequences of such deposition. CR can demonstrate typical "punched out lesions" with marginal overhangs, but the sensitivity for erosion detection is better for DECT and US. US is inexpensive and can identify tophus deposition in and around joints, erosions, and tissue inflammation if power Doppler US is used. MRI can show tophi, bone marrow edema, and inflammation, but MRI findings of tophi may be nonspecific. DECT can identify and color-code tophaceous material, and provide an overview of the tophus burden of a joint area. Because of the lower number of available studies, the strength of evidence for the newer imaging can be improved through further research.
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