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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] [MESH Headings] [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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Yan M, Du M, Yu T, Xiao L, Li Y, Wang C, Li X, Ning C. Concordance of Ultrasound and Dual-Energy CT in Diagnosing Gouty Arthritis in the Knee Joint: A Retrospective Observational Study. Acad Radiol 2024:S1076-6332(24)00605-6. [PMID: 39245598 DOI: 10.1016/j.acra.2024.08.041] [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: 05/18/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
RATIONALE AND OBJECTIVES To assess the consistency between ultrasound and dual-energy computed tomography (DECT) for the diagnosis of gout in the knee joint. MATERIALS AND METHODS The ultrasound and DECT images of 176 knee joints from 167 patients diagnosed with gout at the Gout Specialty Clinic of Qingdao University Affiliated Hospital from February 2022 to December 2023 were retrospectively analyzed. The knee joint was segmented into five anatomical regions: intra-articular, anterior, posterior, medial, and lateral. The location of monosodium urate (MSU) crystal deposition was recorded. Tophi were classified as hypoechogenic, isoechogenic, hyperechogenic, or strongly echogenic. The Kappa test was used to assess the consistency between the two examination methods in different regions of the knee joint. The McNemar chi-square test was utilized to conduct a differential analysis between the DECT and ultrasound results. The chi-square test was used to assess differences in the rate of tophi detection with different echogenicities by DECT. Pearson's correlation coefficient was used to assess the correlation between MSU crystal deposition volume and clinically relevant indicators. RESULTS Double contour (61.4%) was the most common intra-articular ultrasound sign. In the extra-articular region, MSU crystals were commonly deposited in and around the popliteal groove region (ultrasound: 52.3%; DECT: 60.0%). Corresponding MSU deposits on DECT were found in 7 of 54 joints with aggregates detected on ultrasound, and in 15 of 108 joints with DC. Tophi with hyperechogenicity or strong echogenicity were more likely to be detected on DECT than those with hypoechoic or isoechoic features (84.3% and 90.9% vs. 55.1% and 27.8%, respectively). For the assessment of MSU deposits, ultrasound showed an overall higher positive rate than DECT (81.1% vs. 72.2%), with poor consistency between the two examinations (κ = 0.177). In distinct anatomical regions, ultrasound and DECT showed high consistency in the medial (κ = 0.651) and lateral (κ = 0.705) views, with no significant difference. The intra-articular (κ = 0.316) and anterior (κ = 0.346) regions exhibited only fair consistency, with statistically significant diagnostic differences. When exclusively assessing cases with tophi, ultrasound and DECT demonstrated similar consistency in the medial, lateral and anterior views (κ = 0.633, 0.712, and 0.400, respectively), with statistically significant differences. In the intra-articular region, the consistency was reduced (κ = 0.237), and the differences were statistically significant. CONCLUSION Ultrasound and DECT are effective methods to detect MSU deposition in gout of the knee. However, the consistency between the two techniques varies in different anatomical locations. Clinical assessment should be tailored based on the specific anatomical position. DECT is advantageous for the evaluation of intra-articular MSU deposits, while ultrasound is more sensitive for the early detection of scattered MSU deposits.
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Affiliation(s)
- Mengmeng Yan
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Meixia Du
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Tong Yu
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (T.Y., X.L.)
| | - Lishan Xiao
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Yuchen Li
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Can Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (C.N.)
| | - Xiaoli Li
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (T.Y., X.L.)
| | - Chunping Ning
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.).
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Legrand J, Marzin C, Neogi T, Norberciak L, Budzik JF, Pascart T. Associations of Changes in Knee Hyaline Cartilage Composition Measured With Dual-Energy Computed Tomography in Gout, Aging and Osteoarthritis. Cartilage 2024; 15:283-292. [PMID: 37312537 PMCID: PMC11418446 DOI: 10.1177/19476035231172152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout. DESIGN Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of interest were defined in the femorotibial hyaline cartilage. Five DECT parameters were obtained: CT numbers in Hounsfield units (HU) at 80 and 140 kV, the electron density (Rho), the effective atomic number (Zeff), and the dual-energy index (DEI). Zones were compared between patients with gout, with and without knee OA, and between patients with gout and comparators without gout, after adjustment for confounders. RESULTS A total of 113 patients with gout (mean age 63.5 ± 14.3 years) and 15 comparators without gout (mean age 75.8 ± 11.5 years) were included, n = 65 (51%) had knee OA, and 466 zones of hyaline cartilage were analyzed. Older age was associated with lower attenuations at 80 kV (P < 0.01) and 140 kV (P < 0.01), and with Rho (P < 0.01). OA was characterized by lower attenuation at 140 kV (P = 0.03), but the lower Rho was nonsignificant after adjustment for confounders. In gout, hyaline cartilage exhibited lower Rho values (adjusted P = 0.04). Multivariable coefficients of association with Rho were -0.21 [-0.38;-0.04] (P = 0.014) for age, -4.15 [-9.0;0.7] (P = 0.093) for OA and 0.73 [-0.1;1.56] (P = 0.085) for monosodium urate volume. CONCLUSION Gout was associated with DECT-detected changes in cartilage composition, similar to those observed in older patients, with some similarities and some differences to those seen in OA. These results suggest the possibility of potential DECT biomarkers of OA.
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Affiliation(s)
- Julie Legrand
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- Imaging Department, Saint-Philibert Hospital, Lomme, France
| | - Claire Marzin
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lomme, France
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
| | - Tristan Pascart
- MabLab UR4490/Lille and Boulogne-sur-Mer Universities/University of Lille Nord de France, Lomme, France
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
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Han L, Li R, Dalbeth N, Liu M, Yu Q, Jiang C, Ning C, Liu Z, He Y, Li M, Xue X, Jia F, Jia Z, Sun W, Zhang H, Lu J, Wang C, Li C. The value of musculoskeletal ultrasound in predicting gout flares in index joints: A prospective cohort study of people with gout starting urate-lowering therapy. Semin Arthritis Rheum 2024; 67:152418. [PMID: 38422901 DOI: 10.1016/j.semarthrit.2024.152418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate whether ultrasound findings of monosodium urate (MSU) crystal deposition predict frequent gout flares in index joints over 12 months. METHODS This single-center study enrolled people with at least one gout flare involving the MTP1, ankle or knee joint. The most painful or most frequently joint was identified as index joint for analysis. All participants were started on urate-lowering therapy and had an ultrasound scan of the index joints at the baseline visit. OMERACT scores (for tophus, double contour sign and aggregates) were used to analyze whether ultrasound scores predicted frequent (≥2) gout flares in the index joint over 12 months. RESULTS Frequent flares were significantly higher in those with ultrasound findings in all index joints (MTP1: tophus: 85.0% vs 46.0%, P < 0.001, aggregates: 78.8% vs 59.0%, P < 0.01; ankle: tophus: 54.6% vs 20.8%, P < 0.001; aggregates: 60.0% vs 35.9%, P < 0.05; knee: tophus: 68.4% vs 28.6%, P < 0.05). For the MTP1, for each 1-point increase in tophus score, the odds of frequent gout flares increased by 5.19 [(95%CI: 1.26-21.41), 7.91 [(95%CI: 2.23-28.14), and 13.79 [(95%CI: 3.79-50.20)] fold respectively. For the ankle, a tophus score of 3 markedly improved the prediction of the frequent flares [OR= 9.24 (95%CI=2.85-29.91)]. Semi-quantitative sum scores were associated with frequent flares with an OR (95%CI) of 13.66 (3.44-54.18), P < 0.001 at the MTP1, 7.05 (1.98-25.12), P < 0.001 at the ankle. CONCLUSION Ultrasound features of MSU crystal deposition at the MTP1 and knee predict subsequent risk of frequent gout flares in the same joints following initiation of urate-lowering therapy, with the highest risk in those with high tophus scores.
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Affiliation(s)
- Lin Han
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Runze Li
- Department of Medicine, Qingdao University, Qingdao, PR China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mingdi Liu
- Department of Rehabilitation, Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital), Qingdao, PR China
| | - Qing Yu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Caiyun Jiang
- Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Chunping Ning
- Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Maichao Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Xiaomei Xue
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Fenghao Jia
- Department of Psychiatry, Xi 'an Medical University, Xi 'an, PR China
| | - Zhaotong Jia
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Wenyan Sun
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, PR China
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Changgui Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, PR China.
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Pârvănescu CD, Bărbulescu AL, Biță CE, Dinescu ȘC, Trașcǎ BA, Firulescu SC, Vreju FA. Ultrasound Features in Gout: An Overview. Med Sci (Basel) 2024; 12:37. [PMID: 39189200 PMCID: PMC11348250 DOI: 10.3390/medsci12030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024] Open
Abstract
The accurate diagnosis of gout frequently constitutes a challenge in clinical practice, as it bears a close resemblance to other rheumatologic conditions. An undelayed diagnosis and an early therapeutic intervention using uric acid lowering therapy (ULT) is of the utmost importance for preventing bone destruction, the main point of managing gout patients. Advanced and less invasive imaging techniques are employed to diagnose the pathology and ultrasonography (US) stands out as a non-invasive, widely accessible and easily reproducible method with high patient acceptability, enabling the evaluation of the full clinical spectrum in gout. The 2023 EULAR recommendations for imaging in diagnosis and management of crystal-induced arthropathies in clinical practice state that US is a fundamental imagistic modality. The guidelines underline its effectiveness in detecting crystal deposition, particularly for identifying tophi and the double contour sign (DCS). Its utility also arises in the early stages, consequent to synovitis detection. US measures of monosodium urate (MSU) deposits are valuable indicators, sensitive to change consequent to even short-term administration of ULT treatment, and can be feasibly used both in current daily practice and clinical trials. This paper aimed to provide an overview of the main US features observed in gout patients with reference to standardized imaging guidelines, as well as the clinical applicability both for diagnosis accuracy and treatment follow-up. Our research focused on summarizing the current knowledge on the topic, highlighting key data that emphasize gout as one of the few rheumatological conditions where US is recognized as a fundamental diagnostic and monitoring tool, as reflected in the most recent classification criteria.
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Affiliation(s)
- Cristina Dorina Pârvănescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Andreea Lili Bărbulescu
- Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Elena Biță
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Ștefan Cristian Dinescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Beatrice Andreea Trașcǎ
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Sineta Cristina Firulescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.D.P.); (C.E.B.); (B.A.T.); (S.C.F.)
| | - Florentin Ananu Vreju
- Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Sirotti S, Terkeltaub R, Filippou G. Describing calcium pyrophosphate deposition: undoing the tower of Babel! Curr Opin Rheumatol 2024; 36:241-250. [PMID: 38517340 DOI: 10.1097/bor.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW In 1977, McCarty astutely observed, 'The variety of names suggested for the condition associated with deposits of calcium pyrophosphate dihydrate crystals is exceeded only by the variations of its clinical presentation'. Fast forward to 2024, a standardized nomenclature for calcium pyrophosphate deposition (CPPD) is still lacking. This review aims to delineate the challenges in characterizing CPPD through nomenclature and imaging. RECENT FINDINGS Despite the effort of nomenclature standardization in 2011 by the EULAR, confusion persists in the literature and clinical practice, with pseudo-forms and obscure abbreviations. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) has launched a project to redefine CPPD nomenclature and formulate a user-friendly language for effective communication with patients and other stakeholders. Additionally, recent advancements in imaging, have shed light on various aspects of the disorder. SUMMARY Almost 60 years from the first description of a clinical manifestation related to calcium pyrophosphate crystals, a common language describing the disorder is still lacking. A redefined CPPD nomenclature, together with lay-friendly terminology, would significantly contribute to the uniformity of CPPD research, enhance public understanding and awareness and improve doctor-patient communication and therefore disease outcomes. Imaging can provide deep insights into CPPD elements, promoting comprehension of this disorder.
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Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Robert Terkeltaub
- Department of Medicine, Division of Rheumatology, Autoimmunity, and Inflammation, University of California San Diego, La Jolla, California, USA
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Hammam N, Tharwat S, M Elsaman A, Bakhiet A, Mahmoud MB, Ismail F, El Saadany H, R ElShereef R, F Mohamed E, I Abd Elazeem M, Eid A, Ali F, Hamdy M, El Mallah R, Ha Mohammed R, M Gamal R, Fawzy S, Senara S, Hammam O, M Fathi H, Aboul Fotouh A, A Gheita T. Unsupervised cluster analysis of clinical and ultrasound features reveals unique gout subtypes: Results from the Egyptian College of Rheumatology (ECR). Diabetes Metab Syndr 2023; 17:102897. [PMID: 37979221 DOI: 10.1016/j.dsx.2023.102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Gout comprises a heterogeneous group of disorders; however, comorbidities have been the focus of most efforts to classify disease subgroups. OBJECTIVES We applied cluster analysis using musculoskeletal ultrasound (MSUS) combined with clinical and laboratory findings in patients with gout to identify disease phenotypes, and differences across clusters were investigated. PATIENTS AND METHODS Patients with gout who complied with the ACR/EULAR classification criteria were enrolled in the Egyptian College of Rheumatology (ECR)-MSUS Study Group, a multicenter study. Selected variables included demographic, clinical, and laboratory findings. MSUS scans assessed the bilateral knee and first metatarsophalangeal joints. We performed a K-mean cluster analysis and compared the features of each cluster. RESULTS 425 patients, 267 (62.8 %) males, mean age 54.2 ± 10.3 years were included. Three distinct clusters were identified. Cluster 1 (n = 138, 32.5 %) has the lowest burden of the disease and a lower frequency of MSUS characteristics than the other clusters. Cluster 2 (n = 140, 32.9 %) was mostly women, with a low rate of urate-lowering treatment (ULT). Cluster 3 (n = 147, 34.6 %) has the highest disease burden and the greatest proportion of comorbidities. Significant MSUS variations were found between clusters 2 and 3: joint effusion (p < 0.0001; highest: cluster 3), power Doppler signal (p < 0.0001; highest: clusters 2), and aggregates of crystal deposition (p < 0.0001; highest: cluster 3). CONCLUSION Cluster analysis using MSUS findings identified three gout subgroups. People with more MSUS features were more likely to receive ULT. Treatment should be tailored according to the cluster and MSUS features.
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Affiliation(s)
- Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Egypt.
| | - Samar Tharwat
- Internal Medicine, Rheumatology Unit, Mansoura University, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Egypt
| | - Ali Bakhiet
- Computer Science Department, Higher Institute of Computer Science and Information Systems, Culture & Science City, Giza, Egypt
| | - Mohamed Bakrey Mahmoud
- Computer Science Department, Higher Institute of Computer Science and Information Systems, Culture & Science City, Giza, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Egypt
| | | | | | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Egypt
| | | | - Ayman Eid
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Egypt
| | - Fatma Ali
- Rheumatology Department, Faculty of Medicine, Minia University, Egypt
| | - Mona Hamdy
- Rheumatology Department, Faculty of Medicine, Minia University, Egypt
| | - Reem El Mallah
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Reem Ha Mohammed
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rania M Gamal
- Rheumatology Department, Faculty of Medicine, Assiut University, Egypt
| | - Samar Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Egypt
| | - Osman Hammam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, New Valley University, New Valley, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Egypt
| | - Adham Aboul Fotouh
- Egyptian School for Musculoskeletal Ultrasonography (EgySMUS), Egyptian Society of Musculoskeletal and Neuromuscular Sonography (ESMNS), Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt
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Calabuig I, Marty-Ané A, Norberciak L, Budzik JF, Legrand J, Martínez-Sanchis A, Pascart T, Andrés M. Prediction of renal and cardiometabolic outcomes in gout during urate-lowering therapy by sonography. Int J Rheum Dis 2023; 26:2450-2459. [PMID: 37786305 DOI: 10.1111/1756-185x.14935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES To assess whether the extent of monosodium urate (MSU) crystal deposition estimated by ultrasound could predict renal and cardiometabolic events during urate-lowering therapy (ULT). METHODS A prospective study on gout patients from two referral centers initiating ULT who underwent baseline ultrasound and were followed for 1 year. Ultrasound scans assessed six joints for double-contour (DC) signs and tophi. A five-point change (mL/min/1.73 m2 ) in the glomerular filtration rate at month 12 (M12) was considered significant. Outcomes of interest were renal function degraded versus improved and a composite cardiometabolic outcome (new hypertension, diabetes, atherosclerotic disease, and cardiovascular death). Homogeneity analyses and Cox regression models were performed. RESULTS One hundred sixty patients were recruited. At baseline, 81.1% of patients (n = 129) showed sonographic tophi with a mean number of 1.4 joints (±1.3) with a DC sign. At M12, 18 patients (11.3%) were lost to follow-up. The serum urate (SU) target (<6.0 mg/dL) was reached in 86 patients (69.9%). Regarding renal function, 15.9% of patients showed improvement, while in 31.0% it degraded. Fourteen new cardiometabolic events occurred in 12 patients. Neither the DC sign nor tophi showed any significant impact on the outcomes of interest. Baseline SU level was higher in those with renal improvement but not with renal decline, while achieving the SU target protected against new cardiometabolic events (HR = 0.2; 95% CI: 0.05-0.81). CONCLUSIONS Sonographic MSU crystal burden was unhelpful in predicting renal and cardiometabolic events during the first year of ULT. Reaching the SU target prevented cardiometabolic events, while its benefit in preserving/improving renal function is unclear.
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Affiliation(s)
- Irene Calabuig
- Rheumatology Department, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain
| | - Anne Marty-Ané
- Rheumatology Department, Hôpital Saint-Philibert, Lille Catholic Hospitals, Lille, France
| | - Laurène Norberciak
- Research Department, Biostatistics, Hôpital Saint-Philibert, Lille Catholic Hospitals, Lille, France
| | - Jean-François Budzik
- Diagnostic and Interventional Imaging Department, Lille Catholic Hospitals, Lille, France
| | - Julie Legrand
- Diagnostic and Interventional Imaging Department, Lille Catholic Hospitals, Lille, France
| | | | - Tristan Pascart
- Rheumatology Department, Hôpital Saint-Philibert, Lille Catholic Hospitals, Lille, France
| | - Mariano Andrés
- Rheumatology Department, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, Alicante, Spain
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9
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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10
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Calabuig I, Martínez-Sanchis A, Andrés M. Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout. Front Med (Lausanne) 2022; 8:795984. [PMID: 34977097 PMCID: PMC8716736 DOI: 10.3389/fmed.2021.795984] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis. Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0–3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression. Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2–3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.50) and a positive PD signal (OR 1.67; 95% CI 1.09–2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association. Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.
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Affiliation(s)
- Irene Calabuig
- Sección de Reumatología, Hospital General Universitario de Alicante-Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Agustín Martínez-Sanchis
- Sección de Reumatología, Hospital General Universitario de Alicante-Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante-Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
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11
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Shang J, Zhou LP, Wang H, Liu B. Diagnostic Performance of Dual-energy CT Versus Ultrasonography in Gout: A Meta-analysis. Acad Radiol 2022; 29:56-68. [PMID: 32980243 DOI: 10.1016/j.acra.2020.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Dual-energy computed tomography (DECT), along with ultrasound (US), has been increasingly utilized for the diagnosis of gout because of its noninvasive advantages. However, the superiority of DECT over US remains controversial. This meta-analysis was performed to investigate whether DECT is superior to US in the diagnosis of gout. METHODS A comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases was conducted for potentially eligible articles. Studies that evaluated the utility of DECT or US for gout diagnosis were qualified. Two distinctive ultrasonographic features of gout, namely, the double contour sign and the presence of tophus, were also assessed. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Besides, the subgroup analyses of early disease duration (≤ 2 years) was also performed. RESULTS Twenty-eight studies were included in the meta-analysis. The pooled sensitivity and specificity of DECT were 0.89 (0.80-0.94) and 0.91 (0.88-0.94), respectively. The pooled sensitivity and specificity of US were 0.70 (0.58-0.79) and 0.95 (0.87-0.98), respectively, for double contour sign; 0.57 (0.38-0.74) and 0.99 (0.88-1.00), respectively, for tophus; and 0.84 (0.73-0.91) and 0.84 (0.78-0.89), respectively, for overall consideration of US signs. At the early disease duration (≤ 2 years), the pooled sensitivity and specificity were 0.75 (0.60-0.86) and 0.85 (0.75-0.91), respectively, for DECT; 0.93 (0.72-0.99) and 0.80 (0.71-0.86), respectively, for overall consideration of US signs. CONCLUSION DECT and US showed promising accuracy for gout diagnosis. DECT has higher sensitivity, specificity, and AUC than overall consideration of US signs and thus has a better diagnostic ability in diagnosing gout. Moreover, the diagnostic sensitivity of DECT is lower than that of overall consideration of US signs at less than 2 years' disease duration.
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12
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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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13
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Stewart S, Su I, Gamble GD, Dalbeth N. Diagnostic value of different imaging features for patients with suspected gout: A network meta-analysis. Semin Arthritis Rheum 2021; 51:1251-1257. [PMID: 34763198 DOI: 10.1016/j.semarthrit.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Microscopic identification of monosodium urate (MSU) crystals is the gold standard for gout diagnosis. However, joint aspiration is not always practical, and imaging is increasingly used in clinical practice. This study aimed to assess the diagnostic accuracy of imaging features for gout compared with microscopy, using network meta-analysis methodology. METHODS MEDLINE, EMBASE, PubMed and Cochrane databases were searched for studies reporting on the use of imaging modalities to diagnose gout in patients with an unclear diagnosis or suspected gout, which was later confirmed by microscopy. A combination of direct and indirect comparisons were performed by network meta-analysis to evaluate the combined odds ratios for sensitivity, specificity, and accuracy. To assist interpretation, the surface under the cumulative ranking curve (SUCRA) scores were calculated to provide a ranking of the imaging features. RESULTS Fifteen eligible studies were included. Compared to the gold standard microscopic identification of MSU crystals, dual energy computed tomography (DECT) MSU crystal deposition and ultrasound double contour had greater sensitivity than ultrasound tophus. DECT, ultrasound double contour sign and ultrasound tophus all had greater specificity than ultrasound aggregates. The SUCRA scores ranked DECT as highest for overall accuracy, followed by ultrasound double contour, aggregates, and tophus, while ultrasound snowstorm was ranked the lowest. However, there were no significant differences in the odds ratios for overall accuracy between these imaging features. CONCLUSION DECT and ultrasound are both useful modalities for the detection of imaging features of MSU crystal deposition, and have a similar overall diagnostic accuracy for gout diagnoses.
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Affiliation(s)
- Sarah Stewart
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Isabel Su
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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14
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Wang Q, Bao H, Guo LH, Jin FS, Li XL, Yin HH, Yue WW, Zhu AQ, Wang LF, Sun LP, Xu HX. Quantitative assessment of crystal dissolution in gout during urate-lowering therapy with computer-aided MicroPure imaging: a cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1444. [PMID: 34733996 PMCID: PMC8506744 DOI: 10.21037/atm-21-4059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
Background To evaluate whether MicroPure imaging, an ultrasound (US) image-processing technique with computer-aided analysis, can quantitatively detect crystal dissolution during urate-lowering therapy (ULT) in gout. Methods This was a prospective study of gout patients requiring ULT. The first metatarsophalangeal joints were examined using US and MicroPure before and after 3 months of ULT. Elementary lesions of gout, including the double contour sign (DCS), aggregates, tophi, erosion, and other US features were recorded at baseline and 3 months. MicroPure imaging features were automatically calculated by a self-developed software. Patients were divided into goal-achieved and goal-not-achieved groups according to their urate levels at 3 months. The US and MicroPure imaging features of the two groups were analyzed at baseline and 3 months. Results A total of 55 consecutive patients were enrolled (25: goal-achieved group; 30: goal-not-achieved group). US findings demonstrated that the power Doppler signal grade decreased at 3 months, regardless of the group (both P<0.05). From baseline to 3 months, tophi size and the DCS reduced in the goal-achieved group (both P<0.05), while the US aggregate features showed no difference (P=0.250). However, on the MicroPure imaging, the number and density of aggregates at 3 months decreased in the goal-achieved group (both P<0.05). There were no significant changes at 3 months in any of the MicroPure imaging features in the goal-not-achieved group (all P>0.05). Conclusions In comparison with B-mode US, computer-aided MicroPure imaging can sensitively and quantitatively detect aggregate dissolution during effective ULT after only 3 months of treatment.
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Affiliation(s)
- Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Bao
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng-Shan Jin
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao-Hao Yin
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - An-Qi Zhu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Fan Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Medical Ultrasound & Tumor Minimally Invasive Treatment, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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15
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Gouty tophus erodes nasal bone. Clin Rheumatol 2021; 41:939-941. [PMID: 34599715 PMCID: PMC8873052 DOI: 10.1007/s10067-021-05897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
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16
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Christiansen SN, Filippou G, Scirè CA, Balint PV, Bruyn GA, Dalbeth N, Dejaco C, Sedie AD, Filippucci E, Hammer HB, Iagnocco A, Keen HI, Kissin EY, Koski J, Mandl P, Martin J, Miguel ED, Möller I, Naredo E, Pineda C, Schmidt WA, Stewart S, Antonietta D'Agostino M, Terslev L. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum 2021; 51:644-649. [PMID: 33468347 DOI: 10.1016/j.semarthrit.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.
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Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy; Rheumatology Unit, Luigi Sacco University Hospital of Milan, Milan, Italy
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Aw Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - Nicola Dalbeth
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria and Hospital of Brunico (SABES-ASDAA), Department of Rheumatology, Brunico, Italy
| | | | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, DSCB Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | | | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Julia Martin
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz and Universidad Autónoma de Madrid. Madrid, Spain
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Berlin, Germany
| | - Sarah Stewart
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Ambroise Pare´ Hospital, and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hammer HB, Karoliussen L, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann Rheum Dis 2020; 79:1500-1505. [PMID: 32669301 DOI: 10.1136/annrheumdis-2020-217392] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As ultrasound is sensitive for detecting crystal depositions in patients with gout, our objectives were to explore the main locations for depositions and the extent of dissolution of depositions during a treat-to-target approach with urate lowering treatment (ULT) in patients with gout. METHODS Patients with a recent flare of gout were consecutively included in this single-centre study and managed by a treat-to-target approach with ULT. All patients were assessed at baseline, 3, 6 and 12 months including bilateral ultrasound examinations of joints/tendons/entheses of hands, elbows, knees, ankles and feet. A new semiquantitative scoring system of 0-3 of elementary lesions (double contour (DC), tophi and aggregates) was applied to quantify the amount of depositions during the follow-up. RESULTS 209 of the patients were evaluated with ultrasound at baseline (mean (SD) age 56.4 (13.8) years and disease duration 7.9 (7.7) years, 95.2% men). The serum urate levels decreased from baseline to 12 months (mean (SD) 500 (77) to 312 (49) µmol/L) (p<0.001)). The first metatarsophalangeal joint was the most frequent location for all the elementary lesions and erosions were associated with higher levels of crystal depositions. From baseline to 12 months, mean sum scores decreased for DC (4.3 to 1.3), tophi (6.5 to 3.8) and aggregates (9.3 to 6.7) (p<0.001 for all), with DC being most sensitive to change. CONCLUSIONS The ultrasound scoring system for crystal depositions was sensitive to change and showed that a treat-to-target approach with ULT resulted in significant reductions of all the depositions, most extensively for DC.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway .,University of Oslo, Faculty of Medicine, Oslo, Norway
| | | | - Lene Terslev
- Department of Rheumatology, Glostrup University Hospital, Copenhagen, Denmark
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway.,University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway.,University of Oslo, Faculty of Medicine, Oslo, Norway
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18
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Lee YWM, Kok SXS, Wong LW, Wong BSS. Clinics in diagnostic imaging (200). Intra-articular chronic tophaceous gout of the knee. Singapore Med J 2019; 60:502-507. [PMID: 31663097 DOI: 10.11622/smedj.2019129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 39-year-old man presented with acute left knee pain and swelling. There was limitation of movement of the knee joint. His past medical history was significant for gout. Computed radiography showed bony erosions that were not typical of chronic tophaceous gout. Magnetic resonance (MR) imaging showed focal deposits within the knee joint, which demonstrated isointense signal to muscle on T1-weighted sequence and intermediate signal on proton density (PD) and PD fat-saturated sequences. There was extensive, similar signal abnormality in the cruciate ligaments, popliteus tendon and lateral meniscus. These findings were in keeping with an intra-articular manifestation of chronic tophaceous gout. The clinical presentation and imaging features are herein discussed, with an emphasis on MR imaging.
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Affiliation(s)
| | | | - Li Weng Wong
- Department of Radiology, Sengkang General Hospital, Singapore
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19
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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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20
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Impact of Dual-Energy CT Postprocessing Protocol for the Detection of Gouty Arthritis and Quantification of Tophi in Patients Presenting With Podagra: Comparison With Ultrasound. AJR Am J Roentgenol 2019; 213:1315-1323. [PMID: 31553656 DOI: 10.2214/ajr.19.21404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to compare ultrasound (US) tophus and monosodium urate (MSU) deposit detection and US tophus size in the metatarsophalangeal (MTP) 1 joint with dual-energy CT (DECT) using two DECT postprocessing protocols in patients presenting with podagra. SUBJECTS AND METHODS. Seventy-five consecutive patients with podagra (66 men and nine women; mean age, 65.6 years; age range, 33-88 years) and 75 control subjects with MTP 1 joint osteoarthritis (49 men and 26 women; mean age, 63.0 years; age range, 35-87 years) prospectively underwent US and DECT between 2016 and 2018 to assess the MTP 1 joint. Two Syngovia postprocessing DECT protocols with different minimum attenuation thresholds of 150 HU (DECT 150 protocol) versus 120 HU (DECT 120 protocol) and the same maximum attenuation threshold (500 HU) and constant kilovoltage setting of tubes A and B at 80 and 140 kVp were evaluated. Interobserver variability of the two DECT protocols was calculated and compared with that of US. RESULTS. The postprocessing DECT 150 protocol was positive for tophus detection in 55 of 75 patients (73.3%) with podagra, whereas the postprocessing DECT 120 protocol detected MSU deposits in all 75 patients (100%). Tophus size assessed using the DECT 120 protocol showed an improved correlation with tophus size detected on US (p < 0.01). Interobserver variability of DECT was improved when using the DECT 120 protocol (p < 0.01). CONCLUSION. The postprocessing DECT 120 protocol enables improved visualization of MSU deposits and provides more accurate information about tophus size that better correlates with tophus size on US compared with the standard postprocessing DECT 150 protocol.
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21
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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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22
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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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23
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Volland LM, Zhou JY, Barnes RFW, Kruse-Jarres R, Steiner B, Quon DV, Bailey C, Hughes TH, Moore RE, Chang EY, von Drygalski A. Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1569-1581. [PMID: 30371941 DOI: 10.1002/jum.14846] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. METHODS Thirty-one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra- and inter-rater reliability, 8 musculoskeletal US-experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty-three musculoskeletal US-inexperienced providers performed similar assessments. Inter-operator reliability was established by 6 musculoskeletal US-experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. RESULTS The musculoskeletal US-experienced providers showed excellent intra-and inter-rater reliability for tissue measurements (ICCs, 0.94-0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87-0.94). Inter-operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US-inexperienced providers showed excellent inter-rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). CONCLUSIONS The JADE protocol appears feasible for quantifying hemophilic intra-articular abnormalities. Musculoskeletal US-trained hemophilia providers showed high intra-rater, inter-rater, and inter-operator reliability, supporting JADE as a protocol for clinical management and research.
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Affiliation(s)
- Lena M Volland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Cindy Bailey
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Tudor H Hughes
- Department of Radiology, University of California, San Diego, California, USA
| | - Randy E Moore
- General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
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24
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Zhang Q, Gao F, Sun W, Ma J, Cheng L, Li Z. The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis. PLoS One 2018; 13:e0199672. [PMID: 29979706 PMCID: PMC6034830 DOI: 10.1371/journal.pone.0199672] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Musculoskeletal ultrasound is widely used in diagnosing gout, but its accuracy is debatable. We conducted a systematic review and meta-analysis to quantitatively evaluate the value of ultrasound in the diagnosis of gout. METHODS We systematically searched for publications using Cochrane Library, PubMed/Medline and Embase and manually screened the references of eligible articles for additional relevant publications. Studies were included in this systematic review if they assessed the diagnostic accuracy of ultrasound in gout compared to that of the gold standard, demonstration of monosodium urate crystals in joint fluid or tophi. We then conducted quantitative analyses by extracting data from each study and calculating the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). The summary receiver operating characteristic curves (sROCs) were constructed to obtain the Q*-index and the area under the curve (AUC). RESULTS Thirteen studies were included in this meta-analysis. The diagnostic performances of three distinctive ultrasonographic features of gout, double contour sign (DCS), the presence of tophi and the snowstorm sign, were evaluated. For person-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 66% (95% confidence interval (CI) 62%-69%), 92% (95% CI 90%-94%), 25.91 (95% CI 11.80-56.89), 0.8163 and 0.7503, respectively; for the presence of tophi, 56% (95% CI 52%-60%), 94% (95% CI 92%-96%), 21.11 (95% CI 7.84-56.89), 0.8928 and 0.8236, respectively; for the snowstorm sign, 31% (95% CI 27%-36%), 91% (95% CI 88%-93%), 4.54(95% CI 3.13-6.58), 0.5946 and 0.5712, respectively; and for simultaneous consideration of these ultrasonographic features, 80% (95% CI 76%-83%), 83% (95% CI 79%-86%), 19.03 (95% CI 13.97-25.93), 0.889 and 0.8197, respectively. For the joint-/location-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 75% (95% CI 68%-80%), 65% (95% CI 59%-70%), 16.90 (95% CI 5.10-56.03), 0.871 and 0.8014, respectively; and for the presence of tophi, 48% (95% CI 40%-57%), 96% (95% CI 91%-99%), 30.20 (95% CI 9.23-98.87), 0.8776 and 0.8081, respectively. CONCLUSIONS In this meta-analysis, relatively high specificity but modest or low sensitivity were demonstrated in the diagnosis of gout using each of the three ultrasonographic features for person-based evaluations. Simultaneous consideration of these ultrasound findings may improve the diagnostic sensitivity. However, the double contour sign alone is weak in the differentiation of gout and non-gout for joint-/location-based evaluations. Further well-designed studies are still needed to support the current findings.
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Affiliation(s)
- Qingyu Zhang
- Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Chaoyang District, Beijing, China
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Wei Sun
- Graduate School of Peking Union Medical, Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Jinhui Ma
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Liming Cheng
- Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Institute of Clinical Medicine, Beijing, China
| | - Zirong Li
- Graduate School of Peking Union Medical, Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China
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25
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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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26
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Ultrasound scans and dual energy CT identify tendons as preferred anatomical location of MSU crystal depositions in gouty joints. Rheumatol Int 2018; 38:801-811. [PMID: 29442150 DOI: 10.1007/s00296-018-3994-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The present study was performed to localize the articular deposition of monosodium urate (MSU) crystal in joints. We compare the detection efficiencies of dual-energy CT (DECT) and ultrasound scans. METHODS Analyses by DECT and ultrasound were performed with 184 bilateral joints of the lower limbs of 54 consecutive gout patients. All joints were categorized into (1) knee, (2) ankle, (3) MTP1, and (4) MTP2, and sorted into those with and those without detectable MSU deposition. The comparison of the positive rate between DECT and ultrasound and the agreement was performed using the McNemar test and the Cohen's κ coefficient, respectively. Next, we listed the MSU crystal deposition as assessed by ultrasound between the DECT-positive and -negative joints according to their interior structure. We included tendons, synovia, cartilage, subcutaneous tissue, etc. RESULTS: Among all joints, the percentages with MSU crystal deposition detected by DECT (99/184, 53.8%) and ultrasound (106/184, 57.6%) were comparable (P = 0.530 > 0.05). For MTP1 (21/34, 61.8%; 12/34, 35.3%; P < 0.05) and MTP2-5 (17/34, 50.0%; 10/34, 29.4%, P < 0.05), ultrasound and DECT were more efficient, respectively. The data concordance in 46 of 50 joints (92.00%; κ = 0.769, P < 0.05) for knee; and 27 of 34 joints (79.41%; κ = 0.588, P < 0.05) for MTP2-5 and suggested that tendons were the most frequent anatomical location of MSU crystal deposition. CONCLUSIONS The tendons are the most frequent anatomical location of MSU crystal depositions. The concordance rate of knee joints and MTP2-5 joints shows good agreement between DECT and ultrasound depending on the location.
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Ramon A, Bohm-Sigrand A, Pottecher P, Richette P, Maillefert JF, Devilliers H, Ornetti P. Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature. Clin Rheumatol 2018; 37:587-595. [PMID: 29350330 DOI: 10.1007/s10067-017-3976-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/27/2022]
Abstract
The aim of this systematic review was to determine the potential role of dual-energy CT in the diagnosis and follow-up of gout with regard to the Outcome Measures in Rheumatology (OMERACT) filter. A systematic analysis of the literature was conducted using the MEDLINE and Cochrane databases and published abstracts of international congresses, according to the criteria of the OMERACT filter: feasibility, reproducibility, validity versus laboratory (serum urate, MSU synovial fluid aspirate) and other imaging modalities for gout, and its sensitivity to change in patients on urate lowering therapy (ULT). Thirty-two articles were found representing a total of 1502 patients. The data on feasibility showed that the examination took little time and involved low levels of radiation but had current limited availability. Intra- and inter-observer reproducibility was excellent, with intra-class correlation coefficients > 0.9. Validity in comparison with polarized-light microscopy showed good sensitivity and specificity (> 80%). The diagnostic performance was better than that of radiography and conventional CT-scan and at least equivalent to that of ultrasonography. The sensitivity to change varied with effect sizes from 0.05 (low) to 1.24 (high) for decrease in the tophus volume following different ULT in gout patients. Dual-energy CT-scan is a reproducible and accurate imaging modality for the diagnosis of gout, particularly for tophaceous gout (intra- or extra-articular). It can become a second-line imaging modality of choice in cases of diagnostic doubt, such as ultrasonography. Its role remains uncertain in the follow-up of gout patients treated with ULT and needs further clarification.
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Affiliation(s)
- André Ramon
- Department of Rheumatology, Dijon University Hospital, 14 rue Gaffarel, 21000, Dijon, France
| | - Amélie Bohm-Sigrand
- Department of Rheumatology, Dijon University Hospital, 14 rue Gaffarel, 21000, Dijon, France
| | - Pierre Pottecher
- Department of Radiology, Section of Musculoskeletal Imaging and Intervention, Dijon University Hospital, Dijon, France
- LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon, France
| | - Pascal Richette
- INSERM U1132 and University Paris-Diderot, Paris, France
- Department of Rheumatology, Hopital Lariboisiere, Paris, France
| | - Jean-Francis Maillefert
- Department of Rheumatology, Dijon University Hospital, 14 rue Gaffarel, 21000, Dijon, France
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Herve Devilliers
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
- CIC INSERM 1432, Centre Hospitalier Universitaire de Dijon, F-21000, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon University Hospital, 14 rue Gaffarel, 21000, Dijon, France.
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France.
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Lee YH. Overview of the Process of Conducting Meta-analyses of the Diagnostic Test Accuracy. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Young Ho Lee
- Department of Rheumatology, Korea University College of Medicine, Seoul, Korea
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Garcia Ferrer HR, Azan A, Iraheta I, Von Feldt J, Espinoza LR, Manasson J, Scher JU, Garcia Kutzbach A, Ogdie A. Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up. Clin Rheumatol 2017; 37:415-422. [PMID: 29139030 DOI: 10.1007/s10067-017-3911-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
Abstract
The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3-6 months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2 years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2 years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2 years in nearly half of the patients.
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Affiliation(s)
- Helga Raquel Garcia Ferrer
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Alexander Azan
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isa Iraheta
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
| | - Joan Von Feldt
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Julia Manasson
- New York University School of Medicine, New York, NY, USA
| | - Jose U Scher
- New York University School of Medicine, New York, NY, USA
| | - Abraham Garcia Kutzbach
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Lee YH, Song GG. Diagnostic accuracy of ultrasound in patients with gout: A meta-analysis. Semin Arthritis Rheum 2017; 47:703-709. [PMID: 29054295 DOI: 10.1016/j.semarthrit.2017.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/16/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic performance of ultrasound (US) for patients with gout. METHODS We searched the Medline, Embase, Pubmed, and Cochrane Library databases, and performed a meta-analysis of the diagnostic accuracy of US according to the double contour sign, tophus, snowstorm, or bony erosion in patients with gout. RESULTS In total, 11 studies including 938 patients with gout, and 788 controls (patients with nongout inflammatory arthritis) were available for the meta-analysis. The pooled sensitivity and specificity of US were 65.1% ([95% confidence interval (CI): 62.0-68.2] and 89.0% (96.6-91.1), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 5.889 (3.365-10.30), 0.359 (0.266-0.485), and 17.61 (11.11-17.92), respectively. The area under the curve of US was 0.858 and the Q⁎ index was 0.789, indicating good diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses. Meta-regression showed that the sample size, study design, and diagnostic criteria were not sources of heterogeneity, and subgroup meta-analyses did not change the overall diagnostic accuracy. US signs of tophus, snowstorm, or bony erosion besides the double contour sign were not sensitive (54.3%, 30.8%, and 51.6%), but specific (93.2%, 90.6%, and 93.3%) enough as a diagnostic tool. CONCLUSIONS Our meta-analysis of published studies demonstrates that US offers good diagnostic accuracy with high specificity and can play an important role in the diagnosis of gout.
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Affiliation(s)
- Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical Center, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea.
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical Center, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
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Pascart T, Grandjean A, Norberciak L, Ducoulombier V, Motte M, Luraschi H, Vandecandelaere M, Godart C, Houvenagel E, Namane N, Budzik JF. Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study. Arthritis Res Ther 2017; 19:171. [PMID: 28732526 PMCID: PMC5521183 DOI: 10.1186/s13075-017-1381-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background Ultrasonography (US) and dual-energy computed tomography (DECT) can assess urate burden in gout. The objective of this study was to compare the quantification of urate deposition provided by US to the one provided by DECT. Methods Patients with a diagnosis of gout were prospectively recruited to undergo quantification of urate deposition using US and DECT. US examination for tophi and the double contour (DC) sign was performed on the knees and feet and corresponding DECT scans provided volumes of tophi and of overall urate deposition. The primary endpoint was the intra-class correlation coefficient (ICC) of the volume of the index tophus measured by US and DECT and its 95% confidence interval (CI 95%). Results Of the 64 patients included, 34 presented with at least one tophus on US. DECT inter-reader agreement for urate deposition was perfect with an ICC of 1 (1–1) and good for the measurement of the index tophus with an ICC of 0.69 (0.47–0.83). The ICC for the measurement of the index tophus between the two techniques was poor with a value of 0.45 (0.1–0.71). The average ratio between the index tophi volume as assessed by DECT and US was 0.65. The number of DC-positive joints did not correlate with DECT volume of overall deposits (Spearman correlation coefficient of 0.23). Conclusions DECT measurements of tophi give smaller volumes to the same tophi measured with US, and US signs of urate deposition in joints do not correlate with overall DECT volumes of extra-articular deposition. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1381-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France. .,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France. .,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France.
| | - Agathe Grandjean
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Marguerite Motte
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Marie Vandecandelaere
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Catherine Godart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Nasser Namane
- Department of Radiology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Jean-François Budzik
- Department of Radiology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France.,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France
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Ogdie A, Taylor WJ, Neogi T, Fransen J, Jansen TL, Schumacher HR, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Cagnotto G, Cavagna L, Lin C, Chou YY, Tausche AK, Lima Gomes Ochtrop M, Janssen M, Chen JH, Slot O, Lazovskis J, White D, Cimmino MA, Uhlig T, Dalbeth N. Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard. Arthritis Rheumatol 2017; 69:429-438. [PMID: 27748084 DOI: 10.1002/art.39959] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.
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Affiliation(s)
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Jaap Fransen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
| | - Geraldine McCarthy
- University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, BioCruces Health Research Institute, and Basque Country University, Barakaldo, Spain
| | | | - Hang-Korng Ea
- Université Paris Diderot, INSERM UMR 1132 and Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France
| | | | - Giovanni Cagnotto
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy, and Skane University Hospital Malmö/Lund, Lund, Sweden
| | - Lorenzo Cavagna
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | - Yin-Yi Chou
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | | | | | | | - Jiunn-Horng Chen
- China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | - Douglas White
- Waikato District Health Board and Waikato Clinical School, Hamilton, New Zealand
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Norkuviene E, Petraitis M, Apanaviciene I, Virviciute D, Baranauskaite A. An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study. J Int Med Res 2017; 45:1417-1429. [PMID: 28617199 PMCID: PMC5625526 DOI: 10.1177/0300060517706800] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To identify the optimal sites for classification of early gout by ultrasonography. Methods Sixty patients with monosodium urate crystal-proven gout (25 with early gout [≤2-year symptom duration], 35 with late gout [>2-year symptom duration], and 36 normouricemic healthy controls) from one centre were prospectively evaluated. Standardized blinded ultrasound examination of 36 joints and the triceps and patellar tendons was performed to identify tophi and the double contour (DC) sign. Results Ultrasonographic sensitivity was lower in early than late gout. Binary logistic regression analysis showed that two ultrasonographic signs (tophi in the first metatarsophalangeal joint [odds ratio, 16.46] and the DC sign in the ankle [odds ratio, 25.18]) significantly contributed to the final model for early gout diagnosis (sensitivity and specificity of 84% and 81%, respectively). The inter-reader reliability kappa value for the DC sign and tophi was 0.712. Conclusions Four-joint investigation (both first metatarsophalangeal joints for tophi and both ankles for the DC sign) is feasible and reliable and could be proposed as a screening test for early ultrasonographic gout classification in daily practice.
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Affiliation(s)
- Eleonora Norkuviene
- 1 Rheumatology Department, Medical academy Lithuanian University of Health Sciences, Mickeviciaus, Kaunas, Lithuania
| | - Mykolas Petraitis
- 1 Rheumatology Department, Medical academy Lithuanian University of Health Sciences, Mickeviciaus, Kaunas, Lithuania.,2 Rheumatology Department, Hospital of Lithuanian University of Health Sciences Kauno Clinic's, Eiveniu, Kaunas, Lithuania
| | - Indre Apanaviciene
- 1 Rheumatology Department, Medical academy Lithuanian University of Health Sciences, Mickeviciaus, Kaunas, Lithuania
| | - Dalia Virviciute
- 3 Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu pr, Kaunas, Lithuania
| | - Asta Baranauskaite
- 1 Rheumatology Department, Medical academy Lithuanian University of Health Sciences, Mickeviciaus, Kaunas, Lithuania
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Stewart S, Dalbeth N, Vandal AC, Allen B, Miranda R, Rome K. Ultrasound Features of the First Metatarsophalangeal Joint in Gout and Asymptomatic Hyperuricemia: Comparison With Normouricemic Individuals. Arthritis Care Res (Hoboken) 2017; 69:875-883. [PMID: 27635596 DOI: 10.1002/acr.23082] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/19/2016] [Accepted: 09/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The first metatarsophalangeal (MTP1) joint is frequently affected in gout. The aim of this study was to identify ultrasound features of the MTP1 joint in people with gout and people with asymptomatic hyperuricemia compared with normouricemic controls. METHODS Participants with gout (n = 23) and asymptomatic hyperuricemia (n = 29), and age- and sex-matched normouricemic control participants (n = 34), underwent a gray-scale and power Doppler ultrasound assessment of bilateral MTP1 joints by a single musculoskeletal radiologist. No participants had clinical evidence of joint inflammation at the time of scanning. The static images were later read by 2 musculoskeletal radiologists for the presence of the double contour sign, tophus, erosion, effusion, synovial hypertrophy, synovitis, and cartilage thickness. RESULTS Compared to normouricemic control participants, participants with gout and participants with asymptomatic hyperuricemia had more frequent double contour sign (odds ratio [OR] 3.91, P = 0.011 and OR 3.81, P = 0.009, respectively). Participants with gout also had more erosion (OR 10.13, P = 0.001) and synovitis (OR 9.00, P < 0.001) and had greater tophus and erosion diameters (P = 0.035 and P < 0.001, respectively). More severe erosion and synovitis grades and a less severe effusion grade were independently associated with gout compared with asymptomatic hyperuricemia (R2 = 0.65, P < 0.001). CONCLUSION Urate deposition, synovitis, and bone erosion are common at the MTP1 joint in people with gout, even in the absence of flare. Although individuals with asymptomatic hyperuricemia lack ultrasound features of inflammation or structural joint changes, they demonstrate a similar frequency of urate deposition.
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Affiliation(s)
- Sarah Stewart
- Auckland University of Technology, Auckland, New Zealand
| | - Nicola Dalbeth
- The University of Auckland and Auckland District Health Board, Auckland, New Zealand
| | - Alain C Vandal
- Auckland University of Technology and Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | - Bruce Allen
- Auckland University of Technology, Auckland, New Zealand
| | - Rhian Miranda
- Auckland District Health Board, Auckland, New Zealand
| | - Keith Rome
- Auckland University of Technology, Auckland, New Zealand
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Uhlig T, Eskild T, Hammer HB. [Gout - new approaches to diagnostics and treatment]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1804-1807. [PMID: 27883103 DOI: 10.4045/tidsskr.16.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
An attack of gout is extremely painful. Recurrent attacks of arthritis in one or more joints or tendon sheaths accompanied by intense pain are typical of this commonly occurring condition. As these symptoms indicate acute inflammation due to uric acid crystal deposition, good diagnostics are essential to enable initiation of drug treatment which removes the crystals deposited in tissue.
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Affiliation(s)
- Till Uhlig
- Nasjonal kompetansetjeneste for revmatologisk rehabilitering Revmatologisk avdeling Diakonhjemmet Sykehus
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Kissin EY, Pillinger MH. Editorial: The Sound and the Fury: Musculoskeletal Ultrasound in the Diagnosis of Gout. Arthritis Rheumatol 2016; 69:249-252. [PMID: 27748075 DOI: 10.1002/art.39958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/11/2016] [Indexed: 12/26/2022]
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Ventura-Ríos L, Sánchez-Bringas G, Pineda C, Hernández-Díaz C, Reginato A, Alva M, Audisio M, Bertoli A, Cazenave T, Gutiérrez M, Mora C, Py G, Sedano O, Solano C, de Miguel E. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 2016; 35:2039-2044. [DOI: 10.1007/s10067-016-3309-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 12/27/2022]
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Terslev L, Gutierrez M, Schmidt WA, Keen HI, Filippucci E, Kane D, Thiele R, Kaeley G, Balint P, Mandl P, Delle Sedie A, Hammer HB, Christensen R, Möller I, Pineda C, Kissin E, Bruyn GA, Iagnocco A, Naredo E, D'Agostino MA. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group. J Rheumatol 2015; 42:2177-81. [PMID: 26329333 DOI: 10.3899/jrheum.141294] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool in gout, a series of iterative exercises were carried out to obtain consensus-based definitions on US elementary components in gout using a Delphi exercise and subsequently testing these definitions in static images and in patients with proven gout. Cohen's κ was used to test agreement, and values of 0-0.20 were considered poor, 0.20-0.40 fair, 0.40-0.60 moderate, 0.60-0.80 good, and 0.80-1 excellent. RESULTS With an agreement of > 80%, consensus-based definitions were obtained for the 4 elementary lesions highlighted in the literature review: tophi, aggregates, erosions, and double contour (DC). In static images interobserver reliability ranged from moderate to almost perfect, and similar results were found for the intrareader reliability. In patients the intraobserver agreement was good for all lesions except DC (moderate). The interobserver agreement was poor for aggregates and DC but moderate for the other components. CONCLUSION These first steps in evaluating the validity of US as an outcome measure for gout show that the reliability of the definitions ranged from moderate to excellent in static images and somewhat lower in patients, indicating that a standardized scanning technique may be needed, before testing the responsiveness of those definitions in a composite US score.
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Bruyn GA, Naredo E, Iagnocco A, Balint PV, Backhaus M, Gandjbakhch F, Gutierrez M, Filer A, Finzel S, Ikeda K, Kaeley GS, Manzoni SM, Ohrndorf S, Pineda C, Richards B, Roth J, Schmidt WA, Terslev L, D'Agostino MA. The OMERACT Ultrasound Working Group 10 Years On: Update at OMERACT 12. J Rheumatol 2015; 42:2172-6. [PMID: 25774059 DOI: 10.3899/jrheum.141462] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Musculoskeletal ultrasound (US) now thrives as an established imaging modality for the investigation and management of chronic inflammatory arthritis. We summarize here results of the Outcome Measures in Rheumatology (OMERACT) US working group (WG) projects of the last 2 years. These results were reported at the OMERACT 12 meeting at the plenary session and discussed during breakout sessions. Topics included standardization of US use in rheumatic disease over the last decade and its contribution to understanding musculoskeletal diseases. This is the first update report of WG activities in validating US as an outcome measure in musculoskeletal inflammatory and degenerative diseases, including pediatric arthritis, since the OMERACT 11 meeting.
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