Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

10.21203/rs.3.rs-16419/v1 ◽

2020 ◽

Author(s):

Ling Cao ◽

Tianyi Zhao ◽

Chunmei Xie ◽

Shucong Zheng ◽

Weiguo Wan ◽

...

Keyword(s):

Risk Factors ◽

Bone Erosion ◽

Gouty Arthritis ◽

Objective Evaluation ◽

Monosodium Urate ◽

Crystal Deposition ◽

Lowering Therapy ◽

History Of ◽

Msu Crystals ◽

Double Contour

Abstract Objective Evaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. Methods Total 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasounic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared inceasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Conclusion HAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi.

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Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

10.21203/rs.3.rs-108529/v1 ◽

2020 ◽

Author(s):

Ling Cao ◽

Tianyi Zhao ◽

Xiaoxia Zhu ◽

Chunmei Xie ◽

Shucong Zheng ◽

...

Keyword(s):

Risk Factors ◽

Clinical Evaluation ◽

Bone Erosion ◽

Gouty Arthritis ◽

Monosodium Urate ◽

Crystal Deposition ◽

Lowering Therapy ◽

History Of ◽

Msu Crystals ◽

Double Contour

Abstract BackgroundEvaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. MethodsTotal 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasunic assessment results were collected and statistically analyzed. ResultsDeposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared increasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of gout patients and 4.65% (2/43) of hyperuricemia patients, indicating nephrolithiasis occurred in more gout patients than in hyperuricemia patients.ConclusionHAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi. And nephrolithiasis was remarkably relevant to MSU crystal deposition in joints in gout patients.

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Gout of feet and ankles in different disease durations: diagnostic value of single-source DECT and evaluation of urate deposition with a novel semi-quantitative DECT scoring system

Advances in Rheumatology ◽

10.1186/s42358-021-00194-4 ◽

2021 ◽

Vol 61 (1) ◽

Author(s):

Jin Shang ◽

Xiao-Hu Li ◽

Shu-Qin Lu ◽

Yi Shang ◽

Lu-Lu Li ◽

...

Keyword(s):

Scoring System ◽

Diagnostic Performance ◽

Disease Duration ◽

Bone Erosion ◽

Early Stage ◽

Gouty Arthritis ◽

Single Source ◽

Crystal Deposition ◽

Urate Crystal ◽

Sensitivity Specificity

Abstract Objectives To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system. Methods A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1–3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined. Results The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups. Conclusion DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.

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Crystal-Induced Joint Disease

10.2310/im.1213 ◽

2019 ◽

Author(s):

N Lawrence Edwards

Keyword(s):

Inflammatory Arthritis ◽

Gouty Arthritis ◽

Clinical Manifestations ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Monosodium Urate ◽

Crystal Deposition ◽

Acute Gouty Arthritis ◽

Crystal Arthritis ◽

Pyrophosphate Dihydrate

The destructive potential of intracellular crystals has been recognized for over a century. The mechanisms by which crystals induce inflammation and bone and cartilage destruction have been elucidated over the past decade. The three most common crystal-induced arthropathies are caused by precipitation of monosodium urate monohydrate, calcium pyrophosphate dihydrate (CPP) and basic calcium phosphate. The definition, epidemiology, pathogenesis and etiology, diagnosis, and treatment of gout and CPP crystal deposition are reviewed, as well as the clinical stages of gout (i.e., acute gouty arthritis, intercritical gout, advanced gout, nonclassic presentations of gout, and other conditions associated with gout). Also reviewed are the clinical manifestations of calcium pyrophosphate dihydrate deposition disease (CPPD), such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, and chronic CPP crystal inflammatory arthritis. Figures illustrate renal transport of urate, monosodium urate crystals, acute gouty flare, advanced gouty arthritis, gouty synovial fluid, radiographic changes of advanced gout, ultrasound appearance of the femoral intercondylar cartilage, pharmacologic management of gout, the effect of gender and age on knee chondrocalcinosis, radiographs of chondrocalcinosis, and compensated polarized microscopy of CPPD. Tables present the major factors responsible for hyperuricemia, characteristics of classic gouty flares, antiinflammatory therapy for gout, and urate-lowering therapy. This chapter contains 90 references. This review contains 11 figures, 12 tables, and 88 references. Keywords: acute gouty arthritis, intercritical gout, advanced gout, asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis

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Crystal-Induced Joint Disease

10.2310/fm.1213 ◽

2019 ◽

Author(s):

N Lawrence Edwards

Keyword(s):

Inflammatory Arthritis ◽

Gouty Arthritis ◽

Clinical Manifestations ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Monosodium Urate ◽

Crystal Deposition ◽

Acute Gouty Arthritis ◽

Crystal Arthritis ◽

Pyrophosphate Dihydrate

The destructive potential of intracellular crystals has been recognized for over a century. The mechanisms by which crystals induce inflammation and bone and cartilage destruction have been elucidated over the past decade. The three most common crystal-induced arthropathies are caused by precipitation of monosodium urate monohydrate, calcium pyrophosphate dihydrate (CPP) and basic calcium phosphate. The definition, epidemiology, pathogenesis and etiology, diagnosis, and treatment of gout and CPP crystal deposition are reviewed, as well as the clinical stages of gout (i.e., acute gouty arthritis, intercritical gout, advanced gout, nonclassic presentations of gout, and other conditions associated with gout). Also reviewed are the clinical manifestations of calcium pyrophosphate dihydrate deposition disease (CPPD), such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, and chronic CPP crystal inflammatory arthritis. Figures illustrate renal transport of urate, monosodium urate crystals, acute gouty flare, advanced gouty arthritis, gouty synovial fluid, radiographic changes of advanced gout, ultrasound appearance of the femoral intercondylar cartilage, pharmacologic management of gout, the effect of gender and age on knee chondrocalcinosis, radiographs of chondrocalcinosis, and compensated polarized microscopy of CPPD. Tables present the major factors responsible for hyperuricemia, characteristics of classic gouty flares, antiinflammatory therapy for gout, and urate-lowering therapy. This chapter contains 90 references. This review contains 11 figures, 12 tables, and 88 references. Keywords: acute gouty arthritis, intercritical gout, advanced gout, asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis

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Association of Specific Comorbidities with Monosodium Urate Crystal Deposition in Urate-Lowering Therapy-Naive Gout Patients: A Cross-Sectional Dual-Energy Computed Tomography Study

Journal of Clinical Medicine ◽

10.3390/jcm9051295 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1295

Author(s):

Tristan Pascart ◽

André Ramon ◽

Sébastien Ottaviani ◽

Julie Legrand ◽

Vincent Ducoulombier ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Computed Tomography ◽

Chronic Heart Failure ◽

Dual Energy ◽

Bivariate Analysis ◽

Monosodium Urate ◽

Cross Sectional ◽

Crystal Deposition ◽

Lowering Therapy

(1) Background: To determine which factors are associated with the volume of monosodium urate (MSU) crystal deposition quantified by dual-energy computed tomography (DECT) in urate-lowering therapy (ULT)-naive gout patients. (2) Methods: In this multicenter cross-sectional study, DECT scans of knees and feet/ankles were prospectively obtained from ULT-naive gout patients. Demographic, clinical (including gout history and comorbidities), and biological data were collected, and their association with DECT MSU crystal volume was analyzed using bivariate and multivariate analyses. A second bivariate analysis was performed by splitting the dataset depending on an arbitrary threshold of DECT MSU volume (1 cm3). (3) Results: A total of 91 patients were included. In the bivariate analysis, age (p = 0.03), gout duration (p = 0.003), subcutaneous tophi (p = 0.004), hypertension (p = 0.02), diabetes mellitus (p = 0.05), and chronic heart failure (p = 0.03) were associated with the total DECT volume of MSU crystal deposition. In the multivariate analysis, factors associated with DECT MSU volumes ≥1 cm3 were gout duration (odds ratio (OR) for each 10-year increase 3.15 (1.60; 7.63)), diabetes mellitus (OR 4.75 (1.58; 15.63)), and chronic heart failure (OR 7.82 (2.29; 31.38)). (4) Conclusion: Specific comorbidities, particularly chronic heart failure and diabetes mellitus, are more strongly associated with increased MSU crystal deposition in knees and feet/ankles than gout duration, regardless of serum urate level.

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Images in clinical medicine: gouty arthritis with osteomyelitis

Italian Journal of Medicine ◽

10.4081/itjm.2018.1047 ◽

2018 ◽

Vol 12 (4) ◽

pp. 270-272 ◽

Cited By ~ 1

Author(s):

Rosa Scipioni ◽

Luciano Frate ◽

Valentino Di Tomasso ◽

Michele Saltarelli ◽

Francesco Carubbi ◽

...

Keyword(s):

Clinical Medicine ◽

Gouty Arthritis ◽

Monosodium Urate ◽

Joint Function ◽

Tophaceous Gout ◽

Function Impairment ◽

History Of ◽

Acute Attacks ◽

Gout Tophi ◽

Urate Crystals

Gout is one of the most common inflammatory arthropathies, characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues and leading to inflammation. The natural history of articular gout is typically composed of four periods: asymptomatic hyperuricemia, episodes of acute attacks of gout (acute gouty arthritis) with asymptomatic intervals (intercritical gout), and chronic tophaceous gout. Tophi develop in 12-35% of gouty patients without adequate control of uricemia. Initially, they do not cause significant complaints or function limitation of the nearby joints. However, if they become larger, joint instability and movement range limitation, joint function impairment and bone erosions and infection at the sites of their penetration can develop.We report a case of a poorly controlled polyarticular tophaceous gout complicated by osteomyelitis.

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OP0175 IDENTIFYING PERIPHERAL VASCULAR MONOSODIUM URATE CRYSTAL DEPOSITION WITH DUAL-ENERGY CT: FACT OR FICTION? THE VASCURATE STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4522 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 109.2-109

Author(s):

T. Pascart ◽

P. Carpentier ◽

L. Norberciak ◽

J. Legrand ◽

E. Houvenagel ◽

...

Keyword(s):

Computed Tomography ◽

Longitudinal Study ◽

Soft Tissues ◽

Dual Energy ◽

Monosodium Urate ◽

Peripheral Vascular ◽

Crystal Deposition ◽

Lowering Therapy ◽

Crystal Volume

Background:The close relationship between gout and cardiovascular diseases is well established. A growing hypothesis explaining this association would be that monosodium urate (MSU) crystals are deposited within vessel walls. Dual-energy computed tomography (DECT) can identify and quantify MSU crystal deposition in soft tissues. It remains unclear whether vascular spots exhibiting DECT attenuation characteristics of MSU are artefacts or true MSU crystal deposits.Objectives:The objectives of this study were to determine whether the presence of peripheral vascular MSU crystal deposition identified with DECT is associated with the extent of MSU deposits in joint soft tissues, and if this association persists over time under urate-lowering therapy.Methods:Patients with a clinical suspicion or established gout diagnosis prospectively underwent DECT for identification and quantification of the MSU crystal burden in their knees and feet. Some of these patients were also enrolled in the GOUT-DECTUS longitudinal study, and thus underwent follow-up DECT scans of their knees and feet at 6, 12 and 24 months. DECT scans were examined for the presence of vascular spots ≥0.01 cm3 classified as MSU crystal deposits according to the default post-processing settings. Multiple linear regressions adjusting on serum urate levels and gout diagnosis were implemented to determine the association between DECT MSU crystal volume in joint soft tissues, and the presence of vascular MSU deposits. Mixed linear models were used to compare DECT volumes of MSU crystal deposition in soft tissues between vascular MSU positive and negative patients during follow-up.Results:A total of 169 patients were included, of which 140 had a final diagnosis of gout, including 15 also included in the longitudinal study. Patients were mostly male (78.8%) and were 65.5 ± 14.6 years old. Among gout patients, disease duration was 9.3 ± 9.9 years and 56.5% were urate lowering therapy-naive. A total of 11/29 (37.9%) controls and 40/140 (28.6%) gout patients presented with a least one vascular spot of DECT MSU deposition, with an average volume of 0.02 ± 0.02 cm3, and all subjects also presented at least one vascular calcification. In the feet, patients positive for vascular DECT MSU crystal deposition had an MSU volume of 3.81 ± 10.06 cm3 in joint soft tissues, compared with 1.85 ± 7.72 cm3 for those without vascular MSU deposition (p=0.018). In the knees, patients with vascular MSU deposition had an MSU crystal volume of 6.03 ± 24.13 cm3 in joint soft tissues, compared with 0.83 ± 2.88 cm3 for those without vascular evidence of MSU deposition. In the longitudinal subgroup analysis, coefficients of the fixed effects for the presence of vascular MSU deposits on the MSU crystal volume in joint soft tissues was 0.4 (p=0.35) in the feet and 1.21 (p=0.03) in the knees. The presence of vascular DECT MSU deposits was associated with a 3.4-fold increase in MSU crystal volume in knee joint soft tissues throughout follow-up.Conclusion:This study suggests that some vascular spots identified with DECT as MSU crystal deposition may be real and not artefacts. This correlation remains throughout follow-up in the knees. However, the comparable prevalence of vascular DECT MSU deposits between gout patients and controls, the systematic co-existence of vascular calcifications and the uneven regression under urate-lowering therapy requires further analysis to determine which DECT spots are artefacts and which are not.References:[1]Dual-Energy Computed Tomography Detection of Cardiovascular Monosodium Urate Deposits in Patients With Gout. Klauser AS, Halpern EJ, Strobl S, Gruber J, Feuchtner G, Bellmann-Weiler R, Weiss G, Stofferin H, Jaschke W.Disclosure of Interests:Tristan Pascart Grant/research support from: Research Grant Horizon Pharma, Consultant of: Novartis, BMS, Sanofi, Pfizer,, Speakers bureau: Novartis, BMS, Paul Carpentier: None declared, Laurène Norberciak: None declared, Julie Legrand: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Fabio Becce: None declared, Jean-François Budzik: None declared

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High-resolution ultrasound evaluation in the follow-up of treat to target urate-lowering therapy in gout: an observational study

10.21203/rs.3.rs-41654/v1 ◽

2020 ◽

Author(s):

Weijing Zhang ◽

Di Zhao ◽

Min Wu ◽

Zhibin Jin ◽

Huayong Zhang

Keyword(s):

Bone Erosion ◽

Joint Damage ◽

Bone Destruction ◽

Treat To Target ◽

Short Axis ◽

Crystal Deposition ◽

Lowering Therapy ◽

Ultrasound Evaluation ◽

Significant Difference

Abstract Background: The monitoring of treat-to-target (T2T) urate-lowering therapy (ULT) for gout is crucial for the assessing treatment response. However, evidence is lacking about clinical remission on ultrasound (US). The aim of this study was to observe the changes in three outcome domains (urate deposition, joint inflammation and bone erosion) in patients with ULT within 1 year, evaluate the effect of target treatment and analyse the relationships between clinical factors and US features. Methods: The elementary lesions of the bilateral knee, ankle and first metatarsophalangeal joints were evaluated by US before and after 3,6 and 12months of treatment. Urate deposition was assessed by the maximum long and short axis diameters of the tophi and dichotomous data of the double-contour (DC) sign and aggregates. After each follow-up, the most obvious lesions were selected for repeated observation. The effective clearance rates of these three signs in different time groups were compared. A Global OMERACT–EULAR Synovitis Score (GLOESS) was calculated for these three paired joints to observe the remission and recurrence of inflammation. Bone destruction was scored at each time point. The correlation between serum uric acid (sUA) levels and tophi size changes was analysed. Results: This cohort contained 79 patients. The long and short axis diameters of tophi showed a different descending tendency. The decrease of sUA levels correlated with the decrease of long axis values, but not with the short. For tophi, there was no significant difference in the clearance rate between different time groups, while for DC sign and aggregates, significant differences were found by paired comparison. The GLOESS was significantly lower after 6 months of therapy. Bone erosion had not been improved after 1 year of ULT.Conclusion: The decrease in sUA levels was not completely parallel to the decrease in tophi size. ULT with different intensities should be formulated according to different crystal deposition conditions under US assessment. Subclinical inflammation was gradually controlled after 6 months of therapy and can be sensitively observed by US. Joint damage was relatively stable within 12 months of ULT.

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Introduction to gout

10.1093/med/9780198748311.003.0001 ◽

2016 ◽

Author(s):

Nicola Dalbeth

Keyword(s):

Inflammatory Arthritis ◽

Scientific Literature ◽

Gouty Arthritis ◽

Joint Damage ◽

Monosodium Urate ◽

Crystal Deposition ◽

Treatment Targets ◽

Urate Crystal ◽

Practical Information ◽

Low Levels

Gout is a chronic condition of monosodium urate crystal deposition. It is the most common form of inflammatory arthritis in adults, and leads to recurrent flares of severe joint damage and musculoskeletal disability. Although treatment targets are well defined, gout management is currently poor, with low levels of treatment targets achieved. The last decade has seen major advances in the understanding and treatment of gout. This handbook summarizes key scientific advances, including new insights into mechanisms of hyperuricaemia, acute gouty arthritis, and joint damage. Principles of gout diagnosis and management are discussed in detail, with practical information about use of well-established agents and also newer therapies. Gout-specific research tools are outlined to assist clinicians with interpretation of the latest scientific literature in gout. Future strategies for improved gout management are also discussed.

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