Asymptomatic Hyperuricemia: Impact of Ultrasonography

Abstract

Thirty-five patients (23 males) with asymptomatic hyperuricemia for at least two years underwent two-dimensional ultrasonography of knees and ankles. Urate deposits (tophi) in tendons, synovium, and other soft tissues were detected in 12 patients (34%). Increased vascularity (inflammation) was evident in 8 of these patients (23%). Tophi were more frequently found in knees than in ankles and were especially prevalent in the distal patellar tendon. The presence of tophi was unrelated to the known duration of hyperuricemia (mean, 5 years). Ultrasonography allows detection of tophi and inflammation in a third and in a fourth, respectively, of asymptomatic hyperuricemic patients.

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

“…In comparison to DECT, US appears to be more feasible because it is patient-friendly, safe and non-invasive, free of ionizing radiation, allows multiple target assessment in real time, and may aid the aspiration process for relevant material for microscopy 7 . Several published studies have highlighted the ability of US to detect crystal deposits and have addressed its possible role in very early diagnosis, based on their US findings indicative of gout in patients with asymptomatic hyperuricemia 7,8,9 .…”

The place of musculoskeletal ultrasonography in gout diagnosis

“…Ottaviani et al [34] detected articular urate deposits in 60% of gouty patients (the prevalence of tophi for knees and MTPs being 26.7%), more common in patients with higher serum uric acid. The tophi were found as well in patients with asymptomatic hyperuricaemia not only in synovium but also in tendons and soft tissue [45,46].…”

“…Among the periarticular bursae, the pre-patellar and olecranon bursae are the most commonly involved sites [46,49]. Fernandes et al [51] found that hyperechogenicity (91.7%), poorly defined contours (88.6%), multiple grouped nodules (85.6%), and heterogeneity (68.6%) are the most characteristics findings of the tophi from olecranon bursa.…”

Detection of Lumbar Facet Joint Gouty Arthritis Using Dual-energy Computed Tomography

“…MRI has been shown to be of value when evaluating synovial involvement, but at higher cost to the patient 6 . Ultrasonography may suggest early deposition of uric acid crystals and may reveal synovial thickening and inflammation but its use is largely limited to peripheral joints 7 . Although ultrasonography and CT may assist in direct aspiration of a joint for crystal evaluation, neither can specifically identify uric acid crystal deposition.…”