Imaging in gout

Dalbeth, Nicola; Doyle, Anthony; McQueen, Fiona

doi:10.1097/bor.0b013e32834ff5b1

Cited by 29 publications

(3 citation statements)

References 32 publications

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“…The described US pattern in PsA seems to confirm the presence of enthesitis [17][18]. US findings such as the presence of a hyperechoic signal within the cartilage layer (calcium pyrophosphate [CPPD] deposition disease) [19] or very superficial cartilage crystals ("double contour" sign in gout) [20] have been described (fig. 1).…”

Section: Ultrasound In the Detection Of Early Rheumatoid Arthritis An...mentioning

confidence: 66%

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Zufferey¹,

Tamborrini²,

Gabay³

et al. 2013

Swiss Med Wkly

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Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

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Section: Ultrasound In the Detection Of Early Rheumatoid Arthritis An...mentioning

confidence: 66%

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Zufferey¹,

Tamborrini²,

Gabay³

et al. 2013

Swiss Med Wkly

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“…Gout results from the deposition of uric acid salts and crystals in and around the joints and soft tissues ( 1 ). It affects 3.9% of the total North-American adult population ( 10 ), with a peak age incidence occurring between 30 and 50 years, being 5 times more common in men than premenopausal women. After the age of 60 years, the prevalence of the disease in women tends to approach that seen in men ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

Spinal and sacroiliac gouty arthritis: report of a case and review of the literature

Cardoso

Omoumi

Wieërs

et al. 2014

Acta Radiologica Short Reports

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In this case report, we describe an “uncommon” case of axial gouty arthropathy in a 69-year-old woman with bilateral sciatica that was thoroughly evaluated with conventional radiography, CT scan, magnetic resonance imaging, bone scintigraphy, and PET-CT. Axial gouty arthropathy should be included in the differential diagnosis of chronic low back pain, mainly when several risk factors for gout are present.

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“…However, arthrocentesis is an invasive test and is not always practical for all patients. As a result, treatment of gout is often initiated based on clinical evidence only [ 2 , 3 ]. An accurate and convenient modality for the diagnosis of gout is imperative.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis

Gao

Sun

et al. 2018

PLoS ONE

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BackgroundMusculoskeletal 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.MethodsWe 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).ResultsThirteen 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.ConclusionsIn 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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Imaging in gout

Abstract: Imaging modalities have provided important insights into the pathology of gout. The role of various imaging techniques in gout diagnosis, monitoring, and prediction of outcome is rapidly developing.

Cited by 29 publications

References 32 publications

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Spinal and sacroiliac gouty arthritis: report of a case and review of the literature

The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis

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