Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout

Fernandes, Eloy de Ávila; Sandim, Gabriel Barbosa; Mitraud, Sônia A. V.; Kubota, Edson Shinji; Ferrari, Antonio J. L.; Fernandes, Ana

doi:10.1007/s13244-010-0031-x

Cited by 32 publications

(23 citation statements)

References 17 publications

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“…We observed intratendinous hyperechoic deposits in 35.9% of participants with MSU crystal deposits elsewhere. This is consistent with previous reports of tendon involvement in gout (14,15). As shown in Table 2, a substantial proportion of tendon hyperechoic deposits occurred in subjects without ultrasonographic features of MSU crystal deposition in the first MTP joints.…”

Section: Discussionsupporting

confidence: 93%

“…Joint effusion and power Doppler signal were graded on a 0-3 scale. All ultrasonographic assessments were performed using a Toshiba Aplio machine (8)(9)(10)(11)(12)(13)(14). Images with inconclusive readings were reviewed by a second ultrasonographer with >15 years of ultrasonography experience (PC), also under blinded conditions with regard to the subject's serum urate level.…”

Section: Methodsmentioning

confidence: 99%

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Brief Report: Monosodium Urate Monohydrate Crystal Deposits Are Common in Asymptomatic Sons of Patients With Gout: The Sons of Gout Study

Abhishek

Courtney

Jenkins

et al. 2018

Arthritis & Rheumatology

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ObjectiveTo estimate the prevalence and distribution of asymptomatic monosodium urate monohydrate (MSU) crystal deposition in sons of patients with gout.MethodsPatients with gout were mailed an explanatory letter with an enclosed postage‐paid study packet to mail to their son(s) age ≥20 years old. Sons interested in participating returned a reply form and underwent telephone screening. Subsequently, they attended a study visit at which blood and urine samples were obtained and musculoskeletal ultrasonography was performed, with the sonographer blinded with regard to the subject's serum urate level. Images were assessed for double contour sign, intraarticular or intratendinous aggregates/tophi, effusion, and power Doppler signal. Logistic regression was used to examine associations. Adjusted odds ratios (OR adj) and 95% confidence intervals (95% CIs) were calculated.ResultsOne hundred thirty‐one sons (mean age 43.8 years, mean body mass index 27.1 kg/m2) completed assessments. The serum urate level was ≥6 mg/dl in 64.1%, and 29.8% had either a double contour sign or intraarticular aggregates/tophi in ≥1 joint. All participants with MSU deposition had involvement of 1 or both first metatarsophalangeal joints. Intratendinous aggregates were present in 21.4% and were associated with intraarticular MSU crystal deposits (OR adj 2.96 [95% CI 1.17–7.49]). No participant with a serum urate level of ≤5 mg/dl had MSU crystal deposition seen on ultrasonography, and 24.2% of those with serum urate levels between 5 and 6 mg/dl had ultrasonographic MSU deposition. MSU crystal deposition was associated with increasing serum urate levels (OR adj 1.61 [95% CI 1.10–2.36] for each increase of 1 mg/dl).ConclusionAsymptomatic sons of patients with gout frequently have hyperuricemia and MSU crystal deposits. In this study MSU crystal deposits were present in participants with serum urate levels of ≥5 mg/dl. Evaluation of subjects without a family history of gout is needed to determine whether the threshold for MSU crystal deposition is also lower in the general population.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Brief Report: Monosodium Urate Monohydrate Crystal Deposits Are Common in Asymptomatic Sons of Patients With Gout: The Sons of Gout Study

Abhishek

Courtney

Jenkins

et al. 2018

Arthritis & Rheumatology

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“…In gout, most studies using US to examine tophi are descriptive (n=12),16–19 22 23 26 28–32 focusing on describing or categorising tophi. Tophus-like lesions are variably referred to as tophi, or by a description of their US appearance which is varied (see table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Reliability was addressed in only five studies, four of them reported interobserver to be very good to excellent17 23 29 30 and substantial in the fifth study 26. Only one of these studies17 examined interoccasion reliability, the rest reread stored images.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia

2013

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Gout is one of the most common inflammatory arthritides. The literature reveals that management of this condition is often suboptimal. Imaging techniques, such as ultrasound (US), may assist in the diagnosis and management of gout and asymptomatic hyperuricaemia (AH). To undertake a systematic review evaluating US as an outcome tool in gout and asymptomatic hyperuricaemia, articles published in Medline and PubMed (1975–February 2012) were identified. Data was extracted and categorised into four different groups namely tophi, articular cartilage, soft tissue pathologies and bony changes, with a focus on validity, responsiveness, reproducibility and feasibility. Lesions reported in the literature include tophi, cartilage abnormalities, soft tissue lesions and erosions. US is able to detect tophi, using MRI as the gold standard, and is sensitive to change. The double contour sign seen overlying cartilage is specific to gout and sensitive to change. Synovial pathology is identified in gout, with some reporting intrasynovial hyperechogeneicity is suggestive of gout. US was less sensitive than MRI to cortical erosions in gout, but better than conventional radiography. Interobserver reliability when assessed ranged from fair to substantial agreement for soft tissue changes and was very good for assessing tophi, double contour and erosions. US is a promising tool which could be used in the diagnosis and management of gout. More studies are needed to assess responsiveness, reliability and feasibility.

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“…Since the first description by Steiner and Plamer , only a little over 100 cases have been documented. QTR mostly occurs in patients with chronic diseases, including chronic renal failure, gout, systemic lupus erythematosus, and long‐term corticosteroid use . Primary hyperparathyroidism (PHPT) is a common endocrine disorder in adults, which typically manifests as asymptomatic hypercalcemia.…”

Section: Introductionmentioning

confidence: 99%