Generic placeholder image

Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

The Role of Ultrasound in Evaluating the Effect of Urate-lowering Drugs in Gout Patients

Author(s): Reem El-Mallah*, Rehab Ali Ibrahim and Enas A. El Attar

Volume 18, Issue 4, 2022

Published on: 20 May, 2022

Page: [338 - 345] Pages: 8

DOI: 10.2174/1573397118666220429092312

Price: $65


Background: Gout is one of the most common inflammatory arthritis, where identification of MSU crystals in synovial fluid is a widely used diagnostic measure. Ultrasonography has a great sensitivity in detecting signs of MSU deposits, such as tophi and double contour (DC), as mentioned in the latest gout criteria, allowing early clinical diagnosis and therapy.

Objective: The objective of this study was to evaluate the changes in ultrasound of gout patients’ knee and 1st metatarsophalangeal joint (MTP1) after initiation of urate-lowering therapy (ULT) drugs in the six-month period.

Methods: Forty-three patients, fulfilling the ACR/EULAR 2015 criteria of gout with a score of >8, were enrolled; they were in between attacks and not on ULT for the last 6 months, or SUA concentration (SUA) of >6.0 mg/dL. Full examination, evaluation of joints pain by visual analog scale (VAS), ultrasonography (US) for tophus and DC at the knee, and MTP1 were performed at baseline and at 3 and 6 months (M3, M6) after starting ULT.

Result: After 6 months of treatment, patients reached the target SUA level showed higher disappearance of DC sign (p<0.05) and a decrease in tophus size (p<0.05). The percentage of tophus size at 6th month was 26.4% and 3% for DC sign disappearance, which was more at MTP1.

Conclusion: Ultrasound examination in screening for gout tophi or DC sign before starting ULT and during follow-up is important and complements clinical examination.

Keywords: Double contour sign, tophus, Gout, ultrasound, uric acid, urate-lowering therapy, visual analog scale (VAS).

Graphical Abstract
Dalbeth N, Merriman TR, Stamp LK. Gout Lancet 2016; 388(10055): 2039-52.
[] [PMID: 27112094]
Kuo C-F, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: Prevalence, incidence and risk factors. Nat Rev Rheumatol 2015; 11(11): 649-62.
[] [PMID: 26150127]
Bursill D, Taylor WJ, Terkeltaub R. Gout, hyperuricemia, and crystal-associated disease network consensus statement regarding labels and definitions for disease elements in gout. Arthritis Care Res 2019; 71: 427-34.
Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol 2014; 26(2): 186-91.
[] [PMID: 24419750]
Doherty M, Jansen TL, Nuki G, et al. Gout: Why is this curable disease so seldom cured? Ann Rheum Dis 2012; 71(11): 1765-70.
[] [PMID: 22863577]
Richette P, Clerson P, Périssin L, Flipo RM, Bardin T. Revisiting comorbidities in gout: A cluster analysis. Ann Rheum Dis 2015; 74(1): 142-7.
[] [PMID: 24107981]
Fisher MC, Rai SK, Lu N, Zhang Y, Choi HK. The unclosing premature mortality gap in gout: A general population-based study. Ann Rheum Dis 2017; 76(7): 1289-94.
[] [PMID: 28122760]
Neogi T, Jansen TL, Dalbeth N, et al. Gout classification criteria: An American College of Rheumatology/European League against rheumatism collaborative initiative. Ann Rheum Dis 2015; 74(10): 1789-98.
[] [PMID: 26359487]
Gentili A. Advanced imaging of gout. Semin Musculoskelet Radiol 2003; 7(3): 165-74.
[] [PMID: 14593558]
Zufferey P, Valcov R, Fabreguet I, Dumusc A, Omoumi P, So A. A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis. Arthritis Res Ther 2015; 17(1): 188.
[] [PMID: 26198435]
Ottaviani S, Bardin T, Richette P. Usefulness of ultrasonography for gout. Joint Bone Spine 2012; 79: 441-5.
Ottaviani S, Richette P, Allard A, Ora J, Bardin T. Ultrasonography in gout: A case-control study. Clin Exp Rheumatol 2012; 30: 499-504.
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: 1417-29.
Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29-42.
Hui M, Carr A, Cameron S, et al. British society for rheumatology standards, audit and guidelines working group. The british society for rheumatology guideline for the management of gout. Rheumatology 2017; 56(7): 1246.
[] [PMID: 28605531]
Wright SA, Filippucci E, McVeigh C, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: A controlled study. Ann Rheum Dis 2007; 66(7): 859-64.
[] [PMID: 17185326]
Ottaviani S, Allard A, Bardin T, Richette P. An exploratory ultrasound study of early gout. Clin Exp Rheumatol 2011; 29(5): 816-21.
[PMID: 22011529]
Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology 2007; 46(7): 1116-21.
[] [PMID: 17468505]
Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: An ultrasound controlled study. Arthritis Res Ther 2011; 13(1): R4.
[] [PMID: 21241475]
Younes TB. ELattar EA, Aboul Hamayed HF, Elia RZ. Musculoskeletal ultrasonographic assessment of asymptomatic hyperuricemic Egyptian individuals. Egypt Rheumatol Rehabil 2013; 40: 88-95.
Ottaviani S, Gill G, Aubrun A, Palazzo E, Meyer O, Dieudé P. Ultrasound in gout: A useful tool for following urate-lowering therapy. Joint Bone Spine 2015; 82: 42-4.
Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int 2010; 30: 495-503.
Gutierrez M, Schmidt WA, Thiele RG, et al. Omeract ultrasound gout task force group. International consensus for ultrasound lesions in gout: Results of delphi process and web-reliability exercise. Rheumatology 2015; 54(10): 1797-805.
[] [PMID: 25972391]
Möller I, Janta I, Backhaus M, et al. The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 2017; 76(12): 1974-9.
[] [PMID: 28814430]
Bruyn GA, Iagnocco A, Naredo E, et al. OMERACT Ultrasound Working Group. Omeract definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol 2019; 46(10): 1388-93.
[] [PMID: 30709946]
Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol 2007; 34(9): 1888-93.
[PMID: 17659752]
Ebstein E, Forien M, Norkuviene E, et al. Ultrasound evaluation in follow-up of urate-lowering therapy in gout: The USEFUL study. Rheumatology (Oxford) 2019; 58(3): 410-7.
[] [PMID: 30285127]
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(11): 1500-5.
[] [PMID: 32669301]

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy