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Brief four-joint ultrasound effectively confirmed gout among diagnosed patients
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A short ultrasound examination of four joints — including bilateral knees and first metatarsophalangeals — seeking two elemental lesions in gout patients reliably diagnosed the condition, according to pilot study results.
Researchers in Spain studied 29 patients (mean age, 58 years; 93% men) with gout, which was confirmed by urate crystal identification and at least one symptomatic flare in the previous 3 months. Standardized ultrasound (US) exams were conducted on 16 joints and eight tendons by a researcher masked to patients’ clinical data.
In each joint, six gout-related lesions were tested, including hyperechoic spots in the synovial fluid, hyperechoic cloudy areas (HCA), bright stippled aggregates (BSA), double contour sign (DCS), erosions and Doppler signals. Inter-reader analyses using images from the study’s first 15 patients plus all stored images from the cohort were used to calculate reliability.
The most frequently identified elementary lesions were Doppler signals, HCA and BSA that appeared in 100%, 97% and 93% of patients, respectively. Sixty-nine percent of patients displayed DCS, and 93% of patients showed at least one characteristic gout lesion in the first metatarsophalangeal (MTP) joint and/or knees.
When researchers used a simplified 6-minute US test seeking two lesions in just four joints (knees and first MTP) as a method of detecting patients with gout, they found HCA or DCS in 97% of patients.
Consistent results were shown for erosions, Doppler signals, HCA, and DCS in the first MTP joints and DCS in the knees (kappa coefficient=0.818, k=0.958, k=0.739, k=0.697 and k=0.779, respectively).
“Our aim was not a validity study against the gold standard [for gout diagnosis, the identification of crystals in the joint fluid or tophi], but rather a useful and feasible short US test with face and content validity in patients with proven gout,” the researchers reported. “Our study supports the use of US as a complementary test in the diagnosis of gout.”
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