Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout.

Dennis Espejo,Kathleen Y Ogle,Elizabeth Dearing,Keith S Boniface,Maria Portela

doi:10.7759/cureus.15096

Abstract

Gout is the most common crystal arthropathy and is frequently diagnosed and managed by primary care physicians. Point-of-care ultrasound (POCUS) is a valuable tool to aid in the diagnosis of gout via the identification of the double contour sign, aggregates of crystals, tophi, and erosions. In addition, POCUS can aid in the management of gout by recognizing early signs of gout, monitoring the effectiveness of urate-lowering therapy, and guiding aspiration and corticosteroid injection.

Highlights

BackgroundCrystal arthropathies are one of the most common causes of inflammatory arthritis worldwide [1]
The most common type of crystal arthropathy is gout, caused by monosodium urate (MSU), which is characterized by crystal deposition in joints [2]
The objective of this paper is to describe the utility of Point-of-care ultrasound (POCUS) in facilitating the diagnosis, treatment, and delivery of care for patients with gout and to demonstrate the value of POCUS to primary care practitioners when encountering patients with arthropathies

Summary

Introduction

Crystal arthropathies are one of the most common causes of inflammatory arthritis worldwide [1]. Ultrasound of patients with suspected gout focuses on the identification of crystal deposition in the joints and soft tissues through several characteristic sonographic findings These findings include the double contour sign, aggregates or clusters of crystals, tophi, and erosions [25]. While synovial fluid or soft tissue analysis for MSU crystals is the gold standard for diagnosing gout, this procedure is, at times, difficult to perform, especially for small joints, is unsuccessful, or is not able to be performed due to lack of available polarizing light microscopy. In addition to the identification of MSU crystal deposition by DECT and imaging evidence of gout-related joint damage by plain radiographs, the double contour sign by ultrasound is included in the ACR/EULAR consensus guidelines for gout classification criteria [6]. We believe that with adequate training, POCUS use in the evaluation of inflammatory arthritis will become more widespread and an integral part of gout evaluation and management in the outpatient setting

Conclusions

Disclosures

Findings

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