The mounting importance of knee sonographic signs in 425 gouty arthritis patients: A multi-centre study

Abstract

Aim of the workto study the ultrasonographic (US) features of the knee joints in a cohort of confirmed and high risk gouty arthritis patients, to assess their value in diagnosis and their relation to clinical characteristics. Patients and methodsThe multi-centre study included 425 patients with gouty arthritis presenting to one of 12 specialized rheumatology centers across the country. Participants had either mono- or oligo-arthritis with effusion of the knee or the first metatarsophalangeal joint. ResultsThe mean age of the patients was 54.2 ± 10.3 years and disease duration 4.4 ± 4.3 years. They were 267 males and 158 females (M:F 1.7:1). 53.4% were from urban areas and 46.6% rural. 85.9% of the patients had oligoarthritis (monoarthritis in 16.1%). Knees were involved in 82.1% (68.1% unilateral and 14% bilateral). The diagnosis of gouty arthritis was confirmed in 86.6% of cases. Males had a higher number of joints involved (3.5 ± 3.3 vs 2.8 ± 1.3; p = 0.006) and imaging evidence of gout-related damage (0.56 ± 1.4 vs 0.07 ± 0.54; p < 0.0001). US features were comparable except for right knee erosion (28.7% vs 40.8%; p = 0.01) and left knee power Doppler signals (24% vs 36%; p = 0.046) were more frequent in females. The total criteria score and the double contour sign (DCS) of the right medial femoral condyle significantly correlated with SUA (p < 0.0001 and p = 0.015 respectively). On regression, only the total criteria score remained significant (β 0.21, p < 0.0001). ConclusionUS features of the knees in confirmed or suspected gouty arthritis patients, with special consideration of the DCS, represent a potentially imperative window to encompass the disease spectrum.