Diagnosis Of Gouty Arthritis Research Articles

Comparison of diagnostic efficacy of dual-energy CT and ultrasound in gouty arthritis.

To explore the performance and effect of dual-energy computed tomography (CT) and ultrasound in the diagnosis of gouty arthritis and to provide a reference for the clinical diagnosis of gouty arthritis. A retrospective analysis of 76 patients with gouty arthritis admitted to the hospital from June 2020 to June 2022 was conducted. Patients were diagnosed with gouty arthritis using ultrasound and dual-energy CT technology. The accuracy of diagnosis by different imaging techniques was analyzed along with the imaging findings of ultrasound and dual-energy CT. Seventy-six patients, 60 men and 16 women, ranging in age from 20 to 77 years (mean age 50.8 ± 10.92 years), presented with uric acid levels of 254.1-720.05 μmol/L (mean 482.17 ± 105.06 μmol/L) and C-reactive protein levels ranging from 4.25 to 10.3 mg/L. The receiver operating characteristic curve showed that the area under the curve and specificity of serum uric acid were higher by dual-energy CT than those of ultrasound in the diagnosis of gouty arthritis. The dual-energy CT detection rate of tophi was significantly higher than the ultrasound detection rate (p < .05). For inflammatory effusion and synovial thickening, the ultrasound detection rates were significantly higher than the dual-energy CT detection rates (p < .05). Regarding soft-tissue edema, the detection rate of the two methods was not significantly different (p > .05). Compared with ultrasound, dual-energy CT has increased accuracy in the diagnosis of gouty arthritis.

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

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.

Observation of Value and Safety of Musculoskeletal Ultrasound Diagnosis of Gouty Arthritis

Observation of Value and Safety of Musculoskeletal Ultrasound Diagnosis of Gouty Arthritis

Musculoskeletal ultrasound in the Differential Diagnosis of Gouty Arthritis and Rheumatoid Arthritis

Objective:To explore the role of musculoskeletal ultrasound (MSUS) in the differential diagnosis of gouty arthritis (GA) and rheumatoid arthritis (RA) and to analyze the ultrasound imaging features of the two diseases.Methods:A retrospective study was carried out. A total of 66 patients who had been admitted to The First Medical Center of Chinese PLA General Hospital from May 2018 to March 2019 were enrolled. Among them, 34 patients were diagnosed with RA and were included in the RA group; 32 patients were diagnosed with gouty arthritis and were included in the GA group. The imaging features of musculoskeletal ultrasound were compared between the two groups of patients.Results:A total of 34 patients were included in the RA group, including 17 males and 17 females. A total of 32 patients were included in the GA group, including 14 males and 18 females. There were no significant differences in gender composition, age, and duration of disease between the two groups (P>0.05). In the RA group, there were joint bone erosions with a clear boundary in seven cases and with a blurred boundary in 27 cases; synovial hyperplasia was observed in 27 cases, and point-like hyperechoic masses were observed in four cases. In the GA group, there were joint bone erosions with a clear boundary in 27 cases and with a blurred boundary in five cases; synovial hyperplasia was observed in four cases, tophus was observed in 23 cases, point-like hyperechoic masses were observed in 27 cases, and the tram-track sign was observed in 23 cases. The differences in bone erosion boundaries (c2=26.854, P<0.01), synovial hyperplasia (c2=29.631, P<0.01), tophus (P<0.01), point-like hyperechoic mass (c2=33.095, P<0.01), and tram-track sign (P<0.01) were statistically significant between the two groups of patients. In the RA group, blood flow signaling was Grade 0 in one case, Grade-I in five cases, Grade-II in 14 cases, and Grade-III in 14 cases. In the GA group, blood flow signaling was Grade 0 in 26 cases, Grade-I in three cases, Grade-II in three cases, and Grade-III in zero cases. The difference in the synovial blood flow signaling between the two groups of patients was statistically significant (c2=34.323, P<0.01).Conclusions:MSUS has certain diagnostic value in the differentiation of GA and RA. Moreover, the two conditions have their own ultrasound imaging features.

Please Heel Me, I Can't Walk!

A previously healthy 20-year-old man presented to the emergency department with difficulty walking and bilateral heel pain. His pain started acutely in the right heel approximately 3 months prior to presentation with no known trauma or injury. He had previously been treated with steroids for presumed tendinitis and magnetic resonance imaging of his ankle showed a possible partial tear of the right Achilles tendon. His pain worsened and involved swelling of both heels so that he was unable to walk. On presentation, he had a normal neurological exam. His musculoskeletal exam was pertinent for pain over the calcaneus bilaterally and swelling with firmness over both Achilles tendons. Labs were notable for an elevated uric acid, and a computed tomographic scan of his feet showed the presence of monosodium urate crystal deposition, consistent with a diagnosis of gouty arthritis. Despite gout being a disease diagnosed almost exclusively in adults, pediatric providers must consider this and other diseases that typically affect adults, especially when treating patients at the older end of the pediatric spectrum.

Progress of imaging diagnosis of gouty arthritis

The incidence of metabolic rheumatism gout has been increasing with a trend of more younger patients and atypical symptoms. Typical gout is easy to be diagnosed, but it is difficult for atypical cases. Finding uric acid crystal in articular fluid by polarizing light microscope is a gold standard of diagnosis, but it is an invasive diagnostic method and difficult to be widely used. The patients need further imaging examination for assistance of diagnosis and guide of follow-up treatment. This article reviews the research progress of different imaging methods used for diagnosis of gouty arthritis. Key words: Arthritis, gouty; Ultrasonography; Tomography, X-ray computed; Magnetic resonance imaging

Assessment of sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic phases

Aim To study the usefulness of ultrasonography (US) in the diagnosis of gouty arthritis and to assess its sensitivity and specificity in intercritical and chronic stages and also its use in comparing patients with high serum uric acid (HSUA) and low serum uric acid (LSUA). Patients and methods We studied 60 patients known to be gouty in either chronic phase or intercritical phase, diagnosed clinically and through laboratory assessments, and 30 controls. Demographic, clinical, and serological data were evaluated. Knee and first metatarsophalangeal joints were assessed by musculoskeletal US by a blinded radiologist. Results A total of 53 (88.3%) patients were in the intercritical stage of gout during the study, and seven (11.6%) patients had chronic gout with clinically detectable tophi. Double contour sign (DCS) was found in 57.5% and tophi were found in 41.6% of first metatarsophalangeal joints. DCS was present in 42 (70%) patients with gout, and in only one of the control group (P Conclusion Musculoskeletal US is useful for diagnosis of gout in intercritical and chronic stages, especially in patients with HSUA level and long disease duration.

Value of Shear Wave Elastography in the Diagnosis of Gouty and Non-Gouty Arthritis

Our aim was to analyze the diagnostic performance of shear wave elastography (SWE) in the diagnosis of gouty arthritis (GA) and non-gouty arthritis (non-GA). Thirty-nine patients in the GA group and 55 patients in the non-GA group were included in the study. Based on the echo intensity of the joint lesions, the GA group was subdivided into hypo-echoic GA, slightly hyper-echoic GA and hyper-echoic GA subgroups. Quantitative SWE features were evaluated and receiver operating characteristic analysis was performed. On the basis of the study, the elastic modulus (Emax), mean elastic modulus (Emean), minimum elastic modulus (Emin) and elastic modulus standard deviation (ESD) were significantly higher in the GA group than in the non-GA group and were highest in the hyper-echoic GA subgroup (p < 0.01 for all). Emin, Emean and Emax were significantly higher in the hyper-echoic GA subgroup than in the hypo-echoic GA subgroup and non-GA group (p < 0.001 for all), and ESD was significantly higher in the hyper-echoic GA subgroup than in the non-GA group (p = 0.001). Emin, Emean, Emax and ESD were higher in the hypo-echoic GA subgroup than in the non-GA group, and the differences were significant (p < 0.001 for all). Based on the hypo-echoic GA subgroup and non-GA group, areas under the receiver operating characteristic curves for the prediction of GA were 0.749 for Emin, 0.877 for Emean, 0.896 for Emax and 0.886 for ESD, with optimal cutoff values of 29.40 kPa for Emin, 45.35 kPa for Emean, 67.54 kPa for Emax and 7.85 kPa for ESD. Our results indicate that SWE can differentially diagnose GA and non-GA, especially when the ultrasound manifestations are not typical.

Longitudinal transition trajectory of gouty arthritis and its comorbidities: a population-based study.

The aim of the study was to investigate the longitudinal transition trajectory of gout and its comorbidities in male patients with gout in different age groups. A total of 3973 male patients who received a new diagnosis of gouty arthritis were identified from the Taiwan Longitudinal Health Insurance Database and divided into two age cohorts (<50 and ≥50years). Each patient was individually followed from 2000 to 2009 to identify associated comorbidities, namely hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular diseases, and chronic kidney disease. Two outcome measurements of stroke and all-cause cancer were further identified until 2010. The transition trajectory was divided into the following five phenotype groups: persistent hypertension combined with a high prevalence of various gout-related comorbidities, persistent hypercholesterolemia combined with a moderate prevalence of various gout-related comorbidities, persistent low prevalence of various gout-related comorbidities, moderate to high prevalence of various gout-related comorbidities, and low to high prevalence of various gout-related comorbidities. Although the younger and older patients had a similar longitudinal transition trajectory of gout-related comorbidities, the older patients had a higher 10-year likelihood of transition from a low or moderate to a high prevalence of various gout-related comorbidities. In addition, the incidences of stroke and all-cause cancer were higher in the groups with high and moderate to high prevalences of various gout-related comorbidities than in the other groups. The occurrence of gouty arthritis in different life stages can cause cluster effects involving varying degrees of comorbidities over time. The findings of the current study can provide additional knowledge and increase clinical awareness regarding the early assessment and management of gout-related comorbidities in clinical practice.

The comparison between X-ray plain radiography, CT, and MR findings of gouty arthritis

Objective To make a comparison between the plain radiograph, CT, and MR findings of gouty arthritis and to analyse the relationship between clinical data and imaging findings. Methods Fifty-four joints of 33 patients with a confirmed diagnosis of gouty arthritis were included in this study. In the morning, the blood uric acid level of patients was tested before meal. In the afternoon, their clinical data were recorded and joints were examinated by plain radiography, CT, and MRI. The imaging findings were evaluated by tophi, bone erosion, soft tissue swelling, hydrarthrosis, synovial thickness, and bone oedema. The data was analyzed by Chi-square test, indepentdent-samples t test, and logistic regression. Results The Chi-square test was utilized to evaluate number of joints with tophi(CT>plain radiography, MR>plain radiography, P CT>plain radiography, P CT, P<0.01). In addition, 35 joints had bone oedema and 50 joints had synovial thickness. The course of disease(tophi positive group vs tophi negative group, P<0.01)was analyzed by indepentdent-samples t test. The tophi's causative agents including bone erosion and course of disease were analysed by logistic regression(P<0.01). Conclusions MRI is superior to CT and plain radiography on the early diagnosis of gout. Tophi and bone erosion may not affect the blood uric acid level. With the progression of disease, the probability of tophi formation increases. The relationship between the formation of tophi and bone erosion may be interpromotied. Key words: Gouty arthritis; Plain radiograph, X-ray; Computed tomography; Magnetic resonance imaging

First experience with single-source dual-energy computed tomography in six patients with acute arthralgia: a feasibility experiment using joint aspiration as a reference.

Dual-energy computed tomography (DECT) is an emerging imaging technique for examining patients with suspected gout. Single-source dual-energy CT (S-DECT) is a new way of obtaining DECT information on conventional CT scanners rather than using special dual-source CT systems. We tested the feasibility of S-DECT (320-row CT; Aquilion ONE, Toshiba Medical Systems, Otawara, Japan) in 6 patients (5 men, 1 woman; mean age 61.3, range 48 to 69 years) with acute arthralgia and suspected gout, and compared the S-DECT findings with the results of joint aspiration. Three patients had a diagnosis of gouty arthritis with negatively birefringent crystals in synovial fluid, in addition to gouty tophi in S-DECT. Three patients had no detectable crystals by polarization microscopy and no tophi on DECT. Their final diagnoses were rheumatoid arthritis, activated osteoarthritis, and septic arthritis in one case each. This initial experience suggests that S-DECT might be a valuable alternative to dual-source CT. Hence, more patients may benefit from its additional diagnostic abilities in the future.

Spondylodiscitis and Achilles tendonitis due to gout

The patient, a 62-year-old man with a 3-year history of hyperuricemia, presented with severe neck pain, Achilles enthesopathy and polyarthralgia. He consumed alcohol heavily. The biochemical profile was normal except for elevated levels of CRP (3.6 mg/dl; normal < 0.3), uric acid (UA) (10.9 mg/dl; normal 2.5–7.5) and creatinine (1.7 mg/dl; normal 0.5–1.0). Bone scintigraphy showed polyarthritis at the right elbow, wrist and bilateral first MTP joints. Notably, bone scintigraphy with computed tomography also revealed spondylodiscitis of C5-C6, which was confirmed by MRI, and left Achilles tendonitis. Moreover, left Achilles tendonitis was also confirmed by ultrasonography, indicating enthesitis with low-echoic lesion and calcification. Needle aspiration yielded a white viscous liquid, with numerous urate crystals identified on polarized light microscopy. He was diagnosed with gouty arthritis associated with spondylodiscitis and Achilles tendonitis. After the treatment with allopurinol, colchicine and predonisolone, his symptoms were improved, and serum CRP and UA levels were normalized. The cervical spine and Achilles tendon are rare and notable sites of involvements in gout, and differential diagnosis of gouty arthritis from spondyloarthritis, rheumatoid arthritis, tumor, pseudogout, and infection is necessary. When the patient was noted to have neck pain and Achilles enthesopathy, we should always recognize gouty arthritis.

Diagnosis and treatment of gout in the hand or wrist

Objective To explore the diagnosis and treatment of gout in the hand and wrist. Methods Of the 5 cases of gout in the hand and wrist, 2 patients had tophus and underwent extirpating of the tophus, tenolysis and neurolysis. Another 3 patients without tophus underwent carpal tunnel release and localized debridement. All the resected tissues were subject to histological examination. Results Primary healing of the wound was achieved in all cases with no infection. The average postoperative follow-up period was 7 months.Histology confirmed the diagnosis of gouty arthritis. For the 2 patients with tophus, symptoms of finger numbness were alleviated and wrist function was significantly improved. There was, however, recurrence that demanded further treatment. For the 3 patients without tophus, their wrists were pain-free and the grip strength of their hands returned to near normal. Conclusion It is difficult to diagnose non-classic gout of the hand or wrist without tophus. Surgical exploration not only confirms the diagnosis of gout but more importantly is a definitive treatment. Diagnosis of gout with tophus is relatively easy, however surgical treatment leads to less ideal results. Key words: Hand; Carpal joints; Gout; Arthritis

Synovial membrane punch biopsy.

Biopsy material has proved to be of value in investigation of many inflammatory and malignant disease processes. Examination of synovial membrane by open biopsy, under anesthesia, has been performed by orthopedists for many years. Polley and Bickel, in 1951, 1,2 described an instrument for performing a closed punch biopsy. The purpose of this study was to determine value of closed punch biopsy procedure in an active outpatient arthritis clinic. The greatest potential value of a synovial biopsy in clinical practice would be to establish a diagnosis. In certain arthritic conditions, this is possible. If urate crystals are demonstrated in synovial membrane, diagnosis of gouty arthritis may be established. 3 Tuberculous arthritis and pigmented villous synovitis may also be accurately diagnosed by joint biopsy. Unfortunately, histological changes in synovial membrane of osteoarthritis, rheumatoid arthritis, the collagen diseases, and traumatic and infectious arthritis, are