Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis
DOI:
https://doi.org/10.21776/ub.jkb.2020.031.01.7Keywords:
Acute gout flare, gout, MSU crystals, ultrasoundAbstract
Acute gout flare is the most common manifestation of gouty arthritis that intermittently occurs with severe pain in the joints due to interactions between monosodium urate crystals (MSU) and the surrounding tissues. The most common predilection is the metatarsophalangeal joint (the 1st MTP). Ultrasound examination is a modality that can be used to visualize MSU crystal precipitates in and around joints. This study aimed to determine the correlation between the findings of the MSU crystal precipitate on the 1st MTP using ultrasound with the occurrence of acute gout flare in gout patients. This study was an analytical observational study with a cross-sectional method. The samples were 41 patients with a history of previous acute flares and in the intercritical phase when participating in the study. Examinations of ultrasound on the 1st MTP and random serum uric acid level were performed. Evaluations were carried out on both of the 1st MTPs to assess the shape of the MSU crystalline precipitate, namely Double Contour Sign (DCS), aggregate, and tophus. Each sample was evaluated within five days to assess the presence or absence of an acute flare. The diagnostic tests used were the Chi-Square Test and the Fischer Exact Test with a significance value of p <0.05. The results showed the images of DCS were seen in 20 samples with 9 (45%) samples experiencing acute flare (p <0.05), while in 21 samples where no DCS were found, all did not experience any flare. Findings of aggregate and tophus were rarely found, 7.3% and 4.9%, respectively. In this study, the finding of DCS precipitates using ultrasound has a significant correlation to the emergence of acute flare and is a significant form of precipitate findings in this study, whereas aggregate and tophus precipitates are difficult to determine.
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References
Li Q, Li X, Kwong JSW, et al. Diagnosis and Treatment for Hyperuricaemia and Gout: A Protocol for a Systemic Review of Clinical Practice Guidelines an Consensus Statements. British Medical Journal.2016;9(8):1-6.
Saigal R, Agrawal A. Pathogenesis and Clinical Management of gouty Arthtritis. The Journal of the Association of Physicians of India.2015; 12: 56-63.
Widyanto FW. Artritis Gout dan Perkembangannya. Saintika Medika.2014;10(2):145-51
Keenan R, et al. Etiology and Pathogenesis of Hyperuricemia and Gout. In Ruddy S, Sergent J, Harris T, et al editor. Kelley’sTextbook of Rheumatology Ninth Edition. Philadelphia: Elsevier. 2011: 1554-65.
Busso N, So A. Mechanisms of Inflammation in Gout. Arthritis Research & Therapy.2010,12: 206
Neogi T, Jansen TL, Dalbet N , et al. 2015 Gout Classification Criteria. Arthritis & Rheumatology.2015:2557-2568.
Saigal R, Agrawal A. Pathogenesis and Clinical Management of Gouty Arthritis. Journal of The Association of Physicians of India. 2015;63:56-63.
Ragab G, Elshahaly M, Bardin T.Gout: A Old Disease in New Perspective-A Review. Journal of Advanced Research.2017;8(5):495-511
Perez-Ruiz F, Dalbeth N, Bardin T. A Review of Uric Acid, Crystal Deposition Disease, and Gout. Advances in Therapy.2015;32(1):31-41.
Stewart S, Dalbeth N, Vandal A, et.al. Ultrasound Features of The First Metatarsophalangeal Joint in Gout And Asymptomatic Hyperuricaemia: Comparison with Normouricaemia Individuals. Journal of Foot and Ankle Research.2016;10:22 1-16.
Perez-Ruiz F. Treating to Target: A Strategy to Cure Gout. British Society for Rheumatology. 2009; 48:ii9-ii14
Gutierrez M, Schmidt W, Thiele R, et al. International Consensus For Ultrasound Lesions in Gout : Results of Delphi Process and Web-Reliability Exercise. Rheumatology(Oxford).2015;54(10) 1797-805.
Scirocco Chiarra, Rutigliano MR, Finucci A, et al. Musculoskeletal Ultrasonography in Gout. Medical Ultrasonography. 2015;4: 535-540.
Das S, Ghosh A, Ghosh P, et al. Sensitivity and Specificity of Ultrasonographic Fatures of Gout in Intercritical and Chronic Phase. International Journal of Rheumatology Diseases. 2017: 887-893
Ogdie A, Taylor WJ, Dalbeth N. Performance of Ultrasound in the Diagnosis of Gout in a Multi-Center Study: Comparison with Monosodium Urate Crystal Analysis as the Gold Standard. Arthritis & Rheumatology. 2017;69(2): 429-438
Thiele RG, Schlesinger N. Ultrasonography Shows Disappearance of Monosodium Urate Crystal Deposition on Hyaline Cartilage After Sustained Normouricemia is Achieved. Rheumatology International. 2010, 30:495-503.
Zhu l, et al. Combining Hyperechoic Aggregates and The Double Contour Sign Increases the Sensitivity of Sonography for Detection of Monosodium Urate Deposits in Gout. Journal of Ultrasound in Medicine.2017;935-940.
Zhang Q, et al. The Diagnostic Performance of Musculoskeletal Ultrasound in Gout: A Systemic Review and Meta-analysis.Plos One. 2018;7: 1-14
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