Association of urate deposition shown by ultrasound and frequent gout attacks
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Rheumatologie Originalien Z Rheumatol https://doi.org/10.1007/s00393-020-00913-0 Accepted: 19 August 2020 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020 Redaktion U. Müller-Ladner, Bad Nauheim U. Lange, Bad Nauheim
Introduction Gout is the most common inflammatory arthritis that develops after a history of hyperuricemia and subsequent urate deposition within joints and soft tissues [1, 2]. Despite the permanent deposition of monosodium urate (MSU) crystals, flares of the inflammatory response are only intercurrent and difficult to predict [3, 4]. The frequency of acute gout attacks is reported to be associated with higher serum uric acid, longer disease duration, and dietary and lifestyle factors [5–7]. Measuring serum uric acid levels provides an instant snapshot of the urate overload, but it does not assess the accumulation of urate deposits; thus, morphological examination of the extent of urate deposit is a potential tool for monitoring treatment [8, 9]. Previous data suggest an association between urate burden assessed with dual-energy computed
Zhengping Zou1,2 · Mingfeng Yang3 · Yiwen Wang3 · Bin Zhang3 1
Department of Rheumatology and Nephrology, Qianjiang Central Hospital, Qianjiang, China Qianjiang clinical medical college, Yangtze University, Qianjiang, China 3 Department of Rheumatology, Affiliated Hospital of Jiaxing University, the First Hospital of Jiaxing, Jiaxing, China 2
Association of urate deposition shown by ultrasound and frequent gout attacks tomography (DECT) and gout flares [10, 11], but so far, few data have demonstrated the association between urate burden assessed by ultrasound (US) and gout flares. The objective of this study was to determine whether the extent of urate burden measured with US predicts the risk of gout flares.
Patients and methods
quency is affected by ULT itself, patients with gouty tophi or those receiving ULT were excluded. The study protocol was approved by the First Affiliated Hospital of Jiaxing University Ethics Committee. Written informed consent was obtained from each patient. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Patients
Ultrasound examination
Patients with gout seen at the First Affiliated Hospital of Jiaxing University from December 2017 to December 2019 were prospectively recruited. All cases fulfilled the requirement of American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2015 criteria for gout [12]. Because gouty tophi are a strong indication of urate-lowering treatment (ULT), and gout attack fre-
Urate deposition in the hands, knees, and feet was assessed by US. All US scanning was conducted by an experienced ultrasonic expert with more than 5 years of experience in maneuvering musculoskeletal US. The presence of monosodium urate crystal deposits (tophi) or the double contour sign (DCS) were considered positive evidence for the presence of urate deposition.
Fig. 1 8 One patient with double-contour sign (Asterisk) in the ankle by ultrasound
Fig. 2 8 One patient
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