Article
Features of gouty arthritis by high frequency ultrasonography
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Published: | September 12, 2014 |
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Background: To evaluate the sonographic features of gouty arthritis in patients living in Sohag city in Upper Egypt and correlate them with disease duration.
Methods: A study was conducted on 60 patients, aged ≥40 years, attending the outpatient clinic of Rheumatology and Rehabilitation in the period from April to December 2013. Inclusion criteria: mono or oligoarthritis with effusion of knee or 1stmetatarsophalangeal joint, no known history of gout. Each patient was subjected to complete history taking with emphasis on the previously known risk factors or causes of gouty arthritis in other ethnic groups. A Medison linear probe 12 MHZ C 70 was used for ultrasonography. Synovial fluid analysis by polarizing light microscopy was performed on all patiens.
Results: Mean age was 53.6 years. 57 knee joints and 23 1st MTP joints were examined. Crystals were found in 30 knee joints and 17 1st MTP joints. The male to female ratio for those who had crystals was 7:4 (1.75). Gouty arthritis was found by U/S in four forms : (1) floating microtophi in effusion fluid or Backer cyst, (2) deposits on the cartilage surface (double contour sign), (3) forming a tophus and (4) finally erosion. This was found in 63.8%, 40.4%, 19.1%, and 34% of patients, respectively. Sensitivity of U.S. was 84.8% and specificity of double contour 82.6% and for tophus 100%. The earliest sign was microtophi floating in effusion fluid (mean arthritis duration, 1.1 years) followed by double contour sign (5.8 years), erosions (7.42 years) and the latest sign was tophus (9.33 years).
Conclusion: Sonographic findings in gout can be assigned a temporal pattern, with microtophi being associated with the shortest and full tophus formation with the longest disease duration.