Title:The Role of Ultrasound in Evaluating the Effect of Urate-lowering Drugs
in Gout Patients
Volume: 18
Issue: 4
Author(s): Reem El-Mallah*, Rehab Ali Ibrahim and Enas A. El Attar
Affiliation:
- Department of Physical Medicine Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Keywords:
Double contour sign, tophus, Gout, ultrasound, uric acid, urate-lowering therapy, visual analog scale (VAS).
Abstract:
Background: Gout is one of the most common inflammatory arthritis, where identification
of MSU crystals in synovial fluid is a widely used diagnostic measure. Ultrasonography has a
great sensitivity in detecting signs of MSU deposits, such as tophi and double contour (DC), as
mentioned in the latest gout criteria, allowing early clinical diagnosis and therapy.
Objective: The objective of this study was to evaluate the changes in ultrasound of gout patients’
knee and 1st metatarsophalangeal joint (MTP1) after initiation of urate-lowering therapy (ULT)
drugs in the six-month period.
Methods: Forty-three patients, fulfilling the ACR/EULAR 2015 criteria of gout with a score of >8,
were enrolled; they were in between attacks and not on ULT for the last 6 months, or SUA concentration
(SUA) of >6.0 mg/dL. Full examination, evaluation of joints pain by visual analog scale
(VAS), ultrasonography (US) for tophus and DC at the knee, and MTP1 were performed at baseline
and at 3 and 6 months (M3, M6) after starting ULT.
Result: After 6 months of treatment, patients reached the target SUA level showed higher disappearance
of DC sign (p<0.05) and a decrease in tophus size (p<0.05). The percentage of tophus size
at 6th month was 26.4% and 3% for DC sign disappearance, which was more at MTP1.
Conclusion: Ultrasound examination in screening for gout tophi or DC sign before starting ULT
and during follow-up is important and complements clinical examination.
