Esperanza Naredo1, Jacqueline Uson2, Mercedes Jiménez-Palop3, Agustín Martínez4, Esther Vicente5, Elia Brito6, Ana Rodríguez6, Francisco Javier Cornejo7, Santos Castañeda5, María Jesús Martínez2, Jesús Sanz3, Ingrid Möller8, Enrique Batlle-Gualda9, Jesús Garrido10, Eliseo Pascual4. 1. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain Department of Rheumatology, Hospìtal Universitario Severo Ochoa, Madrid, Spain. 2. Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain. 3. Department of Rheumatology, Hospital Puerta de Hierro, Madrid, Spain. 4. Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain. 5. Department of Rheumatology, Hospital de la Princesa, IIS-Princesa, Madrid, Spain. 6. Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain. 7. C.S. Mendiguchia Carriche, Leganés, Madrid. 8. Department of Rheumatology, Instituto Poal, Barcelona, Spain. 9. Department of Rheumatology, Hospital Clínico de San Juan, Alicante, Spain. 10. Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain.
Abstract
OBJECTIVE: The primary objective of this prospective case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)-detected abnormalities in the upper and lower limbs in gout. The secondary objective was to test the concurrent validity of US abnormalities using as gold standard the microscopic demonstration of monosodium urate (MSU) crystals. METHODS: Ninety-one men with gout and 42 age-matched controls were prospectively recruited. All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints, six bursae, eight tendons, 20 tendon compartments, four ligaments, and 18 articular cartilages by experts in US blinded to the patients' group. Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals. Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise. RESULTS: The assessment of one joint (ie, radiocarpal joint) for hyperechoic aggregates (HAGs), two tendons (ie, patellar tendon and triceps tendon) for HAGs and three articular cartilages (ie, first metatarsal, talar and second metacarpal/femoral) for double contour sign showed the best balance between sensitivity and specificity (84.6% and 83.3%, respectively). Intraobserver reliability was good (mean κ 0.75) and interobserver reliability was moderate (κ 0.52). The aspirated material from HAGs was positive for MSU crystals in 77.6% of patients with gout and negative in all controls. CONCLUSIONS: Our results suggest that US bilateral assessment of one joint, three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: The primary objective of this prospective case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)-detected abnormalities in the upper and lower limbs in gout. The secondary objective was to test the concurrent validity of US abnormalities using as gold standard the microscopic demonstration of monosodium urate (MSU) crystals. METHODS: Ninety-one men with gout and 42 age-matched controls were prospectively recruited. All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints, six bursae, eight tendons, 20 tendon compartments, four ligaments, and 18 articular cartilages by experts in US blinded to the patients' group. Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals. Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise. RESULTS: The assessment of one joint (ie, radiocarpal joint) for hyperechoic aggregates (HAGs), two tendons (ie, patellar tendon and triceps tendon) for HAGs and three articular cartilages (ie, first metatarsal, talar and second metacarpal/femoral) for double contour sign showed the best balance between sensitivity and specificity (84.6% and 83.3%, respectively). Intraobserver reliability was good (mean κ 0.75) and interobserver reliability was moderate (κ 0.52). The aspirated material from HAGs was positive for MSU crystals in 77.6% of patients with gout and negative in all controls. CONCLUSIONS: Our results suggest that US bilateral assessment of one joint, three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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