Alexis Ogdie1, William J Taylor2, Tuhina Neogi3, Jaap Fransen4, Tim L Jansen4, H Ralph Schumacher1, Worawit Louthrenoo5, Janitzia Vazquez-Mellado6, Maxim Eliseev7, Geraldine McCarthy8, Lisa K Stamp9, Fernando Perez-Ruiz10, Francisca Sivera11, Hang-Korng Ea12, Martijn Gerritsen13, Giovanni Cagnotto14, Lorenzo Cavagna15, Chingtsai Lin16, Yin-Yi Chou16, Anne-Kathrin Tausche17, Manuella Lima Gomes Ochtrop18, Matthijs Janssen19, Jiunn-Horng Chen20, Ole Slot21, Juris Lazovskis22, Douglas White23, Marco A Cimmino24, Till Uhlig25, Nicola Dalbeth26. 1. University of Pennsylvania, Philadelphia. 2. University of Otago, Wellington, New Zealand. 3. Boston University School of Medicine, Boston, Massachusetts. 4. VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Chiang Mai University, Chiang Mai, Thailand. 6. Hospital General de México, Mexico City, Mexico. 7. Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia. 8. University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland. 9. University of Otago Christchurch, Christchurch, New Zealand. 10. Hospital Universitario Cruces, BioCruces Health Research Institute, and Basque Country University, Barakaldo, Spain. 11. Hospital General Universitario de Elda, Alicante, Spain. 12. Université Paris Diderot, INSERM UMR 1132 and Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France. 13. Westfries Gasthuis, Hoorn, The Netherlands. 14. University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy, and Skane University Hospital Malmö/Lund, Lund, Sweden. 15. University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy. 16. Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China. 17. University Hospital Carl Gustav Carus, Dresden, Germany. 18. Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 19. Rijnstate Hospital, Arnhem, The Netherlands. 20. China Medical University Hospital, Taichung, Taiwan, Republic of China. 21. Copenhagen University Hospital Glostrup, Glostrup, Denmark. 22. Riverside Professional Centre, Sydney, Nova Scotia, Canada. 23. Waikato District Health Board and Waikato Clinical School, Hamilton, New Zealand. 24. University of Genoa, Genoa, Italy. 25. Diakonhjemmet Hospital, Oslo, Norway. 26. University of Auckland, Auckland, New Zealand.
Abstract
OBJECTIVE: To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS: We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS: US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION: US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.
OBJECTIVE: To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS: We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS: US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION: US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.
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