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Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study : Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard

Ogdie, Alexis ; Taylor, William J. ; Neogi, Tuhina ; Fransen, Jaap ; Jansen, Tim L. ; Schumacher, H. Ralph ; Louthrenoo, Worawit ; Vazquez-Mellado, Janitzia ; Eliseev, Maxim and McCarthy, Geraldine , et al. (2017) In Arthritis and Rheumatology 69(2). p.429-438
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,... (More)

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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publication status
published
subject
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Arthritis and Rheumatology
volume
69
issue
2
pages
429 - 438
publisher
John Wiley & Sons
external identifiers
  • pmid:27748084
  • scopus:85010871780
ISSN
2326-5191
DOI
10.1002/art.39959
language
English
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no
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6097cbb8-126f-4337-a16c-7cd9eb4ba264
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2019-05-15 11:07:22
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2019-11-20 05:43:36
@article{6097cbb8-126f-4337-a16c-7cd9eb4ba264,
  abstract     = {<p>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.</p>},
  author       = {Ogdie, Alexis and Taylor, William J. and Neogi, Tuhina and Fransen, Jaap and Jansen, Tim L. and Schumacher, H. Ralph and Louthrenoo, Worawit and Vazquez-Mellado, Janitzia and Eliseev, Maxim and McCarthy, Geraldine and Stamp, Lisa K. and Perez-Ruiz, Fernando and Sivera, Francisca and Ea, Hang Korng and Gerritsen, Martijn and Cagnotto, Giovanni and Cavagna, Lorenzo and Lin, Chingtsai and Chou, Yin Yi and Tausche, Anne Kathrin and Lima Gomes Ochtrop, Manuella and Janssen, Matthijs and Chen, Jiunn Horng and Slot, Ole and Lazovskis, Juris and White, Douglas and Cimmino, Marco A. and Uhlig, Till and Dalbeth, Nicola},
  issn         = {2326-5191},
  language     = {eng},
  month        = {02},
  number       = {2},
  pages        = {429--438},
  publisher    = {John Wiley & Sons},
  series       = {Arthritis and Rheumatology},
  title        = {Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study : Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard},
  url          = {http://dx.doi.org/10.1002/art.39959},
  doi          = {10.1002/art.39959},
  volume       = {69},
  year         = {2017},
}