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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
Author(s) -
Ogdie Alexis,
Taylor William J.,
Neogi Tuhina,
Fransen Jaap,
Jansen Tim L.,
Schumacher H. Ralph,
Louthrenoo Worawit,
VazquezMellado Janitzia,
Eliseev Maxim,
McCarthy Geraldine,
Stamp Lisa K.,
PerezRuiz Fernando,
Sivera Francisca,
Ea HangKorng,
Gerritsen Martijn,
Cagnotto Giovanni,
Cavagna Lorenzo,
Lin Chingtsai,
Chou YinYi,
Tausche AnneKathrin,
Lima Gomes Ochtrop Manuella,
Janssen Matthijs,
Chen JiunnHorng,
Slot Ole,
Lazovskis Juris,
White Douglas,
Cimmino Marco A.,
Uhlig Till,
Dalbeth Nicola
Publication year - 2017
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.39959
Subject(s) - gout , medicine , tophus , gold standard (test) , confidence interval , odds ratio , logistic regression , hyperuricemia , arthrocentesis , gastroenterology , surgery , uric acid , pathology , osteoarthritis , synovial fluid , alternative medicine
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.