Srpski arhiv za celokupno lekarstvo 2011 Volume 139, Issue 3-4, Pages: 161-164
https://doi.org/10.2298/SARH1104161R
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Ultrasonography of the first metatarsophalangeal joint in gout
Radak-Perović Marija (Institut za reumatologiju, Beograd)
Savić Viktorija (Institut za reumatologiju, Beograd)
Milutinović Sanja (Institut za reumatologiju, Beograd)
Zlatković-Švenda Mirjana (Institut za reumatologiju, Beograd)
Introduction. About one half of the first gout attacks occur in the first
metatarsophalangeal joint (MTPJ1); in the disease course this joint is
practically inevitably affected. Radiographic evidence of bone erosions is
the indication for hypouricaemic therapy in order to prevent joint
destruction and nephropathy. Advantages of ultrasonography (US) comparing to
conventional x-ray findings in depicting early bone erosions in various
inflammatory arthropathies have been demonstrated by several studies.
Objective. The aims of this study were to compare US and x-ray findings in
the detection of MTPJ1 erosions in patients with gout, to correlate
sonographic and clinical features, and to detect possible characteristic
sonographic features of gout. Methods. Thirty patients (60 MTPJ1) with
primary gout (ACR) and 10 age-matched control subjects (20 MTPJ1) with
different inflammatory arthropathies were clinically evaluated. Standard
dorsiplantar weight bearing and lateral weight bearing x-ray views of both
feet were taken. US was performed and interpreted by an independent
sonographer on the presence of bone erosions, synovial fluid, synovial
hypertrophy, Doppler signal and hyperechoic spots. Statistical analysis was
performed (Spearman and Pearson correlation coefficient, Wilcoxon and χ2
test.) Results. Twenty-four studied MTPJ1 had evidence of erosions, 17 only
on US and seven both on x-ray and on US (Z=-4.123; p=0.000). US findings
showed that hyperechoic spots were the most prominent feature of gouty MTPJ1
(χ2=40.909; p=0.000), followed by erosions and synovial fluid presentation.
Conclusion. US of MTPJ1 in gout discovers significantly more erosions than
x-ray, which may have therapeutic implications. The evidence of hyperechoic
spots (surrogate crystals) of the different size, number and orientation is a
major sonographic feature of the MTPJ1 in gout, which may be of importance in
the diagnosis of certain cases (low serum urate, unavailable synovial fluid
or the urate crystals absence).
Keywords: gout, ultrasonography, x-ray, metatarsophalangeal joint
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