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Peral-Garrido ML, Gómez-Sabater S, Caño R, Bermúdez-García A, Lozano T, Sánchez-Ortiga R, Perdiguero M, Caro-Martínez E, Ruiz-García C, Francés R, Pascual E, Andrés M. Prevalence of crystal deposits in asymptomatic hyperuricemia according to different scanning definitions: A comparative study. Semin Arthritis Rheum 2024; 68:152470. [PMID: 38924926 DOI: 10.1016/j.semarthrit.2024.152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/24/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND/AIM The appropriate sonographic protocol for assessing urate crystal deposits in asymptomatic hyperuricemia (AH) is undefined, as well as how the choice would impact on deposit rates and accompanying sonographic, clinical and laboratory features. METHODS Patients with AH (serum urate ≥7 mg/dL) underwent musculoskeletal ultrasound of 10 locations for OMERACT elementary gout lesions (double contour [DC] signs, tophi, aggregates). Different definitions for AH with deposits were applied, varying according to deposits (any deposits; only DC and/or tophi); gradation (any grade; only grade 2-3 deposits), location (10 locations; 4-joint scheme including knees and 1MTPs; >1 location with deposits), or pre-defined definitions (DC sign in femoral condyles/1MTP and/or tophi in 1MTP). We evaluated crystal deposits rates and compared between other sonographic features, clinical and laboratory variables. RESULTS Seventy-seven participants with AH showed a median 1 location (IQR 0-2) with tophi, 1 (IQR 1-2) with aggregates, and 0 locations (IQR 0-1) with DC sign. The deposition rate ranged from 23.4% (in >1 location with grade 2-3 DC or tophi) to 87.0% (in any deposit in all 10 locations). Accompanying inflammation - assessed by a positive power-Doppler (PD) signal - and erosions were found in 19.5% and 28.4% of participants, respectively. Positive PD signal was better discriminated by criteria requiring grade 2-3 or >1 location with lesions. Erosions and the different clinical and laboratory variables were similar among protocols. CONCLUSION Rates of sonographic deposition in AH varied dramatically among studied protocols, while some could discriminate accompanying inflammation, all highlighting the need for a validated, consensus-based definition.
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Affiliation(s)
- María-Luisa Peral-Garrido
- Vinalopó University Hospital, Elche, Spain; University Miguel Hernández de Elche (UMH), Alicante, Spain
| | - Silvia Gómez-Sabater
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Rocío Caño
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Alejandra Bermúdez-García
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain
| | - Teresa Lozano
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Cardiology Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Ruth Sánchez-Ortiga
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Endocrinology and Nutrition Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Miguel Perdiguero
- Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Nephrology Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Elena Caro-Martínez
- Internal Medicine Service, Sant Vicent del Raspeig Hospital-HACLE, San Vicente del Raspeig, Spain
| | | | - Rubén Francés
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBEREHD), Spain
| | - Eliseo Pascual
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Alicante Healthcare and Biomedical Research Institute (ISABIAL), Alicante, Spain
| | - Mariano Andrés
- University Miguel Hernández de Elche (UMH), Alicante, Spain; Rheumatology Section, Dr. Balmis General University Hospital, Alicante, Spain; Alicante Healthcare and Biomedical Research Institute (ISABIAL), Alicante, Spain.
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Shao Q, Wang J. The Role of Ultrasound Semi-Quantitative Scoring in the Diagnosis and Assessment of Gout and Hyperuricemia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:281-291. [PMID: 37853928 DOI: 10.1002/jum.16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To develop an ultrasound semi-quantitative scoring system for the diagnosis and evaluation of gout and hyperuricemia. METHODS This study included 348 male patients: 81 patients with asymptomatic hyperuricemia, 182 patients with gout, and 85 patients with other arthritis. Clinical data were collected, ultrasound was detected, gout activity score was calculated to assess disease activity, and statistical analysis was performed. RESULTS Monosodium urate crystal deposition and subclinical arthritis were detected in 17 patients with asymptomatic hyperuricemia, with lesions concentrated in the metatarsophalangeal joint, ankle and peroneus-longus and brevis at rate of 91.8%. Gout was significantly higher than non-gouty arthritis in crystal scores (sum scores of double contour, aggregates, and tophi), but not in inflammation scores (sum scores of synovial hypertrophy, power Doppler [PD] activity, and tenosynovitis) and bone erosion. The optimal cut-off score for the diagnosis of gout by the crystal score was 2. The sensitivity, specificity, and AUC were 95.4%, 97.1%, and .965, respectively. Gout flare had higher inflammation scores than intercritical gout, while bone erosion scores were lower than intercritical gout. The active gout patients had higher ultrasound scores of tophi, bone erosion, and PD activity than the remission group (P < .001). The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the identification with high disease activity gout by ultrasound semi-quantitative composite score were 76.2%, 84.2%, and .812, respectively. CONCLUSION Ultrasound helps early identification of patients at risk in asymptomatic hyperuricemia. Ultrasound semi-quantitative scoring allows for more objective and accurate assessment of gout lesions, correlates with disease activity, and helps in the diagnosis and assessment of gout.
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Affiliation(s)
- Qin Shao
- Department of Rheumatology and Immunology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jing Wang
- Department of Rheumatology and Immunology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
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Wang C, Lu J, Sun W, Merriman TR, Dalbeth N, Wang Z, Wang X, Han L, Cui L, Li X, Ji A, Li H, Ji X, He Y, Li C, Liu Z. Profiling of Serum Oxylipins Identifies Distinct Spectrums and Potential Biomarkers in Young People with Very Early Onset Gout. Rheumatology (Oxford) 2022; 62:1972-1979. [PMID: 36111871 PMCID: PMC10152281 DOI: 10.1093/rheumatology/keac507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Oxylipins modulate inflammation via complex pathways. The oxylipin profile in gout remains unexplored. In this study, we systemically profiled oxylipins in young men and identified new oxylipin biomarkers for clinical use in differentiating gout from hyperuricemia.
Methods
Oxylipin profiling was performed in 90 men (30 very early onset gout, 30 asymptomatic HU (HU) and 30 normouricemia (NU), all aged <20 years) divided into discovery and validation sample sets. The dataset was analyzed based on orthogonal projection to latent structure-discriminant analysis (OPLS-DA). Correlation network and pathway enrichment were conducted to reveal potential oxylipin-involved pathways of gout. Candidate oxylipins were further evaluated and optimized in the validation cohort, and differential oxylipin biomarkers combined with or without serum urate were applied to construct diagnosis models.
Results
In discovery stage 21 differential oxylipins between the gout vs HU comparisons and 14 differential oxylipins between the gout vs NU comparisons were discovered. Correlation network analysis was performed and 14(S)-HDHA(14S-hydroxy-4Z, 7Z, 10Z, 12E, 16Z, 19Z-docosahexaenoic acid)was identified as a hub metabolite in both comparisons. Seven down-regulated oxylipins in gout vs HU group and five down-regulated oxylipins in gout vs NU group were validated. Diagnostic models were constructed with the above oxylipins, with 14(S)-HDHA alone acquiring area under the curve (AUC) 1 (95%CI, 1–1) in both comparisons.
Conclusion
Young men with very early onset gout have distinct oxylipin spectrums, especially those derived from AA (arachidonic acid), EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Differential oxylipins could serve as candidate serum biomarkers in differentiating gout from hyperuricemia.
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Affiliation(s)
- Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
| | - Tony R Merriman
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, , Birmingham, Alabama, United States
| | - Nicola Dalbeth
- University of Auckland Department of Medicine, , Auckland, New Zealand
| | - Zhongjun Wang
- the Affiliated Hospital of Qingdao University Department of Clinical Laboratory, , Qingdao, China
| | - Xuefeng Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Lin Han
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Lingling Cui
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Xinde Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Aichang Ji
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
| | - Hailong Li
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Changgui Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University , Qingdao, China
- Institute of Metabolic Diseases, Qingdao University , Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout , Qingdao, China
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Li S, Xu G, Liang J, Wan L, Cao H, Lin J. The Role of Advanced Imaging in Gout Management. Front Immunol 2022; 12:811323. [PMID: 35095904 PMCID: PMC8795510 DOI: 10.3389/fimmu.2021.811323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022] Open
Abstract
Gout is a common form of inflammatory arthritis where urate crystals deposit in joints and surrounding tissues. With the high prevalence of gout, the standardized and effective treatment of gout is very important, but the long-term treatment effect of gout is not satisfied because of the poor adherence in patients to the medicines. Recently, advanced imaging modalities, including ultrasonography (US), dual-energy computed tomography (DECT), and magnetic resonance imaging (MRI), attracted more and more attention for their role on gout as intuitive and non-invasive tools for early gout diagnosis and evaluation of therapeutic effect. This review summarized the role of US, DECT, and MRI in the management of gout from four perspectives: hyperuricemia, gout attacks, chronic gout, and gout complications described the scoring systems currently used to quantify disease severity and discussed the challenges and limitations of using these imaging tools to assess response to the gout treatment.
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Affiliation(s)
- Shuangshuang Li
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guanhua Xu
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junyu Liang
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Wan
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Cao
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Cipolletta E, Di Battista J, Di Carlo M, Di Matteo A, Salaffi F, Grassi W, Filippucci E. Sonographic estimation of monosodium urate burden predicts the fulfillment of the 2016 remission criteria for gout: a 12-month study. Arthritis Res Ther 2021; 23:185. [PMID: 34243813 PMCID: PMC8268270 DOI: 10.1186/s13075-021-02568-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/28/2021] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate whether baseline monosodium urate (MSU) burden estimated by ultrasound (US) predicts the achievement of the 2016 remission criteria for gout after 12 months. Methods In this 12-month prospective, observational and single-center study, patients with gout fulfilling all the domains of the 2016 preliminary remission criteria for gout at baseline and on urate-lowering therapy (ULT) for at least the preceding 6 months were consecutively enrolled. The US findings indicative of MSU deposits [aggregates, double contour (DC) sign, and/or tophi] were identified according to the Outcome Measure in Rheumatology US Working Group definitions. The US MSU burden was estimated by evaluating elbows, wrists, 2nd metacarpophalangeal joints, knees, ankles, and 1st metatarsophalangeal joints. Results Remission criteria were fulfilled in 21 (42.0%) out of 50 patients at 12 months. The baseline US MSU burden was significantly lower in patients who achieved remission than in those who did not fulfill the remission criteria at 12 months (1.9±1.8 vs 5.1±3.1, p<0.01). US scores and ongoing flare prophylaxis were the only significant predictors of remission with an odds ratio of 10.83 [(95%CI=1.14–102.59), p=0.04] for the absence of MSU deposits, 5.53 [(95%CI=1.34–22.76), p<0.01] for the absence of aggregates, 7.33 [(95%CI=1.71–31.44), p<0.01] for the absence of DC sign, 3.88 [(95%CI=1.08–13.92), p=0.04] for the absence of tophi, and 0.23 [(95%CI=0.07–0.75), p=0.02] for ongoing flare prophylaxis. Conclusion In gout, baseline US estimation of MSU burden is an independent predictor of the achievement of the remission criteria at 12 months. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02568-x.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy.
| | - Jacopo Di Battista
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi (Ancona), Italy
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Espejo D, Dearing E, Ogle KY, Portela M, Boniface KS. Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout. Cureus 2021; 13:e15096. [PMID: 34155462 PMCID: PMC8211301 DOI: 10.7759/cureus.15096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gout is the most common crystal arthropathy and is frequently diagnosed and managed by primary care physicians. Point-of-care ultrasound (POCUS) is a valuable tool to aid in the diagnosis of gout via the identification of the double contour sign, aggregates of crystals, tophi, and erosions. In addition, POCUS can aid in the management of gout by recognizing early signs of gout, monitoring the effectiveness of urate-lowering therapy, and guiding aspiration and corticosteroid injection.
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Affiliation(s)
- Dennis Espejo
- Family Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth Dearing
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kathleen Y Ogle
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maria Portela
- Family Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith S Boniface
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia. J Immunol Res 2021; 2021:5550626. [PMID: 33884273 PMCID: PMC8041551 DOI: 10.1155/2021/5550626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate monosodium urate (MSU) crystal deposition and related lesions in the joints of patients with gout and hyperuricemia (HUA) using ultrasound. To explore the association between ultrasound findings and clinical features in gout and HUA. Methods A total of 202 patients with gout and 43 asymptomatic patients with HUA were included. The clinical data and ultrasonic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals was found in 25.58% (11/43) of patients with asymptomatic HUA and 76.24% (154/202) of patients with gout. Of the 1,082 joints from patients with gout examined, 33.09% (358/1082) displayed MSU crystal deposition. In the joints with MSU crystal deposition, 77.37% (277/358) had a history of attacks. Among the joints of gouty arthritis, double contour sign (DCS), hyperechoic aggregate (HAG), and tophi were found in 32.65% (159/487), 7.80% (38/487), and 24.64% (120/487) of the joints, respectively. DCS and tophi, but not HAG, increasingly appeared with the extension of gout duration. In patients with more than 15 years of gout history, DCS, Tophi, and HAG were found in 48.18%, 40.00%, and 6.36% of US assessed joints, respectively. In patients with gout, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. The synovial lesion was related to HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of patients with gout and 4.65% (2/43) of HUA patients, indicating that nephrolithiasis occurred in more patients with gout than in patients with HUA. Conclusion HAG is an early performance of MSU crystal deposition in joints of gout and HUA. Both DCS and tophi are risk factors for bone erosion. Early urate-lowering therapy (ULT) should be considered in patients with gout, DCS, or tophi.
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Filippucci E, Reginato AM, Thiele RG. Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol 2020; 34:101595. [PMID: 33012644 DOI: 10.1016/j.berh.2020.101595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Crystal-related arthropathies are the result of crystal deposition in joint and periarticular soft tissues. Identification of urate crystals is mandatory to distinguish gout from other crystalline arthropathies, including calcium pyrophosphate dihydrate and basic calcium phosphate crystal deposition diseases. ACR/EULAR classification criteria for gout included dual-energy computed tomography and ultrasound with equal impact to the final score. Different diagnostic strengths of these imaging modalities depend on disease duration and scanned anatomic site. While ultrasound has been indicated as the first-choice imaging technique, especially in the early stages of the disease, dual-energy computed tomography has shown to be highly specific, allowing the detection of crystal deposits in anatomic sites not accessible by ultrasound, such as the spine. At the spinal level, MRI findings are usually nonspecific. Finally, there is preliminary evidence that at the knee, dual-energy computed tomography may discriminate calcium pyrophosphate dihydrate from basic calcium phosphate crystal deposits.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
| | - Anthony M Reginato
- Division of Rheumatology, Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ralf G Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, USA.
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Pascual E, Andres M, Sivera F. Gout. J Clin Rheumatol 2020; 26:208-212. [DOI: 10.1097/rhu.0000000000001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Filippou G, Pascart T, Iagnocco A. Utility of Ultrasound and Dual Energy CT in Crystal Disease Diagnosis and Management. Curr Rheumatol Rep 2020; 22:15. [PMID: 32291581 DOI: 10.1007/s11926-020-0890-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to critically discuss the latest evidence on the use of ultrasound and dual energy computed tomography (DECT) for the assessment of microcrystalline arthritis. RECENT FINDINGS Both techniques have been included in the classification and diagnostic criteria for gout, while only ultrasound appears in the diagnostic recommendations for CPPD. Regarding the management of the diseases, there is encouraging evidence for the use of both techniques for the follow-up of gout patients, while very few or null data are available for CPPD. Ultrasound has been adequately validated for the diagnosis of CPPD, while some issues have still to be clarified regarding gout. DECT has also demonstrated to be accurate for gout diagnosis, but very few data are available regarding CPPD. Future research should aim to improve the reliability of both techniques and to create scoring systems for a more accurate follow-up of patients.
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Affiliation(s)
- Georgios Filippou
- Department of Medical Sciences, Section of rheumatology, Azienda ospedaliero-Universitaria Sant'Anna di Cona, University of Ferrara, via Aldo Moro, Ferrara, Italy
| | - Tristan Pascart
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lille, France
| | - Annamaria Iagnocco
- Dipartimento Scienze Cliniche e Biologiche, Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy.
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Zhang W, Du W, Li G, Zhang C, Yang W, Yang S, Feng Y, Chen H. Constituents and Anti-Hyperuricemia Mechanism of Traditional Chinese Herbal Formulae Erding Granule. Molecules 2019; 24:molecules24183248. [PMID: 31489932 PMCID: PMC6766821 DOI: 10.3390/molecules24183248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Erding granule (EDG) is a traditional Chinese medicine that has recently been identified as having anti-hypouricemic effects. However, the active components and underlying mechanism for this new indication have not been elucidated. Therefore, we compared the effects of different EDG extracts (water, 50% ethanol and 95% ethanol) on serum uric acid concentrations in the hyperuricemia model mouse. We also analyzed the constituents of different extracts by ultra-high performance liquid chromatography combined with electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS/MS) to observe the variation between the active and inactive products. Extract activity and target site were evaluated by assessing uric acid- and inflammation-suppressing effects along with evaluating ability to regulate the uric acid transporter. The results showed that the 50% ethanol extract (EDG-50) had an obvious serum uric acid concentration lowering effect compared with water (EDG-S) and the 95% ethanol extract (EDG-95). UHPLC-Q-TOF-MS/MS analysis showed that EDG-50 was compositionally different to EDG-S and EDG-95. EDG-50 showed dose-dependent effects on reducing uric acid, suppressing inflammation and regulating uric acid transporters. Moreover, western blot analysis showed that EDG-50 down-regulated GLUT9 and URAT1 expression, and up-regulated OAT1 expression. Therefore, our findings enable the preliminarily conclusion that EDG-50 lowers serum uric acid concentrations, mainly by down-regulating the expression of GLUT9 and URAT1 proteins and up-regulating the expression of OAT1 proteins. This provides a research basis for clinical use of EDG as an anti-hyperuricemic agent.
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Affiliation(s)
- Wugang Zhang
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Wendi Du
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Guofeng Li
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Chen Zhang
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Wuliang Yang
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Shilin Yang
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Yulin Feng
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herb Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
| | - Haifang Chen
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China.
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