Gout and Ultrasound: “The Disease of Kings and the Queen of Imaging”

期刊連結：http://www.gouthyperuricemia.com Purpose Gout and its complications constitute a worldwide public health concern and incur significantly higher health care costs. Though preliminary diagnosis of gout can be established clinically, it may be confused with other conditions such as cellulitis, warranting additional workup to confirm the diagnosis. Herein, we review the clinical application of musculoskeletal ultrasound in the out-patient setting that could serve as an early and rapid non-invasive adjuvant tool to diagnose gout. Findings Significant advancement in imaging modalities such as MRI had an important diagnostic applications in gout. However, disadvantages include lack of specificity, considerable cost and the inability to assess early soft tissue changes such as effusion, early erosions and hypervascularity or small tophi. While invasive needle aspiration and identification of crystals on polarizing microscopy remain the gold standard for diagnosing gout, many clinicians do not perform synovial fluid analysis, and therapy is often initiated with an assumed diagnosis. Musculo-skeletal ultrasound has recently been identified as a promising new imaging modality for aiding physicians in the early diagnosis of gout. In addition, it can also be used as imaging outcome measures, monitor responses to anti-inflammatory and urate lowering therapies. Conclusion We suggest that musculoskeletal ultrasound allows a hands on approach for the practicing clinician to assess tophi, erosions, and synovitis and may be particularly applicable in the longitudinal setting. In addition, we propose that employment of such imaging tool can aid clinicians in the assessment of the activity and severity of gout and hence determine clinically meaningful responses to therapy.