title: Ultrasound in gout: a useful tool for following urate-lowering therapy.
abstract: OBJECTIVE
  We aimed to determine the ability of ultrasonography (US) to show decrease or disappearance of urate deposits in gouty patients requiring urate-lowering therapy (ULT).
  
  
  METHODS
  To be included in this prospective single-centre study, patients needed toexhibit (1) proven gout by monosodic urate (MSU) crystals in synovial fluid and (2) US-evidenced urate deposits (double contour [DC] sign and/or tophi) before starting ULT (allopurinol [n=4], febuxostat [n=12]). At baseline and after six months of ULT, one trained ultrasonographer assessed the knee and first metatarsophalangeal (MTP1s) joints. Serum uric-acid (SUA) level was assessed at baseline and at three and six months after ULT initiation. Correlation between US findings and achievement of SUA level objective (< 360μmol/L) was estimated by the kappa coefficient (κ).
  
  
  RESULTS
  We studied 16 patients (all males, mean age 61.0±18.3 years). The mean disease duration was 7.1±6.2 years. Tophi were found at clinical examination in 56% of patients. Baseline SUA levels were 688±153μmol/L. At baseline, US revealed tophi or a DC sign among 62.5 to 75% of patients in knees and 87.5% in MTP1s. After six months of ULT, none of the four patients, not achieving the SUA level objective, had disappearance of US features. Among the remaining 12 patients, US features (tophi or DC sign) disappeared or decreased in all but one with a stable DC sign in one MTP1. The correlation between the whole US examination and SUA level was excellent (κ=0.875).
  
  
  CONCLUSIONS
  US could show disappearance of urate deposits after ULT and appears to be well correlated with efficacy of ULT.
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France. Electronic address: sebastien.ottaviani@bch.aphp.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Ottaviani
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Gill
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Aubrun
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Palazzo
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Meyer
authors.affiliation: Service de rhumatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, UFR de médecine, 75205 Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dieudé
mesh_terms: D000328:Adult; D000368:Aged; D006073:Gout / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid
keywords: Gout; Ultrasound